Clinical Medicine Reviews in Therapeutics

Meropenem is an effective broad-spectrum carbapenem antibiotic frequently prescribed for treatment of severe bacterial infections. We conducted a structured review of the published literature to review the microbiology, clinical efficacy and pharmacokinetics, pharmacodynamics and tolerability of meropenem for the treatment of serious bacterial infections. Robust susceptibility data describes the broad spectrum of action of meropenem against many Gram positive and Gram negative organisms as well as stability against ESBL producing organisms. In clinical trials with other antibiotic comparators such as imipenem/cilastatin and cephalosporins (with and without an aminoglycoside), meropenem has been shown to have comparable efficacy for the treatment of different types of serious bacterial infections including severe community acquired pneumonia, complicated intra-abdominal infections, complicated skin and skin structure infections, bacterial meningitis and complicated urinary tract infections. In clinical studies of meropenem versus ceftazidime and an aminoglycoside, meropenem produced superior results for treatment of nosocomial and ventilator associated pneumonia. Meropenem also has a favourable pharmacokinetic profile enabling distribution into many tissue sites whilst maintaining a good safety and tolerability profile in adult and paediatric patients. Like other beta-lactam antibiotics, distribution into peripheral tissue may be impaired in critically ill patients. Administration can occur by either bolus dosing or intermittent infusion, although poor stability at room temperature complicates possible administration by continuous infusion. Such properties make meropenem a useful treatment for serious bacterial infections as either empiric or directed therapy, with administration by extended infusion appropriate for treatment of infections caused by pathogens with reduced susceptibility.