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

Meropenem (Burns — Severe Sepsis/MDR)

Brand names: Meronem

Meropenem is a broad-spectrum carbapenem antibiotic used intravenously in burns for severe sepsis or infection with multidrug-resistant Gram-negative organisms, including Pseudomonas.

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: Complicated skin and soft tissue infections (adults and adolescents): 500 mg or 1 g every 8 hours. A dose of up to 2 g three times daily may be particularly appropriate when treating some types of infection, such as 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 can be given as an intravenous bolus injection over approximately 5 minutes

Frequency: Every 8 hours

Max: Up to 2 g every 8 hours (three times daily); there are limited safety data available to support administration of a 2 g dose in adults as an intravenous bolus injection

Source is the SPC for Meronem IV 1g Powder for solution for injection or infusion. The SPC gives no burns-specific regimen — the nearest stated indication is complicated skin and soft tissue infections. The dose administered and the duration of treatment should take into account the type of infection, its severity and the clinical response. Other adult/adolescent regimens, all every 8 hours: severe pneumonia including hospital-acquired and ventilator-associated pneumonia 500 mg or 1 g; broncho-pulmonary infections 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; acute bacterial meningitis 2 g; management of febrile neutropenic patients 1 g. No dose adjustment is necessary in hepatic impairment, or for the elderly with normal renal function or creatinine clearance above 50 ml/min. NOTE: the eMC fetch was truncated part-way through §4.4, so §4.5 interactions were not retrieved.

Paediatric dose

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

Frequency: Every 8 hours

Max: Up to 40 mg/kg three times daily may be particularly appropriate for less susceptible bacterial species or very severe infections; there are limited safety data to support a 40 mg/kg dose as an intravenous bolus in children

SPC §4.2, children from 3 months to 11 years of age and up to 50 kg body weight, doses every 8 hours: complicated skin and soft tissue infections 10 or 20 mg/kg; severe pneumonia including hospital-acquired and ventilator-associated pneumonia 10 or 20 mg/kg; complicated urinary tract infections 10 or 20 mg/kg; complicated intra-abdominal infections 10 or 20 mg/kg; broncho-pulmonary infections in cystic fibrosis 40 mg/kg; acute bacterial meningitis 40 mg/kg; febrile neutropenia 20 mg/kg. dosePerKg is left null because the SPC states alternatives (10 or 20 mg/kg) rather than a single value. Children over 50 kg body weight should receive the adult dose. In children under 3 months of age safety and efficacy have not been established and the optimal dose regimen has not been identified, although limited pharmacokinetic data suggest 20 mg/kg every 8 hours may be an appropriate regimen. There is no experience in children with renal impairment. Verify all paediatric dosing against a children's formulary before use.

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

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

Common: diarrhoea, abdominal pain, vomiting and nausea (diarrhoea 2.3% and nausea/vomiting 1.4% in a review of 4,872 patients)
Common: rash and pruritus (1.4%); uncommon urticaria
Common: increased transaminases, blood alkaline phosphatase and blood lactate dehydrogenase; thrombocythaemia; uncommon drug-induced liver injury (including hepatitis and liver failure)
Common: injection site inflammation and pain; uncommon thrombophlebitis
Common: headache; uncommon paraesthesia; rare convulsions and delirium
Uncommon: anaphylaxis and angioedema; toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme; agranulocytosis, haemolytic anaemia, thrombocytopenia, neutropenia, leukopenia and eosinophilia; not known — rhabdomyolysis, DRESS and AGEP

Interactions

US label cross-check: probenecid competes with meropenem for active tubular secretion and inhibits its renal excretion, increasing plasma concentrations — co-administration is not recommended
US label cross-check: valproic acid or divalproex sodium — carbapenems reduce valproic acid concentrations, which may drop 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
eMC §4.5 was not retrieved by the source fetch (truncated during §4.4) — check the full interactions section against the SPC

Clinical monograph

How it works

It inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins and is highly stable to most beta-lactamases, giving extensive activity against Gram-positive, Gram-negative and anaerobic bacteria.

Prescribing in practice

Reserve carbapenems for severe or resistant infection under microbiology guidance and de-escalate on culture results, to limit selection of carbapenem-resistant organisms.
Burns patients often have augmented renal clearance and a large volume of distribution, which can lower drug exposure, while dose reduction is needed if renal function falls.
It can lower the plasma concentration and efficacy of valproate, risking loss of seizure control, and rarely lowers the seizure threshold itself.

Monitoring

Monitor renal function, clinical and microbiological response, and concurrent valproate levels and seizure control where co-prescribed.

Counselling the patient

This is given as an intravenous infusion in hospital and the team will adjust treatment as culture results return.
Report any rash, severe or persistent diarrhoea, or new tremor or twitching.

Evidence & guidelines

Carbapenem stewardship and the meropenem-valproate interaction reducing anticonvulsant levels are well established in UK prescribing references.

Reference: BBA Burns Infection Guidelines; IDSA MDR Gram-Negative Guidelines; 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