MERREM ® Meropenem

MERREM ® is a drug based on Meropenem trihydrate

THERAPEUTIC GROUP: General antimicrobials for systemic use - Other beta-lactam, carbapenym antibiotics

IndicationsAction mechanismStudies and clinical effectiveness Usage and dosage instructionsWarnings Pregnancy and lactationInteractionsContraindicationsUndesirable effects

Indications MERREM ® Meropenem

MERREM® is an antibiotic reserved for hospital use indicated for the treatment of respiratory, urinary, abdominal, cutaneous and soft tissue infections sustained by microorganisms sensitive to meropenem.

MERREM ® has also been shown to be effective in the treatment of acute bacterial meningitis and opportunistic infections in immunosuppressed patients.

Mechanism of action MERREM ® Meropenem

Meropenem, active ingredient of MERREM ®, is a beta-lactam antibiotic belonging to the carbapenem family, characterized:

From the broad spectrum of action, including Gram positive and Gram negative bacteria even when commonly resistant to penicillin therapy;
From the rapid bactericidal action, guaranteed by the high permeability through the bacterial wall;
From the great stability to the hydrolytic action made by bacterial beta-lactamases.

Like other beta lactams, meropenem also performs its therapeutic action by inhibiting the transpeptidation reaction between the pepetidoglycan molecules, thus compromising the typical resistance of the bacterial wall to the osmotic gradient.

This mechanism is guaranteed by the ability of meropenem to bind PBP (penicillin binding proteins), inhibiting the formation of peptidoglycan.

Taken parenterally, meropenem very quickly reaches the maximum plasma concentrations, spreading among the various tissues and biological fluids where it performs its therapeutic action for different hours.

Once the bactericidal activity is over and the betalactam ring is hydrolyzed, this active ingredient is eliminated in an inactive form predominantly via the kidney.

Despite the high efficacy of action, different microorganisms are able to reduce the microbicidal activity of meropenem by reducing the permeability of the bacterial wall to the antibiotic, expressing specific resistance enzymes or increasing the presence of efflux pumps capable of transporting the antibiotic penetrated towards the extracellular environment.

Studies carried out and clinical efficacy

1. FUTURE PROSPECTS: MEROPENEM IN THE TREATMENT OF TUBERCULOSIS

Int J Tuberc Lung Dis. 2012 Feb 8. [Epub ahead of print]

An interesting study that demonstrates how the therapeutic association between meropenem and clavulanic acid can be effective in inhibiting the growth of Mycobacterium Tubercolosis generally resistant to antibiotic therapy in vitro.

2 . MEROPENEM IN HOSPITAL ENVIRONMENT

Crit Care. 2012 Jun 28; 16 (3): R113.

Work that demonstrates how the slow and continuous intravenous infusion of meropenem is safe and effective in countering bacterial proliferation and symptom progression in patients suffering from serious pathologies and hospitalized.

3. THE MEROPEMEN IN THE TREATMENT OF SEPSI SEVERA

JAMA. 2012 Jun 13; 307 (22): 2390-9.

Experimental study demonstrating that the association of meropenem and moxifloxacin in the treatment of severe sepsis in adult patients may be effective and delay the progression of multi-organ dysfunction syndrome resulting in patient death.

Method of use and dosage

MERREM ®

500 mg meropenem injectable powder and solvent;

Powder and solvent for 1000 g solution for injection of meropenem.

Given the use reserved for hospitals, the dosage and the relative dosing schedule for antibiotic therapy with MERREM ® should be defined by the competent doctor based on the physio-pathological characteristics of the patient, the severity of his / her clinical picture and the therapeutic goals.

An adjustment of the dosage used should be provided for elderly patients or those suffering from kidney disease.

Warnings MERREM ® Meropenem

The use of MERREM ® should be preceded by the isolation of the pathogen and the characterization of its sensitivity to carbapenems.

The doctor in charge of the therapy should periodically monitor the patient's state of health, ascertaining the absence of conditions capable of compromising the efficacy and safety of antibiotic therapy such as: advanced age, presence of renal pathologies, history of hypersensitivity to drugs and in particular to antibiotics.

Prolonged use of MERREM ® could compromise the vitality of the intestinal microflora, altering the absorption of active ingredients such as oral contraceptives, facilitating the onset of gastro-enteric diseases such as those sustained by particular microorganisms such as Clostridium Difficile.

Intake of meropenem has rarely been associated with seizures.

MERREM ® contains sodium therefore it should be taken with particular care in patients subjected to low-sodium dietary regimens.

PREGNANCY AND BREASTFEEDING

The absence of studies able to characterize the safety profile of the drug for fetal health when taken during pregnancy or in the subsequent period of breastfeeding considerably limits the use of MERREM ® during the entire gestation and lactation period .

Interactions

From the various pharmacokinetic studies carried out the only clinically relevant interactions are those between meropenem and:

Probenecid, responsible for inhibiting the tubular secretion of meropenem and the consequent increase in blood concentrations of the drug;
Oral anticoagulants, capable of significantly increasing the risk of bleeding.

Contraindications MERREM ® Meropenem

The use of MERREM ® is contraindicated in patients who are hypersensitive to beta lactamines, penicillins and cephalosporins or their excipients.

Undesirable effects - Side effects

Therapy with MERREM ® could lead to the appearance of side effects:

Gastro-enteric system with nausea, diarrhea, vomiting and abdominal pain;
Liver with increased cytolysis markers;
Blood with thrombocytopenia and only rarely haemolytic anemia, agranulocytosis and leukopenia;
Of the skin with eruptions, itching, urticaria and erythema.

Clinically very important are also the side effects related to hypersensitivity to the drug, which in addition to understanding dermatological reactions, especially at the point of inoculation, could determine the appearance of bronchospasm, laryngospasm, hypotension and in more serious cases anaphylactic shock.