Creatinine Clearance Dose frequency Zone Diameter MIC breakpoints Streptococcus milleri, Streptococcus sanguis, Streptococcus viridans, Streptococcus salivarius, Streptococcus morbillorum, Streptococcus Group G, Streptococcus Group F, (mm) (mg/L) 100 mL (500mg meropenem) vial: powder for reconsitution for intravenous administration 100 mL (1g meropenem) vial: powder for reconsitution for intravenous administration . E coli cholecystitis/cholangitis requires antibiotics such as third-generation cephalosporins that cover E coli and Klebsiella organisms. Susceptible >14 <4 Bacillus spp., Corynebacterium diphtheriae, Enterococcus faecalis, Enterococcus fiquifaciens, Enterococcus avium, Listeria monocytogenes, Lactobacillus spp Nocardia asteroides, Staphylococcus aureus (penicillinase negative and positive), Gram-negative aerobes: As with other antibiotics, overgrowth of non-susceptible organisms may occur and, therefore, continuous monitoring of each patient is necessary. Haemophilus parainfluenzae, Haemophilus ducreyi, Helicobacter pylori, Neisseria meningitidis, Neisseria gonorrhoeae (including ~-Iactamase positive, penicillin resistant and spectinomycin resistant strains) Hafnia alvei, Klebsiella pneumoniae, Klebsiella aerogenes, Klebsiella ozaenae, Klebsiella oxytoca, Moraxella (Branhamella) catarrhalis, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Proteus penneri, Providencia rettgeri, Providencia stuartii, Providencia alcalifaciens, Pasteurella multocida, Plesiomonas shigelloides, Pseudomonas aeruginosa, Pseudomonas putida, Pseudomonas alcaligenes, Burkholderia (Pseudomonas) cepacia, Pseudomonas fluorescens, Pseudomonas stutzeri, Plasma protein binding of meropenem is approximately 2%. Meropenem, sold under the brandname Merrem among others, is a broad-spectrum antibiotic used to treat a variety of bacterial infections. presentations. Meronem IV is presented as a sterile white powder containing meropenem 500 mg or 1g as the trihydrate blended with anhydrous sodium carbonate for constitution. Peptostreptococcus magnus, Peptostreptococcus prevotii, Propionibacterium acnes, Propionibacterium avidum, Propionibacterium granulosum. – Intra-abdominal Infections T1/2 Half-life . Vc Volume of distribution â¦ All carbapenems are resistant to Beta-lactamases, including Extended Spectrum Bata-Lactamases (ESBL). All vials are for single use only. – Skin and Skin Structure Infections equivalent to anhydrous meropenem 500 mg 1000 mg | The in vitro antibacterial spectrum of meropenem includes the majority of clinically significant Gram-positive and Gram-negative, aerobic and anaerobic strains of bacteria, as shown below: Gram-positive aerobes: The protein binding of Meronem is low (approximately 2%) and, therefore, no interactions with other compounds based on displacement from plasma proteins would be expected. post-antibiotic effect. Do not freeze Epub 2018 Apr 19. It has been demonstrated both in vitro and in vivo that meropenem has a A 30 minute intravenous infusion of a single dose of Meronem in healthy volunteers results in peak plasma levels of approximately 11 mg/ml for the 250 mg dose, 23 mg/ml for the 500 mg dose and 49 mg/ml for the 1 9 dose. Meronem for IV injection and infusion includes the excipient anhydrous sodium carbonate. MERONEM IV For each gram of meropenem (anhydrous potency) the vial contains 90 mg (3.9 mmol) of sodium. Clipboard, Search History, and several other advanced features are temporarily unavailable. With stratification by diagnosis and region, hospitalized patients with cUTI or AP received IV plazomicin (15 mg/kg q24h) or IV meropenem (1 g q8h) for 4â7 days, followed by optional oral therapy, for a total of 7â10 days of therapy. The structural way was based on protein sequence and active site of the enzymes and classified Î²-lactamases into 4 classes, A, C and D serine Î²-lactamases and B metallo-Î²-lactamases.3 A functional classification correlated the properties of a specific enzyme with the resistance profile of a clinical isolate and included 3 major groups, 1, 2 and 3 with subgroups.3 In Table 1, we summarize the clinically important Î²-lactamâ¦ [Urinary tract infections in primary care]. Meronem should not be mixed with or added to other drugs. Fusobacterium nucleatum, Fusobacterium varium, Mobiluncus curtisii, Mobiluncus mulieris, Peptostreptococcus anaerobius, Peptostreptococcus micros, Peptostreptococcus saccharolyticus, Peptococcus saccharolyticus, Peptostreptococcus