Meropenem (Burns — Severe Sepsis/MDR)

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.