meropenem trihydrate: clinical use

Prescribing considerations

• Reserve carbapenem use for situations where infection severity, microbiology and local resistance patterns support it.
• Obtain cultures where feasible and review therapy against susceptibility results.
• Assess renal function because meropenem is predominantly cleared by the kidneys.
• Review previous immediate or severe reactions to penicillins, cephalosporins and carbapenems.
• Consider product sodium content in patients requiring sodium restriction.

Contraindications and cautions

• Hypersensitivity to meropenem or a listed excipient
• Hypersensitivity to another carbapenem
• Previous severe hypersensitivity, such as anaphylaxis or a severe skin reaction, to another beta-lactam antibacterial

Monitoring

• Clinical and microbiological response
• Renal function
• Hepatic function, particularly with pre-existing liver disease or suspected liver injury
• Full blood count when clinically indicated
• New rash, hypersensitivity, diarrhoea, neurological effects or muscle symptoms
• INR during and shortly after concurrent oral anticoagulant treatment

Clinical pharmacology

Meropenem is a bactericidal carbapenem that inhibits bacterial cell-wall synthesis through penicillin-binding proteins. Elimination is mainly renal as unchanged meropenem.

Formulation and product differences

• Selected vial products are powders requiring reconstitution and can support intravenous injection or infusion according to product instructions.
• The selected two-chamber bag contains meropenem powder and sodium chloride solvent and is intended for intravenous infusion.
• Sodium content differs substantially between vial and two-chamber bag presentations.
• Preparation, compatibility, stability and administration instructions are product-specific and not interchangeable.

Solution for infusion

Route: Intravenous

Strengths: 500 mg, 1000 mg, 2 g

Injection

Route: Parenteral

Strengths: 500 mg, 1 g