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==General==
==General==
*Type: [[Carbapenems]]
*Type: [[Carbapenems]]
*Dosage Forms:
*Dosage Forms: IV
*Common Trade Names:  
*Common Trade Names: Merrem


==Adult Dosing==
==Adult Dosing==
===General===
===General===
*1.5-6 g IV divided q8 hours
*1.5-6g IV daily, divided q8 hours
*First Dose: 0.5-2g IV x 1
*First Dose: 0.5-2g IV x 1
===[[Meningitis]]===
*2g IV every 8 hours.


==Pediatric Dosing==
==Pediatric Dosing==
===General (≥3 Months)===
===General (≥3 Months)===
*30-120 mg/kg/day IV divided q8 hours
*30-120mg/kg/day IV divided q8 hours
*First Dose: 10-40 mg/kg IV x 1
*First Dose: 10-40mg/kg IV x 1
*Max: 6 g/day
*Max: 6 g/day


Line 20: Line 23:
*Renal Dosing
*Renal Dosing
**Adult
**Adult
***CrCl 26-50: Give q12h
***CrCl 10-25: Decrease dose 50%, give q12h
***CrCl 10: Decrease dose 50%, give q24h
***HD: Give dose after dialysis
***PD: No supplement
**Pediatric
**Pediatric
***CrCl 26-50: Give q12h
***CrCl 10-25: Decrease dose 50%, give q12h
***CrCl 10: Decrease dose 50%, give q24h
***HD: Give dose after dialysis
***PD: No supplement
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult
***No adjustment
**Pediatric
**Pediatric
***No adjustment


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*[[Anaphylactic reaction]] to beta-lactams
*Caution
**[[Seizure disorder]]
**[[CNS infection]] or lesion
**Renal impairment
**Recent antibiotic-associated [[colitis]]


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*[[Seizure]]
*Hypersensitivity reaction
*[[Anaphylaxis]]
*[[Stevens-Johnson Syndrome]]
*[[Erythema multiforme]]
*[[Toxic epidermal necrolysis]]
*Drug reaction with eosinophilia and systemic signs
*Superinfection
*[[C. diff]] associated [[diarrhea]]
*[[Thrombocytopenia]]
*[[Agranulocytosis]]
*[[Anemia]], hemolytic
*[[Neutropenia]]
*[[Leukopenia]]
*[[Delirium]]


===Common===
===Common===
*Injection site inflammation
*[[Diarrhea]]
*[[Nausea]]/[[vomiting]]
*[[Headache]]
*[[Rash]]
*Paresthesia


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 1.2h (10h in renal failure)
*Metabolism:  
*Metabolism: Kidney minimally; OAT1 and OAT3 substrate
*Excretion:  
*Excretion: Urine, active secretion (70% unchanged)
*Mechanism of Action:
*Mechanism of Action: Inhibits cell wall synthesis
 
==Mechanism of Action==
 
==Comments==
*Has activity against ESBL organisms
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||'''S'''
|-
| ||Strep. anginosus gp||'''S'''
|-
| ||[[Enterococcus faecalis]]||I
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||R
|-
| ||[[Staph. Epidermidis]]||'''S'''
|-
| ||[[C. jeikeium]]||X1
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||X2
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||'''[[Has ESBL::S]]'''
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||'''S'''
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||'''S'''
|-
| ||[[Citrobacter freundii]]||'''S'''
|-
| ||[[Citrobacter diversus]]||'''S'''
|-
| ||[[Citrobacter sp.]]||'''S'''
|-
| ||[[Aeromonas sp]]||'''S'''
|-
| ||[[Acinetobacter sp.]]||I
|-
| ||[[Pseudomonas aeruginosa]]||'''S'''
|-
| ||[[Burkholderia cepacia]]||'''S'''
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||X1
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||X1
|-
| ||[[Bacteroides fragilis]]||'''S'''
|-
| ||[[Prevotella melaninogenica]]||'''S'''
|-
| ||[[Clostridium difficile]]||X2
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||'''S'''
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
 
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
 
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 04:31, 3 August 2025

General

  • Type: Carbapenems
  • Dosage Forms: IV
  • Common Trade Names: Merrem

Adult Dosing

General

  • 1.5-6g IV daily, divided q8 hours
  • First Dose: 0.5-2g IV x 1

Meningitis

  • 2g IV every 8 hours.

Pediatric Dosing

General (≥3 Months)

  • 30-120mg/kg/day IV divided q8 hours
  • First Dose: 10-40mg/kg IV x 1
  • Max: 6 g/day

Special Populations

  • Pregnancy: B
  • Lactation: Use caution
  • Renal Dosing
    • Adult
      • CrCl 26-50: Give q12h
      • CrCl 10-25: Decrease dose 50%, give q12h
      • CrCl 10: Decrease dose 50%, give q24h
      • HD: Give dose after dialysis
      • PD: No supplement
    • Pediatric
      • CrCl 26-50: Give q12h
      • CrCl 10-25: Decrease dose 50%, give q12h
      • CrCl 10: Decrease dose 50%, give q24h
      • HD: Give dose after dialysis
      • PD: No supplement
  • Hepatic Dosing
    • Adult
      • No adjustment
    • Pediatric
      • No adjustment

Contraindications

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 1.2h (10h in renal failure)
  • Metabolism: Kidney minimally; OAT1 and OAT3 substrate
  • Excretion: Urine, active secretion (70% unchanged)
  • Mechanism of Action: Inhibits cell wall synthesis

Mechanism of Action

Comments

  • Has activity against ESBL organisms

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp S
Enterococcus faecalis I
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis S
C. jeikeium X1
L. monocytogenes S
Gram Negatives N. gonorrhoeae X2
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia S
Stenotrophomonas maltophilia R
Yersinia enterocolitica X1
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida X1
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis S
Prevotella melaninogenica S
Clostridium difficile X2
Clostridium (not difficile) S
Fusobacterium necrophorum S
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
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