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Pharmacologic class: Carbapenem
Therapeutic class: Anti-infective
Pregnancy risk category B
Inhibits bacterial cell-wall synthesis and penetrates gram-negative and gram-positive bacteria
Powder for injection: 500-mg and 1-g vials
Indications and dosages
➣ Intra-abdominal infections
Adults: 1 g I.V. q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection
Children weighing 50 kg (110 lb) or more: 1 g I.V. q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection
Children ages 3 months and older weighing less than 50 kg (110 lb): 20 mg/kg q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection
➣ Bacterial meningitis
Children weighing 50 kg (110 lb) or more: 2 g I.V. q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection
Children ages 3 month and older weighing less than 50 kg (110 lb): 40 mg/kg q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection, to a maximum of 2 g q 8 hours
➣ Complicated skin and skin-structure infections
Adults: 500 mg I.V. q 8 hours
• Renal impairment
• Acute pulmonary exacerbation caused by respiratory tract infection with susceptible organisms in cystic fibrosis patients
• Hypersensitivity to drug, its components, or other beta-lactams
Use cautiously in:
• sulfite sensitivity, renal disease, seizure disorder
• pregnant or breastfeeding patients
• For I.V. bolus, add 10 or 20 ml of sterile water to 500-mg or 1-g vial, respectively, to yield a concentration of 50 mg/ml. Shake until clear. Administer single dose over 3 to 5 minutes.
• For intermittent I.V. infusion, piggyback vials can be reconstituted with compatible I.V. solution (0.9% sodium chloride or 5% dextrose) to yield a concentration of 2.5 to 50 mg/ml. Or vials can be reconstituted as for direct I.V. injection and added to compatible I.V. solution for further dilution. To reconstitute and administer ADD-Vantage systems, follow manufacturer's instructions. Infuse drug over 15 to 30 minutes.
• Use diluted solution immediately, if possible.
CNS: headache, insomnia, dizziness, drowsiness, weakness, seizures
CV: hypotension, phlebitis, palpitations, heart failure, cardiac arrest, myocardial infarction
GI: nausea, vomiting, diarrhea, constipation, tongue discoloration, oral candidiasis, glossitis, pseudomembranous colitis
GU: vaginal candidiasis
Hematologic: anemia, eosinophilia, leukopenia, bone marrow depression, thrombocytopenia, neutropenia
Respiratory: chest discomfort, dyspnea, hyperventilation
Skin: rash, urticaria, pruritus, erythema at injection site
Other: altered taste, fever, pain, fungal infection, anaphylaxis
Drug-drug. Probenecid: increased meropenem blood level
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin, blood urea nitrogen, eosinophils, gamma-glutamyl transpeptidase, lactate dehydrogenase, lipase: increased values
Hematocrit, hemoglobin, platelets, neutrophils, white blood cells: decreased values
International Normalized Ratio, partial thromboplastin time, prothrombin time: increased or decreased values
• Collect specimens for culture and sensitivity testing as needed. However, be aware that drug therapy may start pending results.
☞ Monitor patient for hypersensitivity reaction or anaphylaxis. If either occurs, stop infusion immediately and initiate emergency treatment.
• Monitor for CNS irritability and seizures.
• In prolonged therapy, evaluate hematopoietic, renal, and hepatic function and watch for overgrowth of nonsusceptible organisms.
• If diarrhea occurs, check for pseudomembranous colitis and obtain stool cultures.
• Obtain hearing tests in child being treated for bacterial meningitis.
• Advise patient to report such adverse reactions as CNS irritability, diarrhea, rash, shortness of breath, or pain at infusion site.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.