Adult outpatient parenteral antimicrobial therapy (OPAT) good practice prescribing guide
Meropenem
Meropenem is a carbapenem with a broad spectrum of activity against Gram-positive and Gram-negative bacteria (including Pseudomonas sp). It is licensed for severe pneumonia (including hospital and ventilator associated), gynaecological infections, intra-abdominal infections, complicated urinary tract infections, complicated skin and soft tissue infections and bacterial meningitis.
This guide shares practical experience of the use of meropenem in an OPAT setting. We took an evidence based approach to create the guidance. We also used expert consensus and practical experience from across NHS Scotland.
This drug summary does not provide specific treatment guidance. Individual patient treatment should take into account the core principles of antimicrobial stewardship. This includes selection of the appropriate antimicrobial for the shortest duration with oral therapy being preferred, whenever possible.
For information on Route and method of administration, Contraindications, Cautions and adverse effects and Drug interactions please refer to the following approved resources:
- British National Formulary (BNF), https://bnf.nice.org.uk/
- Summary of Product Characteristics (SPC), https://www.medicines.org.uk/emc/
- The Renal Drug Database, https://renaldrugdatabase.com
- NHS Injectable Medicines Guide (Medusa), https://www.medusaimg.nhs.uk/ or local IV Drug monographs
- Stockley’s Drug Interaction, https://www.medicinescomplete.com/
These resources also have more information on licensed indication, use in pregnancy and use in breast feeding. When using unlicensed medicines, and/or off-label doses or indications, follow local health board governance processes.
The use of broad spectrum antibiotics is associated with an increased risk of Clostridioides difficile infection (CDI). Please monitor patient for new loose stools. If suspicion of CDI send stool sample to microbiology for analysis.
It is strongly recommended that OPAT services in Scotland adhere to the Key performance indicators for the management of patients in an outpatient parenteral antimicrobial therapy (OPAT) setting.
Meropenem
1. Indication and dose
| Licensed indication(s) in the OPAT setting | Dose |
| Complicated intra-abdominal infections | 1g 8 hourly |
| Bacterial meningitis | 2g 8 hourly |
Off-label indications
| Off-label indications in the OPAT setting | Dose |
| Infective exacerbation bronchiectasis | 1g – 2g 8 hourly |
| Malignant otitis externa associated with multi-drug resistant Pseudomonas sp. |
Note 3g once daily is not recommended due to risk of sub-therapeutic concentrations at the end of the dosage interval. Meropenem also cannot be infused as a continuous infusion over 24 hours as it is unstable. See BSAC OPAT Publications (e-opat.com)
2. Dose adjustments
2a. Renal impairment
| Renal function Creatinine Clearance (CrCl) |
Dose Adjustment |
| 26 – 50ml/min | 500mg – 2g 12 hourly |
| 10 – 25ml/min |
500mg – 1g 12 hourly |
| less than 10ml/min | 500mg – 1g 24 hourly |
2b. Other dosage adjustments
| Patient characteristic | Dosage advice |
| Hepatic impairment | No dose adjustment necessary |
| Obesity | No dose adjustment necessary |
3. Monitoring requirements
| Frequency | Recommended monitoring |
| Baseline | Urea and Electrolytes (U&Es), liver function tests (LFTs), C-reactive protein (CRP) and full blood count (FBC) |
| Weekly monitoring (Note this may be more frequent if clinically necessary) |
U&Es, LFTs, CRP and FBC |
| Therapeutic drug monitoring | No therapeutic drug monitoring required |
| Follow up | Ensure follow up is arranged with referring specialty and/or an infection specialist |
For the use of other antibiotics in an OPAT setting please refer to the SAPG website
Scottish Antimicrobial Prescribing Group (SAPG) | January 2024 for review January 2027
Content updated: April 2024