Meropenem (Paediatric)

How it works

It inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, producing bactericidal activity against many Gram-positive, Gram-negative and anaerobic organisms.

Prescribing in practice

• The most important paediatric concern is its very broad spectrum: it should be reserved for serious or resistant infections and used under microbiology/antimicrobial-stewardship guidance to limit carbapenem resistance.
• Dose is weight-based and requires adjustment in renal impairment; doses should be confirmed against a children's formulary.
• Use cautiously in children with a history of severe beta-lactam (penicillin or cephalosporin) hypersensitivity because of potential cross-reactivity, and note that meropenem can lower valproate levels and reduce seizure control.

Monitoring

Monitor clinical and microbiological response, renal and hepatic function, full blood count on prolonged courses, and for signs of Clostridioides difficile-associated diarrhoea.

Counselling the patient

• This antibiotic is given by injection into a vein in hospital for serious infection.
• Report any rash, diarrhoea or signs of an allergic reaction promptly.
• Tell the team if the child takes sodium valproate, as the combination can reduce seizure control.

Evidence & guidelines

Carbapenem stewardship to preserve activity against resistant organisms is endorsed by NICE and UK antimicrobial-resistance guidance.