MEROPENEM

MEROPENEM (mer-o'pe-nem) Merrem Classifications: carbapenem antibiotic; Therapeutic: carbapenem antibiotic Prototype: Imipenem Pregnancy Category: B

Availability

500 mg, 1 g injection

Action

Broad-spectrum carbapenem antibiotic that inhibits the cell wall synthesis of gram-positive and gram-negative bacteria by its strong affinity for penicillin-binding proteins of bacterial cell wall.

Therapeutic Effect

Effective against both gram-positive and gram-negative bacteria. High resistance to most bacterial beta-lactamases.

Uses

Complicated appendicitis and peritonitis, bacterial meningitis caused by susceptible bacteria, complicated skin infections, intraabdominal infections, skin/soft tissue infections.

Unlabeled Uses

Febrile neutropenia.

Contraindications

Hypersensitivity to meropenem, other carbapenem antibiotics including imipenem, penicillins, cephalosporins, or other beta-lactams. Safety and effectiveness in infants <3 mo not established.

Cautious Use

History of asthma or allergies, renal impairment, renal disease; epileptics, history of neurologic disorders, older adult, pregnancy (category B). Safety and effectiveness in infants <3 mo not established.

Route & Dosage

Intraabdominal Infections Adult/Child (>50 kg): IV 1 g q8h Child (≥3 mo, <50 kg): IV 20 mg/kg q8h (max: 1 g q8h) Bacterial Meningitis Adult/Child (>50 kg): IV 2 g q8h Child (≥3 mo, <50 kg): IV 40 mg/kg q8h (max: 2 g q8h) Complicated Skin Infection Adult/Child (>50 kg): IV 500 mg q8h Child (>3 mo, <50 kg): IV 10 mg/kg q8h (max: 500 mg q8h) Renal Impairment Clcr 26–50 mL/min: q12h; 10–25 mL/min: ? dose q12h; <10 mL/min: ? dose q24h

Administration

Intravenous Note: Dosage reduction is recommended for older adults. PREPARE: Direct: Reconstitute the 500-mg or 1-g vial, respectively, by adding 10 or 20 mL sterile water for injection to yield approximately 50 mg/mL. Shake to dissolve and let stand until clear.  IV Infusion: Further dilute in 50–250 mL of D5W, NS, or D5/NS.   ADMINISTER: Direct: Give doses of 5–20 mL over 3–5 min.  IV Infusion: Give over 15–30 min.   INCOMPATIBILITIES Solution/additive: D5W, Ringer's lactate, mannitol, amphotericin B, metronidazole, multivitamins, sodium bicarbonate. Y-site: Amphotericin B, diazepam, doxycycline, metronidazole, ondansetron, zidovudine.

• Store undiluted at 15°–30° C (59°–86° F), diluted IV solutions should generally be used within 1 h of preparation.

Adverse Effects (≥1%)

GI: Diarrhea, nausea, vomiting, constipation. Other: Inflammation at injection site, phlebitis, thrombophlebitis. CNS: Headache. Skin: Rash, pruritus, diaper rash. Body as a Whole: Apnea, oral moniliasis, sepsis, shock. Hematologic: Anemia.

Interactions

Drug: Probenecid delays meropenem excretion; may decrease valproic acid serum levels.

Pharmacokinetics

Distribution: Attains high concentrations in bile, bronchial secretions, cerebrospinal fluid. Metabolism: Renal and extrarenal metabolism via dipeptidases or nonspecific degradation. Elimination: In urine. Half-Life: 0.8–1 h.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Perform C&S tests prior to therapy. Monitor periodically liver and kidney function.
• Determine history of hypersensitivity reactions to other beta-lactams, cephalosporins, penicillins, or other drugs.
• Discontinue drug and immediately report S&S of hypersensitivity (see Appendix F).
• Report S&S of superinfection or pseudomembranous colitis (see Appendix F).
• Monitor for seizures especially in older adults and those with renal insufficiency.

Patient & Family Education

• Learn S&S of hypersensitivity, superinfection, and pseudomembranous colitis; report any of these to physician promptly.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug