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:

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
OR
500mg 8 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