MEROPENEM

Merrem

Reviewed by Dr Malcolm Battin, Dr Lesley Voss (Paediatric Infectious Diseases), Brenda Hughes, and Helen Lamb (NSANP)
December 2005
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

Intravenous: Weight <2000g 20 mg/kg/dose every 12 hours 1

 

Weight >2000g 40 mg/kg/dose every 12 hours for first 7 days, then every 8 hours 2

Indication

  1. Systemic sepsis, for use as a second or third line agent. It could be considered when there is failure of a previous therapy or for those certain situations where broad cover treatment may be necessary.  Use of meropenem must be discussed with the Infectious Diseases Team.

Contraindications and Precautions

  1. Inflammation at injection site.
  2. Caution in infants with impaired renal or hepatic function.
  3. Caution in infants with history of seizures. 3

Clinical Pharmacology

Meropenem, a potent carbapenem antibacterial agent with enhanced beta-lactamase stability, has antimicrobial activity against Gram-negative, Gram-positive and anaerobic micro-organisms. The bacterial concentrations are usually within one doubling dilution of the MICs.4 Meropenem is not licensed for children under 3 months of age, but its efficacy, safety and tolerability have been studied in this age group. 5,6,7  The serum half life is approximately 3 hours in preterm infants and 2 hours in term infants.5  The pharmacokinetics of meropenem, for infants and children, are similar to those for adults. It penetrates most body fluids and tissues including the CSF. Protein binding is minimal, and elimination is predominantly renal as unchanged drug. The only metabolite, produced by non-specific hydrolysis in plasma of the beta-lactam ring, is inactive. 5

Possible Adverse Effects

  1. Leukopenia, neutropenia, thrombocytopenia and anaemia. 3
  2. Inflammation at injection site. 3
  3. Vomiting, diarrhoea, and constipation (1%). 3
  4. Rash (2%) 3
  5. Nephrotoxicity, hepatotoxicity 3

Interactions

Special Considerations

  1. Monitor:
  2. Use under close clinical supervision usually after discussion with ID service.
  3. Meropenem is not licensed for children <3 months of age.
  4. The intramuscular route is not recommended. 2