Carbapenem — Severe / MDR Gram-Negative Infections / Febrile Neutropenia Pregnancy: 'There are no or limited amount of data from the use of meropenem in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precautionary measure, it is preferable to avoid the use of meropenem during pregnancy.' Breast-feeding: 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' (§4.6).

Meropenem (Paediatric)

Brand names: Meronem

Meropenem (paediatric) is a broad-spectrum carbapenem antibiotic given intravenously to children for serious infections such as sepsis, hospital-acquired pneumonia, complicated intra-abdominal infection, meningitis and febrile neutropenia. This page covers its use in the paediatric population.

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 for severe pneumonia (including hospital and ventilator-associated pneumonia), complicated urinary tract infections, complicated intra-abdominal infections, intra- and post-partum infections, and complicated skin and soft tissue infections; 2 g every 8 hours for broncho-pulmonary infections in cystic fibrosis and for acute bacterial meningitis; 1 g every 8 hours for the management of febrile neutropenic patients

Route: Intravenous infusion over approximately 15 to 30 minutes; alternatively, doses up to 1 g can be given as an intravenous bolus injection over approximately 5 minutes

Frequency: Every 8 hours

Max: 'A dose of up to 2 g three times daily in adults and adolescents ... may be particularly appropriate when treating some types of infections, such as infections due to less susceptible bacterial species (e.g. Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp.), or very severe infections.' There are limited safety data supporting a 2 g dose given as an intravenous bolus injection

SOURCE: eMC UK SPC, productName 'Meronem IV 1g Powder for solution for injection or infusion', §4.2. Doses apply to adults and adolescents. '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.' HEPATIC IMPAIRMENT: no dose adjustment necessary. ELDERLY: no dose adjustment required for the elderly with normal renal function or creatinine clearance values above 50 ml/min. Source §4.4 and §4.8 were truncated at the source-fetch limit and §4.5 was not retrieved.

Paediatric dose

Route: Intravenous infusion over approximately 15 to 30 minutes; alternatively, meropenem doses of up to 20 mg/kg may be given as an intravenous bolus over approximately 5 minutes

Frequency: Every 8 hours

Max: 'A dose of up to 40 mg/kg three times daily in children may be particularly appropriate when treating ... infections due to less susceptible bacterial species (e.g. Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp.), or very severe infections.' There are limited safety data supporting a 40 mg/kg dose given as an intravenous bolus injection. Children over 50 kg body weight should be given the adult dose

dosePerKg is left null because the per-kg dose is INDICATION-DEPENDENT (10, 20 or 40 mg/kg), not a single figure. VERBATIM §4.2, children from 3 months to 11 years of age and up to 50 kg body weight, 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.' CHILDREN UNDER 3 MONTHS: 'The safety and efficacy of meropenem in children under 3 months of age has not been established and the optimal dose regimen has not been identified. However, limited pharmacokinetic data suggest that 20 mg/kg every 8 hours may be an appropriate regimen.' 'There is no experience in children with renal impairment.' Verify all under-18 dosing against a children's formulary.

Dose adjustments

Renal

The dose for adults and adolescents should be adjusted when creatinine clearance is less than 51 ml/min, based on the unit dose range of 500 mg, 1 g or 2 g: creatinine clearance 26–50 ml/min — one unit dose every 12 hours; 10–25 ml/min — half of one unit dose every 12 hours; below 10 ml/min — half of one unit dose every 24 hours. There are limited data to support these dose adjustments for a unit dose of 2 g. Meropenem is cleared by haemodialysis and haemofiltration and the required dose should be administered after completion of the haemodialysis cycle. There are no established dose recommendations for patients receiving peritoneal dialysis. There is no experience in children with renal impairment.

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 (2.3%), nausea/vomiting (1.4%) and abdominal pain (common); antibiotic-associated colitis (uncommon)
Rash (1.4%) and pruritus (common); injection site inflammation (1.1%)
Thrombocythaemia (common); agranulocytosis, haemolytic anaemia, thrombocytopenia, neutropenia, leukopenia and eosinophilia (uncommon)
Increased transaminases, blood alkaline phosphatase and blood lactate dehydrogenase (common, 1.5–4.3%); drug-induced liver injury and increased blood bilirubin (uncommon)
Headache (common); paraesthesia (uncommon); convulsions (rare); anaphylaxis and angioedema (uncommon); delirium (rare)

Interactions

Probenecid — competes with meropenem for active tubular secretion, inhibiting renal excretion and increasing meropenem plasma concentrations; co-administration is not recommended (US label §7.1)
Valproic acid or divalproex sodium — carbapenems reduce valproic acid concentrations, which may fall below the therapeutic range and increase the risk of breakthrough seizures; concomitant use is generally not recommended and non-carbapenem antibacterials should be considered in patients whose seizures are well controlled on valproate (US label §7.2)
NOTE: the UK SPC §4.5 interaction section was NOT retrieved in this source bundle — the interactions above are taken from the US label and must be verified against the UK SPC

Clinical monograph

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.

Reference: PHE Antibiotic Guidelines; ECIL Febrile Neutropenia Guidelines; NICE Sepsis NG51; 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

Pathways