meropenem
Meropenem (Merrem) is a carbapenem antibiotic that's used to treat serious bacterial infections, including those caused by antibiotic-resistant bacteria. It can treat stomach infections that have complications and serious skin infections in adults and children. Meropenem (Merrem) is also used as treatment for meningitis in children. This medication is only available in injection form, so it's usually given intravenously (IV) by a trained healthcare provider. Side effects aren't very common.
What is Meropenem (Merrem)?
What is Meropenem (Merrem) used for?
Serious skin infections
Serious stomach infections
Meningitis in children
How Meropenem (Merrem) works
Meropenem (Merrem) is a carbapenem antibiotic. It kills bacteria by preventing them from making their own protective covering.
Drug Facts
What are the side effects of Meropenem (Merrem)?
Common Side Effects
- Headache (up to 8%)
- Nausea (up to 8%)
- Constipation (up to 7%)
- Diarrhea (up to 7%)
- Anemia (low red blood cell count; up to 6%)
- Pain (up to 5%)
- Vomiting (up to 4%)
Other Side Effects
- Inflammation around the area where the medication is injected
- Itching
- Rash
- Trouble breathing
- Sepsis (bloodstream infection)
Serious Side Effects
- Allergic reactions: itching; hives; trouble breathing; trouble swallowing; swelling of your hands, face, or mouth
- Severe skin reactions: skin pain, red rash or red blotches on your skin, blisters and sores on the skin, peeling skin
- Severe diarrhea: watery or bloody stools, painful stomach cramps, signs of dehydration (e.g., dry mouth, headaches, urinating less often than normal)
- Seizures
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
Less common
Bluish lips or skin
chills
cold, clammy skin
confusion
dizziness
fainting
fast heartbeat
fast, weak pulse
itching, skin rash
lightheadedness
rapid, shallow breathing
sweating
Rare
Agitation
black, bloody, or tarry stools
black, bloody vomit
bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
burning sensation while urinating
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
dark urine
decreased awareness or responsiveness
decreased urine output
diarrhea (watery and severe), which may also be bloody
difficult or painful urination
difficulty with breathing
dilated neck veins
extreme tiredness or weakness
fever with or without chills
headache
hives or welts
hostility
irregular breathing
irritability
light-colored stools
loss of consciousness
muscle twitching
no blood pressure or pulse
nosebleed
pale skin
pounding in the ears
rapid weight gain
seizures
severe constipation
severe vomiting
severe sleepiness
slow, irregular heartbeat
stomach cramps, severe
tightness in the chest
troubled breathing with exertion
unconsciousness
unpleasant breath odor
unusual bleeding or bruising
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual weight gain or loss
vomiting of blood or material that looks like coffee grounds
white patches in the mouth, tongue, or throat
yellow eyes or skin
Incidence not known
Back, leg, or stomach pains
bleeding gums
blistering, peeling, or loosening of the skin
confusion as to time, place, or person
general body swelling
general feeling of tiredness or weakness
hoarseness
holding false beliefs that cannot be changed by fact
joint or muscle pain
large, hive-like swelling on the face, eyelids, tongue, throat, hands, legs, feet, or genitals
loss of appetite
lower back or side pain
red skin lesions, often with a purple center
red, irritated eyes
seeing, hearing, or feeling things that are not there
sores, ulcers, or white spots in the mouth or on the lips
swollen glands
unusual excitement, nervousness, or restlessness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Body aches or pain
cold hands and feet
cold sweats
congestion
cool pale skin
dryness or soreness of the throat
increased hunger
indigestion
nightmares
passing of gas
redness, swelling, or soreness of the tongue
shakiness
slurred speech
stomach pain, fullness, or discomfort
trouble swallowing
vaginal yeast infection
voice changes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Meropenem (Merrem)
Pros
Can treat serious infections
Able to kill bacteria that are resistant to other antibiotics
Has mild side effects for most people
Can use if you have liver problems
Available as a lower-cost generic
Cons
Only available as an injection
Usually given 3 times a day
Might not be able to use this medication if you're allergic to penicillin or cephalosporin antibiotics
Can raise the risk of seizures for some people
If you have to take it at home, must have a small tube inserted through your skin and into your vein so that you or a nurse can administer the medication
Pharmacist tips for Meropenem (Merrem)
Before taking meropenem (Merrem), tell your provider if you're allergic to penicillin, cephalosporins, or any other antibiotics. Serious allergic reactions can happen if you've had an allergic reaction to these medications in the past.