asaccharolyticus, 2 g . Adults : Trademark It is recommended to use freshly prepared solutions of Meronem for IV injection and infusion. For children over 3 months and up to 12 years of age the recommended dose is 10 – 20 mg/kg every 8 hours depending on type and severity of infection, susceptibility of the pathogen and the condition of the patient. cadaveris, Clostridium sordellii, Clostridium butyricum, Clostridium clostridiiformis, Clostridium innocuum, Clostridium subterminale, Clostridium tertium, Eubacterium lentum, Eubacterium aerofaciens, Fusobacterium mortiferum, Fusobacterium necrophorum, Show all parts of this monograph; Indications and dose; Unlicensed use; Interactions; Side-effects; Allergy and cross-sensitivity; Pregnancy; Breast feeding; Renal impairment; Monitoring requirements; Effect on laboratory tests; Directions for administration; Medicinal forms; Indications and dose. Subtherapeutic levels may be reached in Anaerobic bacteria: Actinomyces odontolyticus, Actinomyces meyeri, Bacteroides-Prevotella-Porphyromonas spp., Bacteroides fragilis, Bacteroides vulgatus, Bacteroides variabilis, Bacteroides Meronem should not be used in pregnancy unless the potential benefit justifies the potential risk to the foetus. The elimination half-life for meropenem was approximately 1.5 to 2.3 hours in children under the age of 2 years and the pharmacokinetics are linear over the dose range of 10 to 40 mg/kg. Please refer to the outer carton for pack size. Therefore, antibiotics should be prescribed with care for individuals with a history of gastr intestinal complaints, particularly colitis. In subjects with normal renal function, meropenem’s elimination half-life is approximately 1 hour. The co-administration of Meronem with potentially nephrotoxic drugs should be considered with caution. Reconstituted product, constituted as described above, should be used immediately and must be stored for no longer than 24 hours under refrigeration, only if necessary. Effect of Meropenem-Vaborbactam vs Piperacillin-Tazobactam on Clinical Cure or Improvement and Microbial Eradication in Complicated Urinary Tract Infection: The TANGO I Randomized Clinical Trial. However, no specific data regarding potential drug interactions is available (apart from probenecid as mentioned above). Meropenem is a carbapenem antibiotic for parenteral use, that is relatively stable to human dehydropeptidase-1 (DHP-1) and therefore, does not require the addition of an inhibitor of DHP-1. Ibarburu Valbuena I, Labraca SÃ¡nchez J, Lerma Lucas M, Solanas Mateo B. Aten Primaria. Powder for solution for intravenous injection or infusion. Extended-spectrum Î²-lactamases (ESBLs) are enzymes that confer resistance to most Î²-lactam antibiotics. â¢ Complicated urinary tract infections â¢ Complicated intra-abdominal infections â¢ Intra- and post-partum infections â¢ Complicated skin and soft tissue infections â¢ Acute bacterial meningitis. Effect on ability to drive and use machines : No data is available, but it is not anticipated that Meronem will affect the ability to drive and use machines. Imipenem; Meropenem, Doripenem (Carbapenems). The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. Kaye KS, Bhowmick T, Metallidis S, Bleasdale SC, Sagan OS, Stus V, Vazquez J, Zaitsev V, Bidair M, Chorvat E, Dragoescu PO, Fedosiuk E, Horcajada JP, Murta C, Sarychev Y, Stoev V, Morgan E, Fusaro K, Griffith D, Lomovskaya O, Alexander EL, Loutit J, Dudley MN, Giamarellos-Bourboulis EJ. No dosage adjustment is required for the elderly with normal renal function or eatinine clearance values above 50 ml/min. Complicated skin and soft tissue infections . After an IV dose of 500 mg, plasma levels of meropenem decline to values of 1 ~g/ml or less, 6 hours after administration. Effects on the CNS; convulsions in rats and vomiting in dogs, were seen only at high doses (>2000 mg/kg). Tallarigo C, Comunale L, Baldassarre R, Poletti G. Minerva Urol Nefrol. Nitrofurantoin or fosfomycin may also be used for Urinary concentrations of meropenem in excess of 10 ~glml are maintained for up to 5 hours after the administration of a 500 mg dose. