Meropenem

 Action Inhibits cell wall synthesis.

 Indications Treatment of intra-abdominal infections in adults and children ³ mo and meningitis in children ³ 3 mo when caused by susceptible microorganisms.

 Contraindications Hypersensitivity to any component of this product or to other drugs in the same class or in patients who have demonstrated anaphylactic reactions to B-lactarus.

 Route/Dosage

Intra-abdominal infections

ADULTS: IV 1 g IV q 8 hr. CHILDREN ³ 3 MO: IV 20 mg/kg q 8 hr. Maximum dose: 2 g every 8 hr.

Meningitis

CHILDREN ³ 3 MO: IV 40 mg/kg q 8 hr. Maximum dose: 2 g every 8 hr.

 Interactions

Probenecid: Inhibits renal excretion of meropenem. Coadministration is not recommended. INCOMPATIBILITIES: Do not physically mix with solutions containing other drugs.

 Lab Test Interferences None well documented.

 Adverse Reactions

RESP: Apnea. CNS: Headache. DERM: Rash; pruritis. EENT: Stomatitis. GI: Diarrhea; nausea; vomiting; constipation. GU: Vaginitis. OTHER: Injection site reactions (pain, edema, inflammation).

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children < 3 months not established. CNS: Seizures and other CNS adverse events have occurred. Use with caution in patients with CNS disorders, meningitis or renal dysfunction. Renal function impairment: Reduced clearance may occur. Adjust dose downward accordingly in patients with creatinine clearance < 50 ml/min. Refer to manufacturer's package insert for dose calculations. Thrombocytopenia, without bleeding, has been observed. Hypersensitivity: Administer drug with caution to penicillin-sensitive patients due to possible cross-reactivity. Pseudomembranous colitis: Consider possibility in patients with diarrhea. Superinfection: May result in bacterial or fungal overgrowth of non-susceptible organisms.

 Administration/Storage

• For IV administration only. Do not use solution if discolored or if particulate matter is seen.
• For IV bolus administration, reconstitute with sterile water for injection. Shake to dissolve and let stand until clear. May administer over 3–5 min.
• For IV infusion, reconstitute infusion vial with compatible infusion fluid or use ADD-Vantage flexible diluent container for ADD-Vantage vial following instructions. Can administer over 15–30 min.
• Store dry powder for reconstitution at controlled room temperature.
• Stability of reconstituted meropenem is dependent on diluent and container (eg, syringe, infusion vial, minibag, ADD-Vantage diluent bag). Refer to manufacturer's package insert for guidelines.

 Assessment/Interventions

• Obtain complete patient history, including drug history and any known allergies, especially to penicillin and B-lactam antibiotics.
• Notify physician if signs of superinfection (eg, vaginitis, stomatitis) or pseudomembranous colitis (eg, diarrhea with blood or pus) occurs.
• Assess for signs and symptoms of anaphylaxis (shortness of breath, wheezing, laryngeal edema). Have resuscitation equipment available.
• If seizures occur, withhold drug, institute safety measures and notify physician.
• If culture and sensitivity is ordered, obtain specimen(s) rior to first dose.
• Withhold drug and notify physician if any of the following occur: fever, rash, hives.
• Monitor vital signs, sputum, urine, stool and WBC at beginning of and throughout therapy.

 Patient/Family Education

• Instruct patient to report to physician or nurse itching, rash, hives, difficulty breathing, diarrhea, black “furry” tongue, loose, foul-smelling stool or vaginal itching or discharge.