Usage
Meropenem + Sulbactam is prescribed for severe bacterial infections, including:
- Respiratory tract infections (pneumonia, bronchitis)
- Urinary tract infections (complicated UTIs)
- Intra-abdominal infections (appendicitis, peritonitis)
- Gynecological infections
- Skin and soft tissue infections (complicated SSTIs)
- Septicemia
- Bacteremia
- Meningitis and other central nervous system infections
Pharmacological Classification: Carbapenem antibiotic + beta-lactamase inhibitor
Mechanism of Action: Meropenem inhibits bacterial cell wall synthesis, leading to bacterial cell death. Sulbactam, a beta-lactamase inhibitor, protects meropenem from degradation by bacterial enzymes, broadening its spectrum of activity.
Alternate Names
Meropenem/Sulbactam. Brand names include: Merrem IV (meropenem alone). Popular brand names for the combination include: Mepecon-SB, Meroplan S, Merofic Plus, Merofit Plus, Merocare SE, Merowemb TZ.
How It Works
Pharmacodynamics: Meropenem exerts bactericidal activity by inhibiting bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). Sulbactam inhibits beta-lactamase enzymes produced by bacteria, thus extending Meropenem’s effectiveness against resistant strains.
Pharmacokinetics:
- Absorption: Primarily administered intravenously (IV), achieving rapid and complete absorption.
- Metabolism: Meropenem is minimally metabolized. Sulbactam is partially metabolized.
- Elimination: Both drugs are primarily eliminated renally, requiring dose adjustment in patients with renal impairment.
Mode of Action: Meropenem binds to PBPs, disrupting cell wall synthesis. Sulbactam binds to beta-lactamases, preventing meropenem’s degradation.
Elimination Pathways: Primarily renal excretion, with minimal hepatic metabolism.
Dosage
Standard Dosage
Adults:
- cSSTI: 500 mg IV every 8 hours (Pseudomonas aeruginosa infections: 1 g every 8 hours).
- Intra-abdominal infections: 1 g IV every 8 hours.
- Meningitis: 2 g IV every 8 hours.
- Other infections: 1-2g intravenously every 8 hours, infused over 15-30 minutes or administered as an intravenous bolus over 3-5 minutes (up to 1g doses).
- Maximum single dose: 2g
Children (3 months and older):
- cSSTI: 10 mg/kg IV every 8 hours (P. aeruginosa infections: 20 mg/kg every 8 hours).
- Intra-abdominal infections: 20 mg/kg IV every 8 hours.
- Meningitis: 40 mg/kg IV every 8 hours.
- Maximum single dose: 2g
- Infuse IV over 15-30 minutes, or as an intravenous bolus over 3-5 minutes.
Special Cases:
- Elderly Patients: Dose adjustment based on creatinine clearance.
- Patients with Renal Impairment: Dose reduction and/or interval prolongation based on creatinine clearance.
- Patients with Hepatic Dysfunction: No dose adjustment is typically required, but caution is advised.
- Patients with Comorbid Conditions: Consider individual patient factors and adjust accordingly.
Clinical Use Cases
Dosage follows standard guidelines and may be adjusted based on severity and patient factors. Higher doses may be needed for some infections, especially those with resistant organisms. Consider combination therapy if appropriate.
- Intubation: Standard dosage, adjusted for renal function.
- Surgical Procedures: Standard dosage, prophylactic use may be considered.
- Mechanical Ventilation: Standard dosage, adjusted for renal function.
- Intensive Care Unit (ICU) Use: Standard dosage, adjusted for renal function and severity of illness.
- Emergency Situations: Standard dosage or higher depending upon the infection.
Dosage Adjustments
Dose modifications necessary for renal impairment based on creatinine clearance. Consider hepatic function, other comorbid conditions, and concomitant medications.
