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Antibiotic — Carbapenem Pregnancy: Use with caution — limited data; use only if benefit outweighs risk

Meropenem (Burns — Severe Sepsis/MDR)

Brand names: Meronem

Adult dose

Dose: 1–2 g IV every 8 hours; severe/MDR: 2 g every 8 hours as extended infusion (3–4 hours)
Route: IV infusion
Frequency: Every 8 hours
Max: 6 g/day
Broadest-spectrum beta-lactam — covers ESBL producers, AmpC, and Pseudomonas (except MBL). Reserved for severe burns sepsis, treatment failure on Tazocin, or MDR Gram-negative infection. Extended infusion optimises PK/PD for resistant organisms.

Paediatric dose

Dose: 20–40 mg/kg
Route: IV infusion
Frequency: Every 8 hours
Max: 2 g/dose
20 mg/kg (standard) to 40 mg/kg (meningitis/severe) every 8 hours. Max 2 g per dose.

Dose adjustments

Renal

Dose reduction if eGFR <50: 1 g every 12 hours; eGFR <10: 500 mg every 12–24 hours.

Hepatic

No specific adjustment required.

Paediatric weight-based calculator

20 mg/kg (standard) to 40 mg/kg (meningitis/severe) every 8 hours. Max 2 g per dose.

Clinical pearls

  • Valproate interaction: meropenem (and all carbapenems) dramatically reduce valproate levels by up to 70–90% — risk of breakthrough seizures. Switch valproate to alternative AED or change antibiotic if possible.
  • Meropenem does NOT cover MRSA — add vancomycin/teicoplanin if MRSA is a concern
  • Carbapenem stewardship: restrict to confirmed MDR infection or treatment failure — escalation to carbapenems drives resistance

Contraindications

  • Hypersensitivity to carbapenems
  • Caution: 1% cross-reactivity with penicillin allergy

Side effects

  • Diarrhoea (C. difficile risk)
  • Seizures (high doses or renal failure — lower seizure threshold than imipenem)
  • Raised LFTs
  • Thrombophlebitis
  • Anaphylaxis (rare)

Interactions

  • Valproate (meropenem reduces valproate levels — risk of seizures; avoid combination)
  • Probenecid (increases meropenem levels)

Monitoring

  • Culture and sensitivities (guide de-escalation)
  • Renal function (dose adjustment)
  • Seizure monitoring in high-risk patients
  • Valproate levels if co-prescribed

Reference: BNFc; BNF 90; BBA Burns Infection Guidelines; IDSA MDR Gram-Negative Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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