Name /bks_53161_deglins_md_disk/meropenem 02/17/2014 07:24AM Plate # 0-Composite pg 1 # 1
1 Contraindications/Precautions
Contraindicated in: Hypersensitivity to meropenem or imipenem; Serious hyper- PDF Page #1
meropenem (mer-oh-pen-nem) sensitivity to other beta-lactams (penicillins or cephalosporins; cross-sensitivity may
Merrem occur).
Classification Use Cautiously in: Renal impairment (qrisk of thrombocytopenia and seizures;
Therapeutic: anti-infectives dose reduction recommended if CCr ⬍50 mL/min); History of seizures, brain lesions,
Pharmacologic: carbapenems or meningitis; OB, Lactation, Pedi: Pregnancy, lactation, or children ⬍3 mo
(safety not established).
Pregnancy Category B
Adverse Reactions/Side Effects
Indications CNS: SEIZURES, dizziness, headache. Resp: APNEA. GI: PSEUDOMEMBRANOUS COLITIS,
Treatment of: Intra-abdominal infections, Bacterial meningitis. Skin and skin struc- constipation, diarrhea, glossitis (qin children), nausea, thrush (qin children),
ture infections. Unlabeled Use: Febrile neutropenia. Hospital-acquired pneumo- vomiting. Derm: moniliasis (children only), pruritus, rash. Local: inflammation at
nia and sepsis. injection site, phlebitis. Neuro: paresthesias. Misc: allergic reactions including AN-
APHYLAXIS.
Action
Binds to bacterial cell wall, resulting in cell death. Meropenem resists the actions of Interactions
many enzymes that degrade most other penicillins and penicillin-like anti-infectives. Drug-Drug: Probenecidprenal excretion and increases blood levels (coadmin-
Therapeutic Effects: Bactericidal action against susceptible bacteria. Spec- istration not recommended). Maypserum valproate levels (qrisk of seizures).
trum: Active against the following gram-positive organisms: Staphylococcus au- Route/Dosage
reus, Streptococcus pneumoniae, Viridans group streptococci, Enterococcus fae- IV (Adults): 0.5– 1 g q 8 hr. Meningitis— 2 g q 8 hr.
calis. Also active against the following gram-negative pathogens: Escherichia coli, IV (Children ⱖ3 mo– 12 yr): Intra-abdominal infections— 20 mg/kg q 8 hr;
Haemophilus influenzae, Klebsiella pneumoniae, Neisseria meningitidis, Pseu- meningitis— 40 mg/kg q 8 hr (maximum 2 g q 8 hr).
domonas aeruginosa, Proteus mirabilis. Active against the following anaerobes: IV (Neonates ⬍7 days): 20 mg/kg/dose q 12 hr. Neonates ⬎ 7 days, 1200– 2000
Bacteroides fragilis, Bacteroides fragilis group, Peptostreptococcus species.
g— 20 mg/kg/dose q 12 hr. Neonates ⬎ 7 days, ⬎ 2000 g— 20 mg/kg/dose q 8 hr.
Pharmacokinetics Renal Impairment
Absorption: IV administration results in complete bioavailability. IV (Adults): CCr 26– 50 mL/min— 1 g q 12 hr; CCr 10– 25 mL/min— 500 mg q
Distribution: Widely distributed into body tissues and fluids; enters CSF when me- 12 hr; CCr ⬍10 mL/min— 500 mg q 24 hr.
ninges are inflamed.
Metabolism and Excretion: 50– 75% excreted unchanged by the kidneys. NURSING IMPLICATIONS
Half-life: Premature neonates: 3 hr; Term neonates: 2 hr; Infants 3 mo– 2 yr: 1.4 Assessment
hr; Children ⬎2 yr and Adults: 1 hr (qin renal impairment). ● Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;
TIME/ACTION PROFILE (blood levels) WBC) at beginning of and throughout therapy.
