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Here is a comprehensive overview of Meropenem, sourced from Goodman & Gilman's The Pharmacological Basis of Therapeutics:

Meropenem

Meropenem is a carbapenem β-lactam antibiotic and a derivative of thienamycin. Unlike imipenem, it does not require co-administration with cilastatin because it is not degraded by renal dipeptidase. It may also be co-formulated with the β-lactamase inhibitor vaborbactam.

Mechanism of Action

Like all β-lactams, meropenem binds to penicillin-binding proteins (PBPs), disrupting bacterial cell wall synthesis and causing death of susceptible organisms. It is highly resistant to hydrolysis by most β-lactamases.

Antimicrobial Spectrum

Meropenem's activity is broadly similar to imipenem, with key differences:
  • Less active against gram-positive organisms (particularly Enterococcus)
  • More active against gram-negative organisms
Susceptible organisms include:
  • Most Enterobacterales (except carbapenemase-producing strains)
  • Pseudomonas aeruginosa and Acinetobacter (though resistance is increasing)
  • Anaerobes including Bacteroides fragilis
Meropenem/vaborbactam extends coverage to most carbapenemase-producing Enterobacterales, but not metallo-β-lactamase producers.

Pharmacokinetics (ADME)

  • Not absorbed orally — administered IV
  • Half-life (t½): ~1 hour
  • Renal excretion: ~70% of the active drug recovered in urine
  • Dose adjustment required in renal insufficiency

Standard Dosing

  • Meropenem: 0.5–1 g IV every 8 hours in normal renal function
  • Meropenem/vaborbactam: 2 g meropenem + 2 g vaborbactam IV every 8 hours in normal renal function

Adverse Effects

  • Seizures — less common than with imipenem (meropenem has a lower seizure threshold risk)
  • Nausea, vomiting
  • Cross-reactivity possible in patients with severe β-lactam allergy (rare)

Clinical Uses

Meropenem is used for serious infections caused by multidrug-resistant organisms, including:
  • Hospital-acquired / ventilator-associated pneumonia
  • Complicated urinary tract infections (cUTI) — particularly with vaborbactam formulation (FDA-approved)
  • Intra-abdominal infections
  • Meningitis (including nosocomial)
  • Febrile neutropenia
  • Infections due to carbapenem-resistant Enterobacterales (CRE) — meropenem/vaborbactam reserved for MDR gram-negative pathogens
— Goodman & Gilman's The Pharmacological Basis of Therapeutics — The Washington Manual of Medical Therapeutics
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