Side Effects
Common Side Effects:
- Diarrhea
- Nausea and vomiting
- Headache
- Dizziness
- Pain and inflammation at the injection site
Rare but Serious Side Effects:
- Seizures
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Clostridium difficile-associated diarrhea
- Stevens-Johnson syndrome
Long-Term Effects:
Potential for superinfections with prolonged use.
Adverse Drug Reactions (ADR):
- Anaphylaxis
- Severe skin reactions
Contraindications
- Hypersensitivity to carbapenems, penicillins, cephalosporins, or beta-lactamase inhibitors.
Drug Interactions
- Probenecid: Reduces renal excretion of Meropenem.
- Valproic acid: Meropenem may decrease valproic acid levels, potentially increasing seizure risk.
- Anticoagulants: Meropenem may enhance the anticoagulant effect.
Pregnancy and Breastfeeding
- Pregnancy: Use only if clearly needed, benefits outweigh the risks.
- Breastfeeding: Consult with a healthcare professional before using, as the drug is excreted in breast milk in low concentrations.
Drug Profile Summary
- Mechanism of Action: Inhibits bacterial cell wall synthesis, enhanced by beta-lactamase inhibition.
- Side Effects: Diarrhea, nausea, vomiting, headache, dizziness, injection site reactions. Serious side effects are rare but can include seizures and allergic reactions.
- Contraindications: Hypersensitivity to carbapenems, penicillins, cephalosporins, or beta-lactamase inhibitors.
- Drug Interactions: Probenecid, valproic acid, anticoagulants.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Varies depending on infection and patient factors. See detailed dosage section.
- Monitoring Parameters: Renal function, liver function, signs of allergic reactions.
Popular Combinations
While typically administered as a combination of meropenem and sulbactam itself, other combinations may include a third antimicrobial, usually indicated in the context of specific, resistant infections or as directed by antimicrobial stewardship programs.
Precautions
- General Precautions: Assess for allergies, renal and hepatic function, and potential drug interactions before administering.
- Specific Populations: Caution advised in patients with renal impairment, seizures, CNS disorders, pregnant or breastfeeding women. Dose adjustments may be necessary.
- Lifestyle Considerations: Alcohol use may exacerbate certain side effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Meropenem + Sulbactam?
A: Dosage varies depending on the infection, patient age, and renal function. See the detailed dosage section above.
Q2: What are the most common side effects?
A: Common side effects include diarrhea, nausea, vomiting, headache, dizziness, and injection site reactions.
Q3: Is Meropenem + Sulbactam safe to use during pregnancy?
A: Use with caution during pregnancy only if the potential benefits outweigh the risks. Consult a healthcare professional.
Q4: Can Meropenem + Sulbactam be used in patients with renal impairment?
A: Yes, but dose adjustments are necessary based on creatinine clearance.
Q5: What are the contraindications for Meropenem + Sulbactam?
A: Hypersensitivity to carbapenems, penicillins, cephalosporins, or beta-lactamase inhibitors.
Q6: How is Meropenem + Sulbactam administered?
A: Administered intravenously, either by infusion or bolus injection, depending on the dose.
Q7: What are some serious side effects to be aware of?
A: Serious side effects are rare but can include seizures, severe allergic reactions (including anaphylaxis), Clostridium difficile-associated diarrhea, and Stevens-Johnson Syndrome.
Q8: Does Meropenem + Sulbactam interact with other medications?
A: Yes. It can interact with probenecid, valproic acid, and anticoagulants, among others. Always check for potential drug interactions before administering.
Q9: How should I monitor patients receiving Meropenem + Sulbactam?
A: Monitor renal function, liver function, and observe for any signs of allergic reactions.
Q10: What infections is Meropenem + Sulbactam effective against?
A: It’s effective against a broad range of bacterial infections, including those of the respiratory tract, urinary tract, intra-abdomen, skin and soft tissue, bloodstream, and central nervous system. Its use should be guided by local resistance patterns and institutional guidelines.
