Meropenem Hikma Farmacêutica (Portugal) (Meropenem Anhydrous)

• Meropenem is a broad‑spectrum carbapenem antibiotic used for serious bacterial infections.
• Complicated intra‑abdominal infections: provides rapid bactericidal activity to resolve infection and reduce mortality.
• Complicated urinary tract infections: eradicates resistant uropathogens and improves clinical cure rates.
• Skin and soft tissue infections: eliminates mixed flora, aiding recovery of deep tissue infections.
• Community‑acquired and hospital‑acquired pneumonia: achieves high lung concentrations to treat resistant pneumonia.
• Meningitis: penetrates the cerebrospinal fluid to treat bacterial meningitis effectively.
• Sepsis: offers broad coverage against Gram‑negative and Gram‑positive pathogens in systemic infection.

• Meropenem binds with high affinity to penicillin‑binding proteins (PBPs) on bacterial cell walls, inhibiting the final transpeptidation step of peptidoglycan synthesis. This disruption leads to loss of cell wall integrity and bacterial lysis, providing bactericidal activity against a wide range of Gram‑negative, Gram‑positive and anaerobic organisms, including many β‑lactamase‑producing strains.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Headache: transient and usually resolves without intervention.
• Rash: mild skin erythema or pruritus.
• Infusion site phlebitis: localized pain or redness at the injection site.
• Elevated liver enzymes: transient increase in transaminases.

Serious or Rare Side Effects

• Seizures: especially in patients with renal impairment or CNS disorders.
• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Clostridioides difficile‑associated diarrhea: potentially life‑threatening colitis.
• Neutropenia or thrombocytopenia: marked reduction in blood cell counts.
• Renal toxicity: worsening kidney function in susceptible individuals.
• Severe skin reactions: such as Stevens‑Johnson syndrome or toxic epidermal necrolysis.

• Meropenem should be used with caution in specific clinical situations.
• Renal function: adjust dose in patients with impaired renal clearance.
• CNS effects: monitor for seizures in patients with a history of epilepsy or high‑dose therapy.
• Allergy: avoid in individuals with known hypersensitivity to carbapenems or β‑lactams.
• Pregnancy: category B; use only when the potential benefit justifies the risk.
• Valproic acid co‑administration: may reduce valproate levels, increasing seizure risk.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Meropenem may interact with other medicines, requiring attention to dosing and monitoring.

Major Interactions (Avoid)

• Valproic acid: meropenem reduces serum valproate concentrations, risking breakthrough seizures.
• High‑dose aminoglycosides: combined nephrotoxic potential may impair kidney function.
• Loop diuretics: increased risk of renal impairment when used together.

Moderate Interactions (Monitor Closely)

• Warfarin: may enhance anticoagulant effect, requiring INR monitoring.
• Phenytoin: meropenem can lower phenytoin levels, potentially reducing seizure control.
• Rifampin: may decrease meropenem exposure, necessitating dosage adjustment.