Tell your provider or get medical help right away if you have a rash, itchy skin, trouble breathing, or swelling in your face and mouth. This can be a sign of an allergic reaction.
Talk with your provider before starting meropenem (Merrem) if you have a history of seizures or if you're taking valproic acid or divalproex sodium. Meropenem (Merrem) might raise your risk of having a seizure in these situations.
Diarrhea is a possible side effect that should go away when you stop taking meropenem (Merrem). But tell your provider if the diarrhea doesn't stop or if you develop watery or bloody stools because this can be a sign of serious infectious diarrhea.
Tips for using meropenem (Merrem) at home, if instructed by your provider
Before using meropenem (Merrem) at home, speak with your provider to learn about the proper way to give yourself the medication.
Store meropenem (Merrem) as instructed. Depending on how it's prepared, you might need to keep the medication at room temperature or in the refrigerator.
Before injecting meropenem (Merrem), check for particles (solid chunks) or discoloration in the solution. If you see either, don't use the solution because it's probably not safe to use.
Avoid driving or doing other tasks that require you to be alert until you know how meropenem (Merrem) affects you. This medication can sometimes cause headaches, problems with muscle control, and problems with thinking clearly.
Completely finish your treatment with meropenem (Merrem) as instructed by your provider, even if you start to feel better. Your infection can come back and be harder to treat if you stop taking the medication early.
Frequently asked questions about Meropenem (Merrem)
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What are the risks and warnings for Meropenem (Merrem)?
Meropenem (Merrem) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reaction
Risk factors: History of allergy to penicillin or cephalosporin antibiotics | History of allergies to multiple medications
Before taking meropenem (Merrem), be sure your provider is aware if you've had an allergic reaction from taking penicillin-type or cephalosporin antibiotics before. These allergic reactions can include trouble breathing or swelling in your face and neck. Meropenem (Merrem) might not be right for you, and your provider might prescribe another antibiotic. Get medical attention right away if you experience an allergic reaction to meropenem (Merrem) after starting the medication.
Severe skin reactions
In some rare cases, people have developed really bad, potentially life-threatening skin reactions after starting meropenem (Merrem). These allergic rashes can be painful and can cause blisters all over the body. Get medical help right away if you notice a new rash, have a rash and a fever, unexplained blisters, or new sores inside your mouth.
Risk of seizures
Risk factors: History of seizures or problems with the brain | Bacterial meningitis | Kidney problems | People over 65 years old | Taking valproic acid or divalproex sodium | Taking other medications that can raise the risk for seizures
Although rare, meropenem (Merrem) can raise your risk for seizures. Seizures might be more common in people with a history of seizures or problems with the brain. Having kidney problems can also raise the risk for seizures. When the kidneys aren't working well, they can't remove meropenem (Merrem) from the body well so the medication can build up to high levels in the blood, which raises the risk for seizures. So, you might need a lower dose to lower your risk if you have kidney problems.
In addition, your risk for seizures is higher if you take meropenem (Merrem) with valproic acid or divalproex sodium. Meropenem (Merrem) can lower the levels of these two anti-seizure medications in the body, which can lead to the risk for breakthrough seizures. Your provider might have to watch you more closely or prescribe additional anti-seizure medications if you're taking valproic acid or divalproex sodium and have to start taking meropenem (Merrem).
