Dosing and Administration

Merrem I.V. - dosing and flexible administration

Merrem I.V. is indicated as single-agent therapy for the treatment of complicated appendicitis and peritonitis, complicated skin and skin structure infections, and pediatric (≥3 months of age) bacterial meningitis, when caused by susceptible isolates of the indicated pathogens (for list of indicated pathogens, see below).

Dosage adjustment is needed in adult patients with renal impairment (creatinine clearance 50 mL/min or less). There is no experience in pediatric patients with renal impairment.

Merrem I.V. can be administered via infusion or bolus injection¹

Adult dosing

Merrem I.V. should be administered by intravenous infusion over approximately 15 to 30 minutes.

Doses of 1 g may also be administered as an intravenous bolus injection (5 mL to 20 mL) over approximately 3 to 5 minutes.

adult patients with normal renal function
Indication	Dosing
Complicated skin and skin structure infections (CSSSIs)	500 mg q8h
Complicated appendicitis and peritonitis	1 g q8h

adult patients with impaired renal function
Creatinine clearance (mL/min)	Dose (dependent on infection type)	Dosing interval
>50	Recommended dose (500 mg CSSSIs and 1 g complicated appendicitis and peritonitis)	q8h
>25-50	Recommended dose	q12h
10-25	One-half recommended dose	q12h
<10	One-half recommended dose	q24h

Pediatric dosing

Merrem I.V. should be administered by intravenous infusion over approximately 15 to 30 minutes.

Merrem I.V. may also be administered as an intravenous bolus injection (5 mL to 20 mL) over approximately 3 to 5 minutes.

pediatric patients (≥3 months) with normal renal function
Indication	Dosing (patients ≤50 kg)	Dosing (patients >50 kg)
Complicated skin and skin structure infections (CSSSIs)	10 mg/kg q8h	500 mg q8h
Complicated appendicitis and peritonitis	20 mg/kg q8h	1 g q8h
Bacterial meningitis	40 mg/kg q8h	2 g q8h

Safety and effectiveness have not been studied in pediatric patients with renal impairment.

Important Safety Information

MERREM I.V. is contraindicated in patients with known hypersensitivity to any component of the product, or to other drugs in the same class, or in patients who have demonstrated anaphylactic reactions to beta-lactams
Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with beta-lactams. These reactions are more likely to occur in individuals with a history of sensitivity to multiple allergens
There have been reports of individuals with a history of penicillin hypersensitivity who have experienced severe hypersensitivity reactions when treated with another beta-lactam
Seizures and other CNS adverse experiences have been reported during treatment with Merrem I.V.
Co-administration of carbapenems, including MERREM I.V., to patients receiving valproic acid or divalproex sodium reduces serum valproic acid concentrations, which may drop below the therapeutic range and increase the risk of breakthrough seizures. Increasing the dose of valproic acid or divalproex sodium may not be sufficient to overcome this interaction. The concomitant use of MERREM I.V. and valproic acid or divalproex sodium is generally not recommended. Antibacterials other than carbapenems should be considered in patients whose seizures are well controlled on valproic acid or divalproex sodium. If administration of MERREM I.V. is necessary, supplemental anticonvulsant therapy should be considered
Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including MERREM I.V., and may range in severity from mild diarrhea to fatal colitis. CDAD must be considered in all patients who present with diarrhea following antibiotic use
In patients with renal impairment, thrombocytopenia has been observed but no clinical bleeding reported
Co-administration of MERREM I.V. with probenecid is not recommended, since probenecid inhibits renal excretion of meropenem
Dosage adjustment is needed in adult patients with renal impairment (creatinine clearance 50 mL/min or less). There is no experience in pediatric patients with renal impairment
The most common adverse events reported across clinical trials with Merrem I.V. were diarrhea, nausea/vomiting, headache, constipation, anemia, pain, and rash. These events occurred in 3% to 8% of patients

Indications for MERREM I.V.

Merrem I.V. is indicated as single-agent therapy for the treatment of:

Adult and pediatric patients (≥3 months of age) with complicated appendicitis and peritonitis caused by susceptible isolates of viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species
Adult and pediatric patients (≥3 months of age) with complicated skin and skin structure infections caused by susceptible isolates of Staphylococcus aureus (beta-lactamase and non–beta-lactamase-producing, methicillin-susceptible isolates only), Streptococcus pyogenes, S. agalactiae, viridans group streptococci, Enterococcus faecalis (excluding vancomycin-resistant isolates), P. aeruginosa, E. coli, Proteus mirabilis, B. fragilis, and Peptostreptococcus species
Pediatric patients (≥3 months of age) with bacterial meningitis caused by susceptible isolates of S. pneumoniae*, Haemophilus influenzae (beta-lactamase- and non–beta-lactamase-producing isolates), and Neisseria meningitides

* The efficacy of meropenem as monotherapy in the treatment of meningitis caused by penicillin nonsusceptible isolates of S. pneumoniae has not been established.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Merrem I.V. and other antibacterial drugs, Merrem I.V. should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

Please click here for full Prescribing Information(PDF - 1.3MB).

Important Pages:
Important Safety Information
Dosing with MERREM I.V.
Complicated Skin and Skin Structure Infections

This product information is intended for US health care professionals only.

Merrem I.V. is a registered trademark of the AstraZeneca group of companies.