MEROPENEM

Posology The tables below provide general recommendations for dosing. The dose of meropenem administered and the duration of treatment should take into account the type of infection to be treated, including its severity, and the clinical response.

g. ) or very severe infections. Additional considerations for dosing are needed when treating patients with renal insufficiency (see further below). Adults and adolescents Infection Dose to be administered every 8 hours Severe pneumonia including hospital and ventilator- associated pneumonia.

6). Alternatively, doses up to 1 g can be given as an intravenous bolus injection over approximately 5 minutes. There are limited safety data available to support the administration of a 2 g dose in adults as an intravenous bolus injection.

Special populations Patients with renal impairment The dose for adults and adolescents should be adjusted when creatinine clearance is less than 51 ml/min, as shown below. There are limited data to support the administration of these dose adjustments for a unit dose of 2 g Creatinine clearance (ml/min) Dose (based on “unit” dose range of 500 mg or 1 g or 2 g, see table above) Frequency 26-50 one unit dose Every 12 hours 10-25 half of one unit dose Every 12 hours <10 half of one unit dose Every 24 hours Meropenem is cleared by haemodialysis and haemofiltration.

The required dose should be administered after completion of the haemodialysis cycle. There are no established dose recommendations for patients receiving peritoneal dialysis. 4). Dose in elderly patients No dose adjustment is required for the elderly with normal renal function or creatinine clearance values above 50 ml/min.

Paediatric population Children under 3 months of age The safety and efficacy of meropenem in children under 3 months of age have not been established and the optimal dose regimen has not been identified. 2). Children from 3 months to 11 years of age and up to 50 kg body weight The recommended dose regimens are shown in the table below: Infection Dose to be administered every 8 hours Severe pneumonia including hospital and ventilator- associated pneumonia 10 or 20 mg/kg Broncho-pulmonary infections in cystic fibrosis 40 mg/kg Complicated urinary tract infections 10 or 20 mg/kg Complicated intra-abdominal infections 10 or 20 mg/kg Complicated skin and soft tissue infections 10 or 20 mg/kg Acute bacterial meningitis 40 mg/kg Management of febrile neutropenic patients 20 mg/kg Children over 50 kg body weight The adult dose should be administered.

There is no experience in children with renal impairment. 6). Alternatively, meropenem doses of up to 20 mg/kg may be given as an intravenous bolus over approximately 5 minutes. There are limited safety data available to support the administration of a 40 mg/kg dose in children as an intravenous bolus injection.

6.

1%). 3 %). Tabulated risk of adverse reactions In the table below all adverse reactions are listed by system organ class and frequency: very common (≥ 1/10); common (≥ 1/100 to <1/10); uncommon (≥ 1/1,000 to <1/100); rare (≥ 1/10,000 to <1/1,000); very rare (< 1/10,000) and not known (cannot be estimated from the available data).

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. 4) Common transaminases increased, blood alkaline phosphatase increased, blood lactate dehydrogenase increased. 4). 4). Paediatric population Meropenem is licensed for children over 3 months of age.

There is no evidence of an increased risk of any adverse drug reaction in children based on the limited available data. All reports received were consistent with events observed in the adult population. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store

The selection of meropenem to treat an individual patient should take into account the appropriateness of using a carbapenem antibacterial agent based on factors such as severity of the infection, the prevalence of resistance to other suitable antibacterial agents and the risk of selecting for carbapenem-resistant bacteria.

Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp resistance Resistance to penems of Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp. varies across the European Union. Prescribers are advised to take into account the local prevalence of resistance in these bacteria to penems.

8). Patients who have a history of hypersensitivity to carbapenems, penicillins or other beta-lactam antibiotics may also be hypersensitive to meropenem. Before initiating therapy with meropenem, careful inquiry should be made concerning previous hypersensitivity reactions to beta-lactam antibiotics.

If a severe allergic reaction occurs, the medicinal product should be discontinued and appropriate measures taken. 8). If signs and symptoms suggestive of these reactions appear, meropenem should be withdrawn immediately and an alternative treatment should be considered.

8).

Rhabdomyolysis:

Rhabdomyolysis has been reported with the use of meropenem. 8). Antibiotic-associated colitis Antibiotic-associated colitis and pseudomembranous colitis have been reported with nearly all anti- bacterial agents, including meropenem, and may range in severity from mild to life threatening.

8). Discontinuation of therapy with meropenem and the administration of specific treatment for Clostridium difficile should be considered. Medicinal products that inhibit peristalsis should not be given. 8). 8). If severe DILI occurs, treatment discontinuation should be considered as clinically appropriate.

Meropenem should be reintroduced only if assessed as essential for treatment. Use in patients with liver disease: patients with pre-existing liver disorders should have liver function monitored during treatment with meropenem. 2). Direct antiglobulin test (Coombs test) seroconversion A positive direct or indirect Coombs test may develop during treatment with meropenem.

5). Meropenem contains sodium. 25% of the WHO recommended maximum daily intake of 2 g sodium for an adult.

1. Hypersensitivity to any other carbapenem antibacterial agent. g. g. penicillins or cephalosporins).