Antimicrobials

Active against:

• Most Gram-positive organisms, including Enterococcus faecalis
• Most Gram-negative organisms, including Pseudomonas aeruginosa
• Anaerobes (including Bacteroides fragilis)

Not active against:

• Methicillin-resistant Staphylococcus aureus (MRSA)
• Enterococcus faecium
• Stenotrophomonas maltophilia
• Listeria

Appropriate Uses:

• Treatment of serious Gram-negative or mixed infections in which organisms are documented to be sensitive to meropenem but resistant to other antibiotics

Inappropriate Uses:

• Surgical prophylaxis
• Monotherapy for serious enterococcal infections
• Treatment of infections for which a less costly agent would be appropriate

• The potential for cross-reactivity exists among penicillins, cephalosporins and carbapenems
• Seizures have occurred rarely (much lower risk than with imipenem); risk factors for meropenem-associated seizures include renal insufficiency and/or underlying CNS disorders (brain lesions, history of seizures)
• Avoid concurrent use with valproic acid (significantly decreases concentrations of valproic acid that may not be overcome with an increase in dose)
• For use in Pregnancy and Breastfeeding, see Safe Use of Antibacterial Agents: Pregnancy & Breastfeeding section

• Hypersensitivity: drug fever, skin rash, urticaria, anaphylaxis
• Hematologic: positive Coombs test, rarely thrombocytopenia, leucopenia
• Hepatic/Renal: transient rise in AST, ALT, and urea nitrogen (no clinical evidence of renal impairment)
• Gastrointestinal: nausea, vomiting, diarrhea, oral candidiasis, rarely pseudomembranous colitis
• CNS: seizures at high dosage, particularly in patients with compromised renal function

• Usual dosage: 500 mg IV q6h 
• Automatic Dosage Substitution Policy:
  • Orders for greater than 2g/day will be converted to 500 mg IV q6h.
  • Exceptions: CNS infections and endocarditis infections may require 2 g IV q8h. For all other indications, there is no therapeutic benefit for dosing meropenem at 1 g IV q8h vs 500 mg IV q6h.

Renal Insufficiency:

• For preparation/administration, see IV drug monograph

• Brown P, Battistella M. Principles of Drug Dosing in Sustained Low Efficiency Dialysis (SLED) and Review of Antimicrobial Dosing Literature. Pharmacy (Basel). 2020 Mar 9;8(1):33. doi: 10.3390/pharmacy8010033. PMID: 32182835; PMCID: PMC7151685.