Carbapenem
Aerobic gram-positive microorganisms: S. aureus including penicillinase-producing strains, Group D streptococcus including Enterococcus spp., Streptococcus pneumoniae, S. pyogenes, S. viridans group
Aerobic gram-negative microorganisms: Acinetobacter spp., Citrobacter spp., Enterobacter cloacae, E. coli, H. influenzae, K. pneumoniae, P. aeruginosa
Anaerobic gram-positive microorganisms: Peptostreptococcus spp.
Anaerobic gram-negative microorganisms: Bacteroides spp., Fusobacterium spp.
Cause rapid bacterial cell death by covalently binding to penicillin-binding proteins (PBPs) involved in the biosynthesis of mucopeptides in bacterial cell walls. Bactericidal effects result through inhibition of cellular growth and division and the loss of cell wall integrity, eventually causing cell wall lysis. The primary target is PBP 2.
Carbapenems produce time-dependent killing.
Cmax: 61.6mcg/ml; Half-life: 0.98 hours; Volume of distribution: 12.5L; Table 2
Hematologic: Bleeding, gastrointestinal hemorrhage, bone marrow aplasia (leucopenia, neutropenia, thrombocytopenia, anemia)
Cardiovascular System: Phlebitis or thrombophlebitis
Central Nervous System: Headache, insomnia, agitation, confusion, dizziness, nervousness, paresthesia, hallucinations; Seizures
Gastrointestinal: Nausea, abdominal pain, vomiting, diarrhea, constipation
Renal: Dysuria, kidney failure
Hepatic: Abnormalities of liver function tests
Dermatologic: Rash, pruritus
20 mL (500mg meropenem) injection vial for intravenous administration
30 mL (1g meropenem) injection vial for intravenous administration
100 mL (500mg meropenem) vial: powder for reconsitution for intravenous administration
100 mL (1g meropenem) vial: powder for reconsitution for intravenous administration
Intra-abdominal infections: 1 g IV every 8 hrs
Meningitis, bacterial: 2 g IV every 8 hrs
Disease state based dosing:
Renal failures: Table 4
Hepatic failures: Dosage adjustment is not required.
Dosing during Continuous Renal Replacement Therapy
CVVH (Continuous venovenous hemofiltration): 1g IV q12h
CVVHD (Continuous venovenous hemodialysis): 1g IV q12h
CVVHDF (Continuous venovenous hemodiafiltration) 1g IV q12h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Contraindications/Warnings/Precautions:
Precautions: Anaphylactic reactions to beta-lactam antibiotics, renal impairment, patients with epilepsy, history of seizures or other neurological disorders, Liver dysfunction (possible hepatotoxic effects)
Live Typhoid Vaccine (moderate severity): A decreased immunological response to the vaccine
Category B: No evidence of risk in humans but studies inadequate.
Monitoring Requirements:
Therapeutic: Resolution of clinical signs of infection (fever, decreased white blood cell count), Culture and sensitivity, CBC w/differential, urinalysis, temperature
Toxicity: Hepatic and renal function tests during therapy
Brand names/Manufacturer:
§ Merrem/Astra Zeneca in the following countries: United States, Italy, Australia, Canada, Mexico, New Zealand
§ Merrem/Astra Zeneca in the following countries: United Kingdom, Ireland, Sweden, South Africa, Belgium, Switzerland, Spain, Germany, Netherlands, Denmark, Portugal, Hong Kong, Israel, Norway, Thailand, Singapore, Finland, Brazil, Malaysia, Greece, Chile, Hungary, and the Czech Republic
§ Optinem/Astra Zenica in Austria
§ Meropen/Sumitomo in Japan