VIHA (South Island) IV MONOGRAPH MEROPENEM

References available on the VIHA (South Island) Pharmacy Web site (http://intranet.viha.ca/clinical_support/pharmacy/si/) Rev Dec 2004

OTHER NAMES Merrem

CLASSIFICATION Antibiotic - carbapenem, β lactam

ALLERGY ALERT See Contraindications/Cautions

INDICATIONS FOR IV USE HEALTH CANADA APPROVED1 • Treatment of various infections due to susceptible organisms, including the following: lower respiratory tract, skin and

soft tissue, intra-abdominal, gynaecological, meningitis and bacteraemia. SPECTRUM OF ACTIVITY:2 gram positive: most gram positive organisms except E. faecium and methicillin-resistant Staphylococcus. gram negative: most gram negative aerobic organisms including Pseudomonas and Burkholderia cepacia. Poor activity vs. Stenotrophomonas maltophilia. anaerobes: most anaerobes including Bacteroides and Clostridium. CONTRAINDICATIONS Hypersensitivity to meropenem.

CAUTIONS Hypersensitivity to penicillins, cephalosporins or other β lactam antibiotics, e.g. imipenem.

• Compromised renal function and/or CNS lesions; potential to cause seizures.1 PREGNANCY/BREAST FEEDING: Contact pharmacy for most recent information. ADMINISTRATION

DIRECT INTO IV TUBING INTERMITTENT INFUSION CONTINUOUS INFUSION MODE

YES YES YES

WHO MAY GIVE All registered nurses All registered nurses All registered nurses

ADULT Over 3 - 5 minutes.3 Dilute in 50 - 100 mL minibag; NS preferred. Infuse over 15 - 30 minutes.

Dilute ½ the daily dose in 500 mL NS and infuse over 12 hours.

PAEDIATRIC As above.3 See Syringe pump infusion table. No information

NEONATE No information Over 30 minutes4 No information

REQUIREMENTS None

MONITORING REQUIRED • None RECOMMENDED • None RECONSTITUTION • Available as meropenem 500 mg and 1 g vials. • Vials may be reconstituted with sterile water, NS or D5W.3 A reconstitution device may be used. • Volume of diluent required may vary with brand. See vial for exact volume of diluent and resulting concentration.

VIHA (South Island) IV MONOGRAPH MEROPENEM

References available on the VIHA (South Island) Pharmacy Web site (http://intranet.viha.ca/clinical_support/pharmacy/si/) Rev Dec 2004

COMPATIBILITY/STABILITY5

• Compatible with dextrose, saline, dextrose-saline combinations, Ringer's and lactated Ringer's solution. • Vials reconstituted with sterile water or NS are stable for 2 hours at room temperature and at least 12 hours in the

refrigerator. • Vials reconstituted with D5W are stable for 1 hour at room temperature and 8 hours in the refrigerator. • Stable in NS at conc. of 1 - 5 mg/mL for 24 hours at room temperature and at least 24 hours in the refrigerator.

Stable in NS, at room temperature, at conc. of 10 mg/mL for 20 hours; at conc. of 50 mg/mL for 8 hours. Stability is concentration and temperature dependent.

• Stable in D5W (1 - 50 mg/mL) for at least 3 hours at room temperature and at least 24 hours in the refrigerator. Stability is concentration and temperature dependent.

• For drug-drug compatibility, contact Drug Information. ADVERSE EFFECTS1 LOCAL REACTIONS • Inflammation at injection site, thrombophlebitis. HYPERSENSITIVITY • Anaphylaxis, including bronchospasm and hypotension (rare). • Urticaria, pruritus. GASTROINTESTINAL • Nausea and vomiting, diarrhoea. • Pseudomembranous colitis (rare). MISCELLANEOUS • Headache, rash. • Seizures (incidence appears less than with imipenem). DOSE ADULT • 500 mg - 1 g every 8 hours, depending on severity of infection.1 • 2 g every 8 hour for meningitis.1 • Has been given by continuous infusion in critically ill patients and in cystic fibrosis. Stability in solution is concentration

and temperature dependent. ELDERLY • No dosage adjustment is necessary for elderly patients with normal (for their age) renal function.1 PEDIATRIC6 Infants over 3 months and children: • Mild to moderate infections: 60 mg/kg/day divided every 8 hours. Max: 3 g/ 24 hours • Meningitis and severe infections: 120 mg/kg/day divided every 8 hours. Max 6 g /24 hours. NEONATE4

• Sepsis: 20 mg/kg/dose every 12 hours. • Meningitis and infections caused by Pseudomonas species: 40 mg/kg/dose every 8 hours. RENAL IMPAIRMENT ADJUSTMENTS1 Creatinine Clearance/GFR

mL/min Dose

Dependent on type of infection Dosing interval

26 – 50 Recommended dose Every 12 hours 10 – 25 ½ recommended dose Every 12 hours Less than 10 ½ recommended dose Every 24 hours HEPATIC IMPAIRMENT ADJUSTMENTS • None required as long as renal function is normal.1 HEMO/PERITONEAL DIALYSIS • Meropenem is removed by haemodialysis, give dose after dialysis.7 • CAPD: ½ recommended dose every 24 hours.7 MISCELLANEOUS • IM or SC use: no information available at this time.

References available on the VIHA (South Island) Pharmacy Web site (http://intranet.viha.ca/clinical_support/pharmacy/si/) Rev Dec 2004

MEROPENEM - REFERENCES 1. Repchinsky C, editor. Compendium of Pharmaceuticals and Specialties. 39th ed. Ottawa: Canadian Pharmaceutical

Association; 2004. 2. Gilbert DN, Moellering RC, Eliopoulos GM, Sande AE, editors. The Sanford guide to antimicrobial therapy 2004. 34th

ed. Dallas: Antimicrobial Therapy; 2004. p. 52. 3. Gahart BL, Nazareno AR, editors. Intravenous medications: a handbook for nurses and other allied health personnel.

20th ed. St Louis: Mosby; 2004. p. 730-3. 4. Young TE, Mangum B, editors. Neofax®: A manual of drugs used in neonatal care. 15th ed. Raleigh: Acorn; 2002. p.

38. 5. Trissel LA, editor. Handbook of injectable drugs. 11th ed. Bethesda: American Society of Hospital Pharmacists; 2001. p.

835-41. 6. Gunn VL, Nechyba C, editors. The Harriet Lane Handbook. A manual for pediatric house officers. 16th ed. Philadelphia:

Mosby; 2002. p. 748-9. 7. Aronoff GR, Berns JS, Brier ME, Golper TA, Morrison G, et al, editors. Drug prescribing in renal failure: Dosing

guidelines for adults. 4th ed. Philadelphia: American College of Physicians; 1999. p. 49.