Meropenem
lINDICATIONS AND DOSE
Aerobic and anaerobic Gram-positive and Gram-negative
infections|Hospital-acquired septicaemia
▶BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶Neonate up to 7 days: 20 mg/kg every 12 hours.▶Neonate 7 days to 28 days: 20 mg/kg every 8 hours.▶Child 1 month–11 years (body-weight up to
50 kg): 10 – 20 mg/kg every 8 hours
▶Child 1 month–11 years (body-weight 50 kg and
above): 0. 5 – 1 g every 8 hours
▶Child 12–17 years: 0. 5 – 1 g every 8 hours
Severe aerobic and anaerobic Gram-positive and Gram-
negative infections
▶BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶Neonate up to 7 days: 40 mg/kg every 12 hours.▶Neonate 7 days to 28 days: 40 mg/kg every 8 hours.Exacerbations of chronic lower respiratory-tract infection
in cystic fibrosis
▶BY INTRAVENOUS INFUSION
▶Child 1 month–11 years (body-weight up to
50 kg): 40 mg/kg every 8 hours
▶Child 1 month–11 years (body-weight 50 kg and above): 2 g
every 8 hours
▶Child 12–17 years: 2 g every 8 hours
Meningitis
▶BY INTRAVENOUS INFUSION
▶Neonate up to 7 days: 40 mg/kg every 12 hours.▶Neonate 7 days to 28 days: 40 mg/kg every 8 hours.▶Child 1 month–11 years (body-weight up to
50 kg): 40 mg/kg every 8 hours
▶Child 1 month–11 years (body-weight 50 kg and above): 2 g
every 8 hours
▶Child 12–17 years: 2 g every 8 hourslUNLICENSED USENot licensed for use in children under
3 months.
lINTERACTIONS→Appendix 1 : carbapenems
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.diarrhoea.
headache.inflammation.nausea.pain.skin reactions.
thrombocytosis.vomiting
▶UncommonAgranulocytosis.antibiotic associated colitis.
eosinophilia.haemolytic anaemia.increased risk of
infection.leucopenia.neutropenia.paraesthesia.severe
cutaneous adverse reactions (SCARs).thrombocytopenia.
thrombophlebitis
▶Rare or very rareSeizure
lALLERGY AND CROSS-SENSITIVITYAvoid if history of
immediate hypersensitivityreaction to beta-lactam
antibacterials.
Use with caution in patients with sensitivity to beta-
lactam antibacterials.
lPREGNANCYUse only if potential benefit outweighs risk—
no information available.
lBREAST FEEDINGUnlikely to be absorbed (however,
manufacturer advises avoid).
lHEPATIC IMPAIRMENT
MonitoringMonitor liver function in hepatic impairment.
lRENAL IMPAIRMENT
Dose adjustmentsUse normal dose every 12 hours if
estimated glomerularfiltration rate
26 – 50 mL/minute/ 1. 73 m^2.Use half normal dose every 12 hours if estimated
glomerularfiltration rate 10 – 25 mL/minute/ 1. 73 m2
.
Use half normal dose every 24 hours if estimated
glomerularfiltration rate less than^10 mL/minute/^1.^73 m(^2).
lEFFECT ON LABORATORY TESTSPositive Coombs’test.
lDIRECTIONS FOR ADMINISTRATIONIntravenous injectionto
be administered over 5 minutes.
Displacement value may be significant when
reconstituting injection, consult local guidelines. For
intravenous infusion, dilute reconstituted solution further
to a concentration of 1 – 20 mg/mLinGlucose 5 %or
Sodium Chloride 0. 9 %; give over 15 – 30 minutes.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for injection
ELECTROLYTES:May contain Sodium
▶Meropenem (Non-proprietary)
Meropenem (as Meropenem trihydrate) 500 mgMeropenem
500 mg powder for solution for injection vials| 10 vialP£ 84. 70 –
£ 103. 14 DT = £ 84. 70 | 10 vialP£ 83. 00 DT = £ 84. 70 (Hospital only)
Meropenem (as Meropenem trihydrate) 1 gramMeropenem 1 g
powder for solution for injection vials| 10 vialP£ 169. 30 – £ 206. 30
DT = £ 169. 30 | 10 vialP£ 160. 00 – £ 206. 28 DT = £ 169. 30 (Hospital
only)
▶Meronem(Pfizer Ltd)
Meropenem (as Meropenem trihydrate) 500 mgMeronem 500 mg
powder for solution for injection vials| 10 vialP£ 103. 14 DT =
£ 84. 70
Meropenem (as Meropenem trihydrate) 1 gramMeronem 1 g
powder for solution for injection vials| 10 vialP£ 206. 28 DT =
£ 169. 30
ANTIBACTERIALS›CEPHALOSPORINS
Cephalosporins
Overview
The cephalosporins are broad-spectrum antibiotics which
are used for the treatment of septicaemia, pneumonia,
meningitis, biliary-tract infections, peritonitis, and urinary-
tract infections. The pharmacology of the cephalosporins is
similar to that of the penicillins, excretion being principally
renal. Cephalosporins penetrate the cerebrospinalfluid
poorly unless the meninges are inflamed; cefotaxime p. 320
and ceftriaxone p. 322 are suitable cephalosporins for
infections of the CNS (e.g meningitis).
The principal side-effect of the cephalosporins is
hypersensitivity and about 0. 5 – 6. 5 % of penicillin-sensitive
patients will also be allergic to the cephalosporins. If a
cephalosporin is essential in patients with a history of
immediate hypersensitivity to penicillin, because a suitable
alternative antibacterial is not available, then cefixime
p. 320 , cefotaxime, ceftazidime p. 321 , ceftriaxone, or
cefuroxime p. 319 can be used with caution; cefaclor p. 318 ,
cefadroxil p. 317 , cefalexin p. 317 , and cefradine p. 318
should be avoided.
The orally active‘first generation’cephalosporins,
cefalexin, cefradine, and cefadroxil and the‘second
generation’cephalosporin, cefaclor have a similar
antimicrobial spectrum. They are useful for urinary-tract
infections which do not respond to other drugs or which
occur in pregnancy, respiratory-tract infections, otitis
media, and skin and soft-tissue infections. Cefaclor has good
activity againstH. influenzae. Cefadroxil has a long duration
of action and can be given twice daily; it has poor activity
againstH. influenzae.Cefuroxime axetil, an ester of the
‘second generation’cephalosporin cefuroxime, has the same
antibacterial spectrum as the parent compound; it is poorly
absorbed and needs to be given with food to maximise
absorption.
316 Bacterial infection BNFC 2018 – 2019
Infection
5