Antimicrobials
Meropenem

Meropenem

Restricted

Medium
N/A

General Information

Administration

  • Refer to AHSM Extended-Infusion protocol (3 hour or 30 minute infusion depending on indication)

Preparation

  • Reconstitute vials with SWFI

  • 500mg vials: use 10mL diluent

  • 1gm vials: use 20mL diluent

  • Further diluted to final concentration of 1-20 mg/mL

Compatibility

  • NS, only in concentrations of up to 20mg/mL

  • Incompatible in D5W and LR

Therapy of serious, often nosocomial infections involving resistant gram negative organisms

  • Intra-abdominal infections

  • Meningitis

  • Complicated SSTI

Tier 3 Protected Antimicrobial

  • Limited to use for the listed indications. For all other indications, the antimicrobial must be ordered by an ID physician or an ID consult placed. Prospective audit with feedback with provided by ASP/Pharmacy and utilization/compliance reported quarterly.

AHS Use Criteria:

  • Last line options for Culture-proven infection due to gram-negative MDRO

  • Empiric for suspected gram-negative resistance due to recent broad-spectrum antibiotic use

  • Empiric with recent history of culture-proven multi-drug resistant gram-negative organism

  • Empiric for treatment failure in a patient currently receiving anti-pseudomonal beta-lactam

  • Serious gram-negative infection where other alternative treatments cannot be used due to allergy/intolerance

During prolonged therapy, monitor CBC, renal and liver function

  • Immediate and delayed-type allergy

  • GI disturbance: esp. nausea and vomiting

  • Cytopenias, positive Coombs

  • Liver enzyme abnormalities

  • CNS distubrances: some seizure risk, delirium, myoclonic jerking

  • Skin rash

  • Valproic acid - Carbapenems decrease valproate levels and may decrease seizure threshold

  • Probenecid increases concentration of meropenem

Antimicrobial class: Carbapenem

Pregnancy category: B

Average serum half life: 1 hour

  • Neonates: 1.6-3.8 hours

Biliary penetration: Therapeutic

CSF penetration: Therapeutic, takes 2-3 hours with inflamed meninges for peak concentration

Lung penetration: Therapeutic

Urine penetration: Therapeutic, 70% unchanged drug excreted in urine

Bone penetration: Therapeutic

Dosing per AHSM Extended Infusion/Alternative Dosing of Antibiotics Protocol

Exclusions:

  • Patients not being admitted (i.e. Emergency Department)

  • One-time pre-operative surgery dosing

  • Medication incompatibility problems upon initiation of therapy or after. A pharmacist must review these medications and determine if patient is unable to utilize protocol dosing

  • Patients < 17 y.o. and under the minimum weight

  • Pregnancy

  • Physician writes "Do Not Substitute"