Meropenem - A review of its use in patients in intensive care

Meropenem is a carbapenem antibacterial agent that has antimicrobial activi ty against Gram-negative, Gram-positive and anaerobic micro-organisms. rn v itro studies involving isolates from patients in intensive care units (ICUs ) indicate that meropenem is more active against most Gram-negative pathoge ns than other comparators (including imipenem), although, compared with imi penem, meropenem is less active against most Gram-positive organisms. Resis tance to meropenem is uncommon in most bacteria. Treatment with meropenem as initial empirical monotherapy was effective in a range of serious infections in adult and paediatric ICU patients. Meropen em monotherapy was as effective as imipenem/cilastatin in 4 comparative tri als in terms of satisfactory clinical and bacteriological responses. Meropenem monotherapy was significantly more effective than ceftazidime-bas ed combination treatments in 2 trials in patients with nosocomial lower res piratory tract infections (LRTIs) in terms of both clinical and bacteriolog ical responses. Meropenem was also more active than ceftazidime-based treat ments against both Gram-positive and Gram-negative organisms, However, 2 st udies in patients with a range of serious infections found no significant d ifferences between meropenem and cephalosporin-based treatments in terms of clinical or bacteriological response. Meropenem was also as effective as c ephalosporin-based treatments in comparative trials in children with seriou s infections. Meropenem is well tolerated as either a bolus or an infusion, and clinical trials have shown similar incidences of adverse events to those observed wi th cephalosporin-based treatments. It is well tolerated by the CNS, with se izures reported infrequently, and can therefore be used at high doses and i n patients with meningitis. The incidence of drug-related nausea and vomiti ng is low and, in contrast to imipenem/cilastatin, does not increase with d ose or speed of administration. Conclusions: Meropenem is a well tolerated broad spectrum antibacterial age nt that, when used as initial empirical monotherapy, is as effective as imi penem/cilastatin in the treatment of a range of serious infections (includi ng nosocomial) in adults and children in ICUs. Compared with cephalosporin- based combination treatments, meropenem monotherapy may be more effective i n the treatment of nosocomial LRTIs and can be used as monotherapy. Meropen em has an important role in the empirical treatment of serious infections i n adults and children in ICUs.