Meropenem for use in neonates
Meropenem for use in neonates
Dose and administration
Intravenous:
40 mg/kg/dose every 8 hours
Indication
Systemic sepsis, for use as a second or third line agent or severe infections caused by Gram-negative organisims resistant to other conventional antibiotics e.g. Extended Spectrum Beta Lactamase (ESBL) - producing organisims. It could be considered when there is failure of a previous therapy or for those certain situations where broad cover treatment may be necessary. Use of Meropenem must be discussed with the Infectious Diseases Team.
Contraindications and precautions
Hypersensitivity to Penicillins, Cephalosporins and Carbapenems.
Colitis - due to risk of pseudomembranous colitis.
Caution in infants with impaired renal or hepatic function.
Caution in infants with history of seizures.
Clinical Pharmacology
Meropenem, a potent Carbapenem antibacterial agent with enhanced Beta-Lactamase stability, has antimicrobial activity against Gram-negative, Gram-positive and anaerobic micro-organisms. The bacterial concentrations are usually within one doubling dilution of the MICs. Meropenem is not licensed for children under 3 months of age, but its efficacy, safety and tolerability have been studied in this age group. The serum half life is approximately 3 hours in preterm infants and 2 hours in term infants. The pharmacokinetics of Meropenem, for infants and children, are similar to those for adults. It penetrates most body fluids and tissues including the CSF. Protein binding is minimal, and elimination is predominantly renal as unchanged drug. The only metabolite, produced by non-specific hydrolysis in plasma of the Beta-Lactam ring, is inactive. Meropenem attains a high concentration in the CSF particularly with inflamed meninges and has a lower incidence of seizures than other Carbapenems (NeoMed).
Possible adverse effects
Leukopenia, neutropenia, eosinophillia, thrombocytopenia and anaemia.
Inflammation at injection site.
Vomiting, diarrhoea, and constipation (1%).
Rash (2%).
Nephrotoxicity, hepatotoxicity
Interactions
Sodium Valproate - Meropenem may result in clinically significant reduction in concentration of Sodium Valproate which may cause seizures.
Special considerations
Monitor:
FBC – monitor for thrombocytosis and eosinophilia with prolonged use.
Renal function - increase dose interval in renal failure.
Hepatic function – at the beginning of treatment, and weekly thereafter.
Vomiting and pseudomembranous colitis – consider alternate antibiotic.Use under close clinical supervision after discussion with Starship ID service.
Meropenem is not licensed for children <3 months of age.
The intramuscular route is not recommended.
Management of Meropenem administration
Description
White powder for reconstitution as 500 mg or 1 g vials
Reconstituted solution is clear or pale yellow and has pH 7.3 to 8.3
Contains 3.92 mmol sodium per 1 g.
Prescription
Chart on prescription chart as mg per dose
Administration
Infusion
Reconstitute with sterile water for injection immediately prior to use.
Meropenem 500 mg (Ranbaxy) | Meropenem 1 (Ranbaxy) | |
Powder | 0.4 ml | 0.9 ml |
Water for injection to be added | 9.6 ml | 19.1 ml |
50 mg/ml | 50 mg/ml |
Use this solution within 2 hours of preparation.
Administer dose over 15 minutes, using a PALL 0.2 micron in-line filter.
Compatible with sodium chloride 0.9%, glucose 5 % and 10%.
Incompatible with Aciclovir, Amphotericin, calcium gluconate, Metronidazole, intravenous multivitamins, Ondansetron.
It is preferable not to co-infuse Meropenem with Parenteral Nutrition and Intralipid 20% with vitamins .
Nursing considerations
Observe intravenous site closely for extravasation.
Observe for signs of renal, hepatic, or haematological dysfunction.
Observe for skin rashes.
Measure urine output.
Storage
Store unopened vials at <25°C