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent. 2018 Aug;37(8):1411-1419. doi: 10.1007/s10096-018-3260-4. Complicated intra-abdominal infections . Meronem IV injection contains 208 mg sodium carbonate for each gram of meropenem (anhydrous potency). In addition to cUTI, the Medicines Company, which is the developer of meropenem-vaborbactam, is also exploring the fixed-dose antibiotic combination for carbapenem-resistant Enterobacteriaceae (CRE) infections of blood, lung, urinary tract, and abdominal organs. Overview; Side Effects; Dosage; Professional ; Interactions; More; Applies to the following strengths: 500 mg; 1000 mg; 500 mg/ 50 mL-NaCl 0.9%; 1000 mg/ 50 mL-NaCl 0.9%. The ease with which it penetrates bacterial cell walls, its high level of stability to all serine Iactamases and its marked affinity for the Penicillin Binding Proteins (PBPs) explain the potent bactericidal action of meropenem against a broad spectrum of aerobic and anaerobic bacteria. | A meta-analysis of 27 randomised controlled trials directly comparing imipenem-cilastatin with meropenem found meropenem to be narrowly superior in both clinical and bacteriological outcomes.13 The clinical response rates (complete remission or improvement in signs and symptoms of sepsis) for meropenem and imipenem were 91.4% (1660/1817 patients) and 87.2% (1731/1985) â¦ Meronem IV for intravenous infusion may be constituted with compatible infusion fluids (50 to 200 ml) (see “Incompatibilities and Special precautions for storage”). Meropenem and imipenem demonstrate good activity against Enterobacteriaceae, including strains producing ESBLs or AmpC (100% for E coli, 99% for other Enterobacteriaceae), meropenem usually being 2 to 4 fold more potent than imipenem [21â23]. Meronem may reduce serum valproic acid levels. ESBL-producing bacteria also typically show increased levels of resistance to other agents and therefore treatment options are often limited. Achromobacter xylosoxidans, Acinetobacter anitratus, Acinetobacter Iwoftii, Acinetobacter baumannii, Aeromonas hydrophila, Aeromonas sorbria, Aeromonas ca viae, A/~igenes HealthDay NewsâFor the treatment of adults with complicated urinary tract infections (cUTIs), a combination of meropenem-vaborbactam (M-V) is non-inferior to piperacillin-tazobactam (P-T), according to a study presented at the annual meeting of the Infectious Diseases Society of America (IDWeek), held in New Orleans. Efficacy and tolerability in infants under 3 months old have not been established; therefore, Meronem is not recommended for use below this age. Meropenem is also used to treat bacterial meningitis (infection that causes inflammation of the tissue that covers the brain and spinal cord). Interactions with other medicinal products and other forms of interaction : Probenecid competes with meropenem for active tubular secretion and thus inhibits the renal excretion, with the effect of increasing the elimination half-life and plasma concentration of meropenem. Enterobacter aerogenes, Enterobacter (Pantoea) agglomerans, Enterobacter cloacae, Enterobacter sakazakii, Escherichia coli, Escherichia hermannii, Gardnerella vaginalis, Haemophilus influenzae (including ~-Iactamase positive and ampicillin resistant strains). Wagenlehner FM, Sobel JD, Newell P, et al. 1 g . Pharmacokinetic studies in patients with renal insufficiency have shown the plasma clearance of meropenem correlates with creatinine clearance. It is given by injection into a vein. Ertapenem 1 g IV q24H can be used for uncomplicated UTI. Dosage in Adults with Hepatic Insufficiency : No dosage adjustment is necessary in patients with hepatic insufficiency (see” Special warnings and precautions for use”). The FDA has approved Vabomere, an intravenous antibiotic, for the treatment of complicated urinary tract infections (UTIs), including pyelonephritis, in adults.. Medically reviewed by Drugs.com. EPIC was a randomized, double-blind study. In every case, it should be used under the direct supervision of the physician. Animal studies have not shown any adverse effect on the developing foetus. 5% or 10% Glucose solution The dosage and duration of therapy shall be established depending on type and severity of infection and the condition of the patient. concentration of 50 mg/ml. Meropenem 1 g IV q8H should be used for all severe urinary infections if the organism is susceptible. injection or infusion Meronem 500 mg 1000 mg ** Ceftaroline (5th Gen) does NOT cover Pseudomonas. Pharmacokinetic studies in the elderly have shown a reduction in plasma clearance of meropenem, which correlated with age-associated reduction in creatinine clearance. Approximately 70% of the administered dose is recovered as unchanged meropenem in the urine over 12 hours, after which little further urinary excretion is detectable. some patients. Cefepime (4th Gen Cephalosporin). The only metabolite of meropenem is microbiologically inactive. Table 3 âIn vitroâ MIC-50 and MIC-90 for most relevant uropathogens. UV Ultra Violet spectrometry . 