Carbapenem Antibiotic Pregnancy: There are no or limited data from use in pregnant women; animal studies do not indicate reproductive toxicity — as a precautionary measure it is preferable to avoid use during pregnancy. Small amounts are excreted in human milk; meropenem should not be used in breast-feeding women unless the potential benefit for the mother justifies the potential risk to the baby.

Meropenem (Multi-resistant Gram-negative Bone Infections)

Brand names: Meronem

Meropenem is a broad-spectrum carbapenem beta-lactam antibiotic, used intravenously here for bone and joint infections caused by multi-resistant Gram-negative organisms, typically guided by microbiology and bone-penetration considerations.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 500 mg or 1 g every 8 hours (the SPC unit dose used across most licensed indications); a dose of up to 2 g three times daily may be particularly appropriate when treating infections due to less susceptible bacterial species (e.g. Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp.) or very severe infections

Route: Intravenous infusion over approximately 15 to 30 minutes; alternatively doses up to 1 g may be given as an intravenous bolus injection over approximately 5 minutes (limited safety data support a 2 g bolus)

Frequency: Every 8 hours

Max: Up to 2 g three times daily in adults and adolescents

BONE OR JOINT INFECTION IS NOT LISTED IN THE SPC §4.2 DOSE TABLE and no dose or duration is stated for it — the figures above are the SPC's general adult/adolescent recommendations; confirm the bone-infection regimen and duration against local/specialist guidance. SPC §4.2 table (dose every 8 hours, adults and adolescents): severe pneumonia including hospital- and ventilator-associated pneumonia 500 mg or 1 g; broncho-pulmonary infection in cystic fibrosis 2 g; complicated urinary tract infections 500 mg or 1 g; complicated intra-abdominal infections 500 mg or 1 g; intra- and post-partum infections 500 mg or 1 g; complicated skin and soft tissue infections 500 mg or 1 g; acute bacterial meningitis 2 g; febrile neutropenia 1 g. The dose and duration should take into account the type of infection, its severity and the clinical response. Hepatic impairment: no dose adjustment necessary (monitor liver function if pre-existing liver disorder). Elderly with normal renal function or CrCl above 50 ml/min: no adjustment. PAEDIATRIC (§4.2 — no bone-infection row, so not rendered as a structured per-kg value): children 3 months to 11 years and up to 50 kg — severe pneumonia 10 or 20 mg/kg every 8 hours; cystic fibrosis broncho-pulmonary infection 40 mg/kg every 8 hours; complicated UTI 10 or 20 mg/kg; complicated intra-abdominal infection 10 or 20 mg/kg; complicated skin and soft tissue infection 10 or 20 mg/kg; acute bacterial meningitis 40 mg/kg; febrile neutropenia 20 mg/kg. Children over 50 kg receive the adult dose. Under 3 months of age safety and efficacy are not established and the optimal regimen has not been identified (limited PK data suggest 20 mg/kg every 8 hours may be appropriate). Up to 40 mg/kg three times daily may be appropriate in children for less susceptible species or very severe infections; doses up to 20 mg/kg may be given as a 5-minute bolus. There is no experience in children with renal impairment — verify against a children's formulary. §4.5 (interactions) was not part of the fetched bundle, so no interaction list is given; §4.4 and §4.8 were truncated at the source-fetch limit.

Dose adjustments

Renal

Adjust the dose for adults and adolescents when creatinine clearance is less than 51 ml/min, based on the unit dose of 500 mg, 1 g or 2 g (limited data support these adjustments for a 2 g unit dose): CrCl 26–50 ml/min — one unit dose every 12 hours; CrCl 10–25 ml/min — half of one unit dose every 12 hours; CrCl less than 10 ml/min — 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.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Hypersensitivity to any other carbapenem antibacterial agent
Severe hypersensitivity (e.g. anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent (e.g. penicillins or cephalosporins)

Side effects

Diarrhoea, abdominal pain, nausea and vomiting (common)
Headache (common); paraesthesia (uncommon); convulsions (rare); delirium (rare)
Rash and pruritus (common); toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme and urticaria (uncommon); DRESS and AGEP (frequency not known)
Transaminases, alkaline phosphatase and lactate dehydrogenase increased (common); drug-induced liver injury including hepatitis and liver failure (uncommon)
Injection/infusion site inflammation and pain (common); thrombophlebitis (uncommon)
Thrombocythaemia (common); agranulocytosis, haemolytic anaemia, thrombocytopenia, neutropenia, leukopenia and eosinophilia (uncommon); anaphylaxis and angioedema (uncommon); rhabdomyolysis (frequency not known)

Clinical monograph

How it works

It binds penicillin-binding proteins to inhibit bacterial cell-wall peptidoglycan synthesis, and its stability against many beta-lactamases (including extended-spectrum and AmpC enzymes) underlies its activity against resistant Gram-negative bacilli.

Prescribing in practice

Reserve for confirmed or strongly suspected multi-resistant Gram-negative bone infection on microbiology and antimicrobial-stewardship advice, as carbapenem overuse drives carbapenemase emergence.
Lowers the seizure threshold, so use cautiously in patients with CNS disorders or epilepsy and review the dose in renal impairment.
Co-administration reduces valproate levels and can precipitate seizures, so avoid the combination where possible.

Monitoring

Monitor renal function, inflammatory markers and clinical response over prolonged courses, with neurological review if confusion or seizures emerge.

Counselling the patient

Report any rash, new confusion, or seizure activity promptly.
Diarrhoea during or after treatment may indicate C. difficile and should be reported.
Complete the full prescribed course even once feeling better.

Evidence & guidelines

UK antimicrobial-stewardship and bone and joint infection guidance supports reserving carbapenems for resistant organisms confirmed on culture.

Reference: IDSA Osteomyelitis Guidelines; WHO AWaRe Classification; MHRA Carbapenem-Valproate Interaction; SPC Meronem; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways