MERCARB 1000

Indications

• Bacterial infections
• Hospital-acquired septicaemia
• Complicated urinary-tract infections including pyelonephritis
• Complicated intra-abdominal infections
• Meningitis
• Endocarditis (in combination with another antibacterial)
• Hospital-acquired pneumonia
• Ventilator-associated pneumonia

Dosage

Adults: 0.5–1 g every 8 hours, for complicated urinary-tract infections, complicated intra-abdominal infections, and bacterial meningitis, 2 g every 8 hours for 5-10 days; may be continued for up to 14 days depending on the site of infection.

Mechanism of action

The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. It readily penetrates the cell wall of most Gram-positive and Gram-negative bacteria to reach penicillin-binding protein (PBP) targets. Its strongest affinities are toward PBPs 2, 3, and 4 of Escherichia coli and Pseudomonas aeruginosa, and PBPs 1, 2, and 4 of Staphylococcus aureus.

Pharmacodynamics

Meropenem is a broad-spectrum carbapenem antibiotic that is active against both Gram-positive and Gram-negative bacteria. It penetrates bacterial cells and interferes with the synthesis of vital cell wall components, leading to cell death. The bactericidal concentrations are generally 1-2 times the bacteriostatic concentrations.

Pharmacokinetics

Meropenem is administered intravenously and has a volume of distribution of approximately 0.2-0.3 L/kg, indicating rapid distribution into body fluids and tissues. It is primarily eliminated via the kidneys, with a half-life of around 1 hour. Dose adjustments are recommended in patients with renal impairment, particularly those with creatinine clearance less than 90 mL/minute.

Contra-indications

• History of hypersensitivity to meropenem or any component of the formulation
• Severe allergic reactions to other beta-lactam antibiotics

Adverse effects

• Abdominal pain
• Diarrhoea
• Nausea
• Vomiting
• Headache
• Skin reactions
• Thrombocytosis
• Bacteraemia
• Seizures
• Agitation
• Increased risk of infection
• Antibiotic-associated colitis
• Eosinophilia
• Hemolytic anemia
• Leukopenia
• Neutropenia
• Paraesthesia
• Severe cutaneous adverse reactions (SCARs)
• Thrombophlebitis

Interactions

• Other nephrotoxic agents may enhance the risk of renal toxicity
• Probenecid may reduce renal clearance and increase serum levels of meropenem

Precautions

• Caution in patients with renal impairment; dose adjustments may be necessary
• Monitor liver function due to risk of hepatotoxicity
• Caution in patients with a history of seizures or central nervous system disorders
• Positive Coombs' test reported

Pregnancy

Meropenem should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Meropenem is excreted in breast milk; caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place. Protect from light. After reconstitution, use promptly or store as recommended in product guidelines.

Formulations

• Powder for solution for injection 500 mg
• Powder for solution for injection 1 g
• Powder for solution for infusion

Mechanism of action

The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. Meropenem readily penetrates the cell wall of most Gram-positive and Gram-negative bacteria to reach penicillin-binding- protein (PBP) targets. Its strongest affinities are toward PBPs 2, 3 and 4 of <i>Escherichia coli</i> and <i>Pseudomonas aeruginosa</i>; and PBPs 1, 2 and 4 of <i>Staphylococcus aureus</i>. The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. Meropenem readily penetrates the cell wall of most Gram-positive and Gram-negative bacteria to reach penicillin-binding-protein (PBP) targets. Its strongest affinities are toward 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 log10 reduction in cell counts within 12 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.

Pharmacodynamics

Meropenem is a broad-spectrum carbapenem antibiotic. It is active against Gram-positive and Gram-negative bacteria. Meropenem exerts its action by penetrating bacterial cells readily and interfering with the synthesis of vital cell wall components, which leads to cell death.