1995 Sep;47(3):147-56. It is important to consider the diagnosis of pseudomembranous colitis in the case of patients who develop diarrhoea in association with the use of Meronem. – Meningitis COVID-19 is an emerging, rapidly evolving situation. Vial for I.V. There was no evidence of mutagenic potential in the 5 tests conducted and no evidence of reproductive and teratogenic toxicity in studies at the highest possible doses in rats and monkeys; the no effect dose level of a (small) reduction in F1 body weight in rat was 120 mg/kg. Before initiating therapy with meropenem, careful inquiry should be made concerning previous hypersensitivity reactions to beta-Iactam antibiotics. Meronem IV injection contains 208 mg sodium carbonate for each gram of meropenem (anhydrous potency). Meronem is generally well tolerated. For E coli intra-abdominal abscess, antibiotics also must include anaerâ¦ In meningitis the recommended dose is 40 mg/kg every 8 hours. Aztreonam (a monobactam) Ciprofloxacin (Resistance is increasing) & â¦ National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Limited post-marketing experience indicates that adverse events following over dosage are consistent with the adverse event profile described in the undesirable effects 500 mg or 1 g . Studies in children have shown that the pharmacokinetics of Meronem in children are Meropenem penetrates well into most body fluids and tissues including cerebrospinal fluid There is no experience in children with altered hepatic or renal function. Meronem is contraindicated in patients who have demonstrated hypersensitivity to this product. 5% Glucose with 0.225% Sodium Chloride solution Although studies indicate that a toxin produced by Clostridium difficile is one of the main causes of antibiotic-associated colitis, other causes should be considered. Intermediate 12 to 13 8 For uncomplicated enterococcal urinary tract infections, ampicillin or amoxicillin is the empiric drug of choice until further speciation, unless patient has severe penicillin allergy, in which case nitrofurantoin or levofloxacin can be used as an alternative based on susceptibilities. If an allergic reaction to meropenem occurs, the drug should be discontinued and appropriate measures taken. Clin Infect Dis 2016; 63:754. Meropenem-vaborbactam: a carbapenem and beta-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae. In normal individuals rapid renal elimination will occur; in subjects with renal impairment, haemodialysis will remove meropenem and its metabolite. 500 mg or 1 g . If we perform the same previous estimations for the renal parenchyma, the dose of meropenem 1 g iv can cover with bactericidal effect to bacteria whose MIC-90 is up to 1.75 µg/mL. 0.9% Sodium Chloride solution Jody A. Charnow Microbial eradication occurred in significantly more patients treated with meropenem-vaborbactam than piperacillin-tazobactam. United Kingdom. Treatment of overdosage should be symptomatic. Complicated urinary tract infections . 5% Glucose solution and 0.9% Sodium Chloride Staphylococci-coagulase-negative; including, Staphylococcus epidermidis, Staphylococcus saprophyticus, Staphylococcus capitis, Staphylococcus cohnii, Staphylococcus xylosus, Staphylococcus warneri, Staphylococcus hominis, Staphylococcus simulans, Staphylococcus intermedius, Staphylococcus sciuri, Staphylococcus lugdunensis, Streptococcus pneumoniae (penicillin susceptible and resistant). 500 mg IV every 8 hours in the treatment of pneumonia, UTI, gynaecological infections such as endometritis, skin and skin structure infections. should be used. Regular sensitivity testing is recommended when treating Pseudomonas aeruginosa infection. Over the past 10 years there has been an increase in the incidence of infections due to ESBL-producing organisms in the UK and globally.1 ESBL infections are associated with higher mortality and increased costs, and therefore pose a significant new challengâ¦ UTI Urinary tract infection . The potential effect of Meronem on the protein binding of other drugs or metabolism has not been studied. Get the latest public health information from CDC: https://www.coronavirus.gov. The intravenous formulation was well tolerated in animal studies. The