MEROBAC 1G

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

Carbonate ions participate in buffering reactions that help maintain pH homeostasis in biological systems. They can react with acids to form bicarbonate and carbon dioxide, thus neutralizing excess acidity in the body. This mechanism is crucial in processes such as respiration and metabolism.

Pharmacodynamics

As a buffer, carbonate helps to stabilize pH levels in different biological environments, preventing excessive acidity or alkalinity that could impair cellular functions. It is involved in the transport of carbon dioxide in the blood and plays a role in maintaining the acid-base equilibrium necessary for physiological processes.

Pharmacokinetics

Carbonate ions are readily absorbed in the gastrointestinal tract when ingested and can be found in various body fluids. They are involved in the bicarbonate buffering system, where they are converted to bicarbonate (HCO3-) and carbon dioxide (CO2) through reactions with acids. The kidneys regulate the levels of bicarbonate and carbonate in the body, excreting or reabsorbing them as needed to maintain homeostasis.

Pregnancy

There is no specific information available regarding the use of carbonate compounds during pregnancy. Consult a healthcare provider for advice.

Breast-feeding

There is no specific information available regarding the use of carbonate compounds while breastfeeding. Consult a healthcare provider for advice.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Diabetes mellitus
• Type 1 diabetes
• Type 2 diabetes
• Hyperglycemia management

Dosage

Children: Refer to specific product guidelines, as dosages vary by formulation and individual patient needs.

Adults: Refer to specific product guidelines, as dosages vary by formulation and individual patient needs.

Mechanism of action

The mechanism of action of premixed formulations depends on the specific drugs included. For example, in the case of premixed insulin, it combines a rapid-acting insulin with an intermediate-acting insulin to provide both immediate and prolonged glucose control. Rapid-acting insulins facilitate the uptake of glucose by promoting its transport into cells, while intermediate-acting insulins help maintain blood glucose levels over a longer duration.

Pharmacodynamics

Pharmacodynamics of premixed formulations varies based on their individual components. In insulin combinations, the rapid-acting component begins to lower blood glucose levels within minutes of administration, while the intermediate component has a more sustained action, contributing to glycemic control over several hours. The overall effect is to mimic the natural insulin response to meals and basal needs.

Pharmacokinetics

Pharmacokinetics of premixed formulations are determined by the pharmacokinetics of each individual component. For insulin, absorption rates can differ based on the formulation; rapid-acting insulins are absorbed quickly from the injection site, reaching peak action within 1-3 hours, while intermediate-acting insulins have a slower absorption profile, typically peaking at 4-12 hours post-administration. Metabolism occurs primarily in the liver and kidneys, with elimination half-lives varying based on the specific insulin types used.

Pregnancy

Consult a healthcare professional before use. Safety during pregnancy has not been established.

Breast-feeding

Consult a healthcare professional before use. It is not known if this drug is excreted in human milk.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

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.