ROUTE ONSET PEAK DURATION ● Obtain a history before initiating therapy to determine previous use of and reac-
tions to penicillins. Persons with a negative history of penicillin sensitivity may still
IV rapid end of infusion 8 hr have an allergic response.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/meropenem 02/17/2014 07:24AM Plate # 0-Composite pg 2 # 2
2 ● Y-Site Compatibility: alemtuzumab, aminophylline, anidulafungin, argatroban,
atropine, azithromycin, bivalirudin, bleomycin, carboplatin, carmustine, caspo-
● Obtain specimens for culture and sensitivity prior to initiating therapy. First dose fungin, cisplatin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, PDF Page #2
may be given before receiving results. daptomycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem,
● Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryn- diphenhydramine, docetaxel, doxorubicin liposomal, enalaprilat, eptifibatide,
geal edema, wheezing). Discontinue the drug and notify physician im- etoposide, etoposide phosphate, fluconazole, fludarabine, foscarnet, furosemide,
mediately if these symptoms occur. Have epinephrine, an antihistamine, gemcitabine, gentamicin, granisetron, heparin, hetastarch, hydromorphone, ifos-
and resuscitative equipment close by in the event of an anaphylactic re- famide, insulin, irinotecan, leucovorin calcium, linezolid, lorazepam, mechlor-
action. ethamine, methotrexate, metoclopramide, metronidazole, milrinone, mitoxan-
● Assess injection site for phlebitis, pain, and swelling periodically during adminis- trone, morphine, nesiritide, norepinephrine, octreotide, oxaliplatin, oxytocin,
tration. paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, phenobarbi-
● Lab Test Considerations: Monitor hematologic, hepatic, and renal functions tal, potassium acetate, potassium chloride, rocuronium, tacrolimus, telavancin,
periodically during therapy. teniposide, thiotepa, tigecycline, tirofiban, vancomycin, vasopressin, vecuronium,
● BUN, AST, ALT, LDH, serum alkaline phosphatase, bilirubin, and creatinine may vinblastine, vincristine, vinorelbine, voriconazole, zoledronic acid.
be transientlyq.
● Y-Site Incompatibility: amphotericin B colloidal, amphotericin B lipid com-
● Hemoglobin and hematocrit concentrations may bep.
plex, amphotericin B liposome, diazepam, dolasetron, doxorubicin, epirubicin,
● May cause positive direct or indirect Coombs’ test.
fenoldopam, idarubicin, ketamine, mycophenolate, nicardipine, pantoprazole,
Potential Nursing Diagnoses quinupristin/dalfopristin.
Risk for infection (Indications) (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching) Patient/Family Teaching
● Advise patient to report the signs of superinfection (black, furry overgrowth on the
Implementation tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy.
IV Administration ● May cause dizziness. Caution patient to avoid driving or other activities requiring
● Direct IV: Reconstitute 500-mg and 1-g vials with 10 mL and 20 mL, respectively, alertness until response to drug is known.
of sterile water for injection, 0.9% NaCl, or D5W. Vials reconstituted with sterile ● Caution patient to notify health care professional if fever and diarrhea
water for injection are stable for 2 hr at room temperature and 12 hr if refriger- occur, especially if stool contains blood, pus, or mucus. Advise patient
ated; if reconstituted with 0.9% NaCl, stable for 2 hr at room temperature and 18 not to treat diarrhea without consulting health care professional. May
hr if refrigerated; if reconstituted with D5W, stable for 1 hr at room temperature occur up to several weeks after discontinuation of medication.
and 8 hr if refrigerated. Concentration: 50 mg/mL. Rate: Administer over 3– ● Advise patient to notify health care professional of all Rx or OTC medications, vita-
5 min. mins, or herbal products being taken and to consult with health care professional
● Intermittent Infusion: Reconstitute 500-mg and 1-g vials with 10 mL and 20 before taking other medications.
mL, respectively, of sterile water for injection, 0.9% NaCl, or D5W. Diluent: Fur-
ther dilute in 0.9% NaCl or D5W to achieve concentration below. Infusions further Evaluation/Desired Outcomes
diluted in 0.9% NaCl are stable for 4 hr at room temperature and 24 hr if refrig- ● Resolution of the signs and symptoms of infection. Length of time for complete res-
erated. Infusions further diluted in D5W are stable for 1 hr at room temperature olution depends on the organism and site of infection.
and 4 hr if refrigerated. Concentration: Final concentration should be 1– 20
mg/mL. Rate: Infuse over 15– 30 min. Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company