sole metabolite of meropenem had a similar profile of toxicity in animal studies. Method of Administration : VABP/VAP Ventilator Acquired (Bacterial) Pneumonia . pneumosintes, Bacteroides coagulans, Bacteroides uniformis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides eggerthii, Bacteroides capsillosis, Prevotella buccalis, Prevotella corporis, Bacteroides gracilis, Prevotella melaninogenica, Prevotella intermedia, Prevotella bivia, Prevotella splanchnicus, Prevotella oralis, Prevotella disiens, Prevotella rumenicola, Bacteroides ureolyticus, Prevotella oris, Prevotella buccae, Prevotella denticola, Bacteroides levii, Porphyromonas asaccharolytica, Bifidobacterium spp., Bilophila wadsworthia, Clostridium perfringens, Clostridium bifermentans, Clostridium ramosum, Clostridium sporogenes, Clostridium Animal studies indicate that meropenem is well tolerated by the kidney. FOR INTRAVENOUS ADMINISTRATION. – Empiric treatment, for presumed infections in adult patients with febrile neutropenia, used as monotherapy or in combination with anti-viral or anti-fungal agents. In children over 50 kg weight, adult dosage Dosing: Intra-abdominal infections: 1 g IV every 8 hrs Meningitis, bacterial: 2 g IV every 8 hrs Disease state based dosing: Renal failures: See Table 4 Hepatic failures: Dosage adjustment is not required. Qualitative and quantitative composition : Meronem IV is presented as a sterile white powder containing meropenem 500 mg or 1g as the trihydrate blended with anhydrous sodium carbonate for constitution. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. There is no experience in children with renal impairment. Meronem 500 mg 1000 mg 500 mg or 1 g . Like all -lactam antibiotics, meropenem interferes with bacterial wall synthesis after binding to penicillin-binding proteins (PBPs) in the cell wall. [Multicenter open randomized trial of meropenem in comparison to ceftazidime and amikacin used in combination in severe hospital infections]. Note: Ertapenem, a new carbapenem doesnât cover pseudomonas. TOC Test of cure . Iakovlev SV, Iakovlev VP, Derevianko II, Kira EF; Meropenem Study Group. Abstract Meropenem (Merrem, Meronem) is a broad-spectrum antibacterial agent of the carbapenem family, indicated as empirical therapy prior to the identification of causative organisms, or for disease caused by single or multiple susceptible bacteria in both adults and children with a â¦ Meropenem is cleared by haemodialysis; if continued treatment with Meronem is necessary, it is recommended that the unit dose (based on the type and severity of infection) is administered at the completion of the haemodialysis procedure to restore therapeutically Pharmacokinetic studies in patients with liver disease have shown no effects of liver disease on the pharmacokinetics of meropenem. The only adverse effect observed in animal reproductive studies was an increased incidence of abortions in monkeys at 13 times the expected exposure in man. Ceftazidime-avibactam Versus Doripenem for the Treatment of Complicated Urinary Tract Infections, Including Acute Pyelonephritis: RECAPTURE, a Phase 3 Randomized Trial Program. Dosage adjustments are necessary in subjects with renal impairment. 2000 Jun 15;26(1):65. doi: 10.1016/s0212-6567(00)78610-0. There was no evidence of increased sensitivity to meropenem in juveniles compared to adult animals. Management of febrile neutropenic patients . For 76% of the bacteria tested, the MBC:MIC ratios were 2 or less. JAMA. E coli pneumonia requires respiratory support, adequate oxygenation, and antibiotics, such as third-generation cephalosporins or fluoroquinolones. Intravenous infusions of 1 9 over 2 minutes, 3 minutes and 5 minutes were compared in a three-way crossover trial. HHS For an IV dose the LDso in rodents is greater than 2000 mg/kg. Meropenem Dosage. Accidental overdosage could occur during therapy, particularly in patients with renal impairment. Keep all medicines away from children. E coli meningitis requires antibiotics, such as third-generation cephalosporins (eg, ceftriaxone). Pregnancy Meronem may reduce serum valproic acid levels. Children : CATEGORISATION METHOD OF ASSESSMENT The recommended daily dosage is as follows: In repeat dose studies (up to 6 months) only minor effects were seen including a small decrease in red cell parameters and an increase in liver weight in dogs treated with doses of 500 mg/kg.
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