Meropenem - instructions for use, dose, side effects, contraindications

The formation of an acyl bond with the active center of transpeptidase of bacteria (disruption of the -CO-N- bond in the β-lactam ring): irreversible inhibition of penicillin-binding proteins of bacteria, including transpeptidases involved in the last (3) stage of cell wall formation. Activation of (relative) endogenous peptidohydrolases (autolysins) of bacteria. The death of bacteria from osmotic shock.

It is active against most Gram-positive (including penicillin-resistant Streptococcus pneumoniae, Enterococcus spp., Besides Enterococcus faecium and penicillin-resistant strains that do not produce β-lactamase) and Gram-negative (including Pseudomonas aeruginosa), anaerobic microorganisms.

It is resistant to the action of β-lactamases of gram-positive and gram-negative microorganisms (with the exception of metal-β-lactamases) that destroy penicillins and cephalosporins.

Inactive with methicillin-resistant staphylococci, Stenotrophomonas maltophilia.

Strains resistant to other carbapenems may exhibit cross-resistance to meropenem.

Acts as a synergist of aminoglycosides against certain strains Pseudomonas aeruginosa.

Pharmacokinetics:

Well distributed in most tissues, including cerebrospinal fluid. Relationship with plasma proteins 2%. Biotransformation is absent. Half-life is 1-1.5 hours. It is excreted by the kidneys (70% of the used dose is allocated in 12 hours). Removed during hemodialysis.

Indications:

Pneumonia.

Infections of the urinary system.

Infections of the abdominal cavity.

Gynecological infections.

Infections of the skin and soft tissues.

Meningitis.

Septicemia.

Empirical therapy for suspected bacterial infection in adult patients with febrile episodes against neutropenia.

ICD-10

I.A30-A49.A46 Erys

I.A30-A49.A49 Bacterial infection of unspecified site

VI.G00-G09.G00 Bacterial meningitis, not elsewhere classified

X.J10-J18.J18 Pneumonia without clarification of the pathogen

XI.K35-K38.K37 Appendicitis, unspecified

XI.K65-K67.K65 Peritonitis

XII.L00-L08.L01 Impetigo

XII.L00-L08.L08.9 Local infection of skin and subcutaneous tissue, unspecified

XII.L20-L30.L30.3 Infectious dermatitis

XIII.M70-M79.M79.9 Soft tissue disorder, unspecified

XIV.N10-N16.N12 Tubulointerstitial nephritis, not specified as acute or chronic

XIV.N30-N39.N39.0 Urinary tract infection without established localization

XIV.N70-N77.N71 Inflammatory diseases of the uterus, except the cervix

XIV.N70-N77.N73.9 Inflammatory diseases of female pelvic organs, unspecified

XV.O85-O92.O85 Postpartum sepsis

Contraindications:

Individual intolerance to other beta-lactam antibiotics.

Breast age is up to 3 months.

Carefully:

With liver diseases, with diseases of the lower respiratory tracts caused by Pseudomonas aeruginosa.

Pregnancy and lactation:

Action category on the fetus by FDA - B. In pregnancy, use is possible if the intended benefit to the mother exceeds the potential risk to the fetus. When appointing during breastfeeding, the child should be transferred to the mixture.

Dosing and Administration:

The dosage regimen is set individually, depending on the type and severity of the infection and the patient's condition. Adults 500 mg every 8 hours, with nosocomial infections - 1 g 3 times a day, with meningitis - 2 g every 8 hours.

Intravenously can be administered as a bolus.

Side effects:

Allergic reactions: skin rash, itching, urticaria, multiforme exudative erythema, angioedema, anaphylactic shock.

Thrombophlebitis (pain at the injection site, hyperemia, extremity edema - 1%), inflammation, tenderness at the injection site; damage to tissues (with intramuscular injection).

Thrombocytopenia (in persons with renal insufficiency): bleeding - melena, stool with a trace of blood, vomiting coffee grounds, with blood, nosebleeds.

Pseudomembranous colitis (severe abdominal pain, severe diarrhea, bloody diarrhea, fever) - requires withdrawal of treatment.

Convulsions (0.5%) - more often in patients with CNS pathology, history of convulsions, with meningitis (0-12%); paresthesia, insomnia, increased excitability, anxiety, depression, impaired consciousness, hallucinations, epileptiform seizures.

Dysfunction of the gastrointestinal tract: diarrhea (5%), nausea (1%), vomiting, constipation, epigastric pain, cholestatic hepatitis, hyperbilirubinemia, increased activity of "liver" transaminases and alkaline phosphatase, lactate dehydrogenase, rarely - candidiasis of the oral cavity.

Headache (2.8%).

Cardiovascular system: development or aggravation of heart failure, cardiac arrest, tachycardia or bradycardia, a decrease or increase in blood pressure, fainting,myocardial infarction, thromboembolism of the branches of the pulmonary artery.

Urinary system: dysuria, edema, renal dysfunction (hypercreatininaemia, increased urea concentration in plasma), hematuria.

Blood: eosinophilia, neutropenia, leukopenia, rarely - agranulocytosis, reduction of partial thromboplastin time.

Others: Positive direct or indirect samples of Coombs, anemia, dyspnea, vaginal candidiasis.

Overdose:

When an overdose develops confusion, dizziness, a syndrome of neuroreflex excitability, convulsions. Treatment is symptomatic. The effectiveness of hemodialysis is not established.

Interaction:

Valproate - a decrease in the concentration of valproate.

Ganciclovir - increased risk of generalized seizures.

Heparin sodium is a pharmaceutical incompatibility.

Probenicid - a decrease in renal excretion of meropenem, an increase in the half-life of 38% and an increase in the duration of its systemic circulation. Joint use is not recommended.

Special instructions:

At the instructions in the anamnesis on reaction of hypersensitivity to beta-lactam antibiotics development of reactions of hypersensitivity to meropenem is possible.As with the use of other antibiotics, against the backdrop of treatment with meropenem should be borne in mind the likelihood of developing pseudomembranous colitis.

Instructions

Meropenem (Meropenum)