Mechanism of Action
The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. Meropenem penetrates the cell wall of most gram-positive and gram-negative bacteria to bind penicillin-binding-protein (PBP) targets. Meropenem binds to PBPs 2, 3 and 4 of Escherichia coli and Pseudomonas aeruginosa; and PBPs 1, 2 and 4 of Staphylococcus aureus. Bactericidal concentrations (defined as a 3 log 10 reduction in cell counts within 12 hours to 24 hours) are typically 1-2 times the bacteriostatic concentrations of meropenem, with the exception of Listeria monocytogenes, against which lethal activity is not observed.
Meropenem does not have in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE).
There are several mechanisms of resistance to carbapenems: 1) decreased permeability of the outer membrane of gram-negative bacteria (due to diminished production of porins) causing reduced bacterial uptake, 2) reduced affinity of the target PBPs, 3) increased expression of efflux pump components, and 4) production of antibacterial drug-destroying enzymes (carbapenemases, metallo-β-lactamases).
Drug Label Information | Brands:
Brands of Meropenem available in Kenya
Bestinem®, Sun Pharmaceutical Industries Limited
Inno-Mero®, Innocia Lifesciences Pvt. Ltd.
Monan® , M.J. Biopharm Pvt. Limited
Merogram® , Auronext Pharma. Pvt. Ltd
Meromark®, Marksans Pharma Limited
Meropen®, Renata Limited
Meronem®, Pfizer Laboratories Limited
Meropenem, Pharmathen Pharmaceuticals Ltd
Meronia®, Dafra Pharma GmbH
Merrobe® , Glenmark Pharmaceuticals Limited
Mepran®, Kopran Limited
Penem®, Theon Pharmaceuticals Ltd
Merosan®,PT Sanbe Farma
Ronem®, Venus Remedies Limited
Specbac®, Square Pharmaceuticals Ltd.
Zaxter®, Alkem Alkem Laboratories
Meropenem is a penem antibacterial indicated for the treatment of:
- Complicated skin and skin structure infections (adult patients and pediatric patients 3 months of age and older only).
- Complicated intra-abdominal infections (adult and pediatric patients).
- Bacterial meningitis (pediatric patients 3 months of age and older only).
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Meropenem for injection (I.V.) and other antibacterial drugs, Meropenem for injection (I.V.) should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
DOSAGE AND ADMINISTRATION
500 mg every 8 hours by intravenous infusion over 15 to 30 minutes for complicated skin and skin structure infections (cSSSI) for adult patients. When treating infections caused by Pseudomonas aeruginosa, a dose of 1 gram every 8 hours is recommended.
1 gram every 8 hours by intravenous infusion over 15 minutes to 30 minutes for intra-abdominal infections for adult patients.
1 gram every 8 hours by intravenous bolus injection (5 mL to 20 mL) over 3 minutes to 5 minutes for adult patients.
Dosage should be reduced in adult patients with renal impairment.
Known hypersensitivity to product components or anaphylactic reactions to β-lactams.
WARNINGS AND PRECAUTIONS
- Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving β-lactams.
- Severe cutaneous adverse reactions have been reported in patients receiving Meropenem for injection (I.V.)
- Seizures and other adverse CNS experiences have been reported during treatment.
- Co-administration of Meropenem for injection (I.V.) with valproic acid or divalproex sodium reduces the serum concentration of valproic acid potentially increasing the risk of breakthrough seizures.
- Clostridium difficile-associated diarrhea (ranging from mild diarrhea to fatal colitis) has been reported. Evaluate if diarrhea occurs.
- In patients with renal dysfunction, thrombocytopenia has been observed.
Most common adverse reactions (2% or less) are: headache, nausea, constipation, diarrhea, anemia, vomiting, and rash
- Co-administration of Meropenem for injection (I.V.) with probenecid inhibits renal excretion of meropenem and is therefore not recommended.
- The concomitant use of Meropenem for injection (I.V.) and valproic acid or divalproex sodium is generally not recommended. Antibacterial drugs other than carbapenems should be considered to treat infections in patients whose seizures are well controlled on valproic acid or divalproex sodium.