Meropenem
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| Image:Meropenem.svg | |
| Meropenem
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| Systematic (IUPAC) name | |
| 3-[5-(dimethylcarbamoyl) pyrrolidin-2-yl] sulfanyl-6- (1-hydroxyethyl)-4-methyl-7-oxo- 1-azabicyclo[3.2.0] hept-2-ene-2-carboxylic acid | |
| Identifiers | |
| CAS number | |
| ATC code | J01 |
| PubChem | |
| DrugBank | |
| Chemical data | |
| Formula | C17H25N3O5S |
| Mol. mass | 383.464 g/mol |
| Pharmacokinetic data | |
| Bioavailability | 100% |
| Protein binding | Approximately 2%. |
| Metabolism | ? |
| Half life | 1 hour |
| Excretion | Renal |
| Therapeutic considerations | |
| Pregnancy cat. |
B |
| Legal status |
℞-only (U.S.) |
| Routes | IV |
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Meropenem is an ultra-broad spectrum injectable antibiotic used to treat a wide variety of infections, including meningitis and pneumonia. It is a beta-lactam and belongs to the subgroup of carbapenem, similar to imipenem and ertapenem. Meropenem was originally developed by Sumitomo Pharmaceuticals. It is marketed outside Japan by AstraZeneca with the brand names Merrem® and Meronem®. Other brand names include Mepem® (Taiwan) and Meropen® (Japan, Korea). It gained FDA approval in July 1996. It penetrates well into many tissues and body fluids including the cerebrospinal fluid, bile, heart valves, lung, and peritoneal fluid.[1]
Mechanism of action
Meropenem is bactericidal except against Listeria monocytogenes where it is bacteriostatic. It inhibits bacterial wall synthesis like other beta-lactam antibiotics. In contrast to other beta-lactams, it is highly resistant to degradation by beta-lactamases or cephalosporinases. Resistance generally arises due to mutations in penicillin binding proteins, production of metallo-beta-lactamases, or resistance to diffusion across the bacterial outer membrane.[1] Unlike imipenem, it is stable to dehydropeptidase-1 and can therefore be given without cilastatin.
Indications
The spectrum of action includes many gram-positive and gram-negative bacteria and even some anaerobic bacteria. The overall spectrum is similar to imipenem although meropenem is more active against Enterobacteriaceae and less active against gram-positive bacteria. It is also very resistant to extended-spectrum beta lactamases but may be more susceptible to metallo-beta-lactamases.[1] However, meropenem should not be used to treat MRSA infections.
Administration
Meropenem must be administered intravenously. It is supplied as a white crystalline powder to be dissolved in 5% monobasic potassium phosphate solution.
Common adverse effects
The most common adverse effects are diarrhea (4.8%), nausea and vomiting (3.6%), injection-site inflammation (2.4%), headache (2.3%), rash (1.9%), and thrombophlebitis (0.9%).[1] Many of these adverse effects were observed in the setting of severely ill individuals who were already taking many medications. Meropenem also has a reduced potential for causing seizures in comparison with imipenem.
References
Antibacterials for systemic use: beta-lactam antibiotics - cephalosporins and related (J01D) | |
|---|---|
| First generation | Cefacetrile, Cefadroxil, Cefalexin, Cefaloglycin, Cefaloridine, Cefalotin, Cefapirin, Cefatrizine, Cefazedone, Cefazolin, Cefradine, Cefroxadine, Ceftezole |
| Second generation | Cefaclor, Cefamandole, Cefmetazole, Cefonicid, Ceforanide, Cefotiam, Cefprozil, Cefuroxime |
| Third generation | Cefdinir, Cefditoren, Cefetamet, Cefixime, Cefmenoxime, Cefodizime, Cefoperazone, Cefotaxime, Cefpiramide, Cefpodoxime, Cefsulodin, Ceftazidime, Ceftibuten, Ceftizoxime, Ceftriaxone, Latamoxef |
| Fourth generation | Cefepime, Cefpirome, Cefquinome |
| Fifth generation | Ceftobiprole |
| Other beta-lactam antibacterials | Monobactams (Aztreonam), Carbapenems (Parenteral - Meropenem, Ertapenem, Imipenem, Doripenem, Oral - Faropenem) |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
