Meropenem
Class
Carbapenem
Dose
2g q8h (initial dose)
1g q8h (step down/non pseudomonal infections)
Mechanism
Bactericidal
MoA
Inhibits cell wall synthesis by binding to penicillin binding proteins
Time v Concentration
Time dependant killing; Time > MIC
Post dose effect
short
Spectrum
Covers
Doesn't Cover
Broadest spectrum a/b
G+
G-
Pseudomonas
ESBL
Pseudomonas can develop Resistance on Tx
Enterococcus
Atypicals
Sternotrophomonas
Multi drug resistant Acinobacter (problematic in ICUs of Southern Europe & South East Asia)
Indications
Patients at high risk of Resistant Organisms
PK
A
IV only
D
Distributes to most body fluids, only 2%PPB
M
Minimal metabolism
E
Unchanged in urine. Dose adjustment renal failure
A/E
Neuro: Lowers Seizure Threshold
Renal: Nephritis
Liver: hepatic failure, jaundice
Resistance
Can occur on treatment
Intrinsic to Sternotrophomonas
Monitoring
Many lab abnormalities
Increases transaminases, bili, crt, urea
Decreases Hb, HCt, WCC