Severe diarrhea
Risk factors: Use of multiple antibiotics | Long-term use of antibiotics | People over 65 years old | Recent hospital stay | People with weakened immune systems | Previous infection from or known exposure to Clostridioides difficile
Like all antibiotics, meropenem (Merrem) can cause diarrhea because it can get rid of the "good" bacteria that's normally in your gut. In rare cases, this diarrhea is caused by a bacteria called Clostridioides difficile (or C. diff) that's usually kept under control by your gut bacteria. Ask your provider or pharmacist about taking probiotic supplements while you're using meropenem (Merrem) to help prevent infection from C. diff.
C. diff diarrhea can cause fast heart rate, foul-smelling diarrhea, fever, nausea, and very frequent bowel movements. This diarrhea can lead to life-threatening dehydration (low fluids in the body). Get medical help right away if you experience these symptoms because you should get treated as soon as possible. Since C. diff is very contagious, be sure to frequently wash your hands with soap for 20 seconds and try to use a different bathroom from anyone living with you until you're better.
Development of drug-resistant bacteria
Risk factors: Using meropenem (Merrem) for too long | Taking meropenem (Merrem) for a non-bacterial infection | Taking meropenem (Merrem) to prevent a bacterial infection
You should only take meropenem (Merrem) to treat bacterial infections for the prescribed amount of time. Using antibiotics like meropenem (Merrem) when they aren't necessary or for too long can lead to infections caused by drug-resistant bacteria. These new or worsened infections from drug-resistant bacteria can be much harder to treat. Let your provider know if you notice symptoms of a new infection or if the original symptoms don't get better after you've finished your entire course of meropenem (Merrem).
Low number of platelets in people with kidney problems
If you have kidney problems, taking meropenem (Merrem) might make it more likely for your platelet counts to drop (thrombocytopenia). So far, cases of low platelet counts weren't dangerous and didn't raise the risk for bleeding.
Nerve and muscle problems
In some rare cases, meropenem (Merrem) can affect your mental alertness and muscle control. It's possible to have side effects like confusion, headache, or a tingling feeling. If you're taking meropenem (Merrem) at home, don’t drive or do anything requiring a lot of concentration until you know how this medication affects you.
Meropenem (Merrem) dosage forms
Typical dosing for Meropenem (Merrem)
Adults: The typical dose is 500 mg to 1,000 mg infused into the veins (IV) every 8 hours.
Children 3 months of age and older:
Skin infections: The typical dose is 10 mg/kg of body weight infused through an IV every 8 hours. The maximum amount given per dose is 500 mg.
Stomach infections: The typical dose is 20 mg/kg of weight infused through an IV every 8 hours. The maximum amount given per dose is 1,000 mg.
Meningitis: The typical dose is 40 mg mg/kg of weight infused through an IV every 8 hours. The maximum amount given per dose is 2,000 mg.
Children younger than 3 months with stomach infection: The typical dose is 20 mg/kg to 30 mg/kg of body weight infused through an IV every 8 to 12 hours.
Your dose might differ if you have kidney problems.
Interactions between Meropenem (Merrem) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cholera Vaccine, Live
- Valproic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Meropenem (Merrem) contraindications
Allergic reaction to beta-lactam antibiotics, such as penicillin, amoxicillin, and cephalexin (Keflex)
What are alternatives to Meropenem (Merrem)?
Serious skin infections
Serious stomach infections
Meningitis in children
Serious stomach infection
Serious skin infection (e.g., cellulitis, diabetic foot infection)
Serious urinary tract infection (UTI), including those affecting the kidneys
Pelvic infection
Prevention of infection from colorectal surgery
Stomach infection in people ages 2 months and older
Pneumonia in people ages 2 months and older
Skin infection (e.g., cellulitis, foot infection due to diabetes) in adults
Pelvic infection in adult females
Meropenem (Merrem) images
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References
Best studies we foundArmas Pharmaceuticals Inc. (2023). Meropenem injection [package insert]. DailyMed.
Bush, L. M. (2023). Pseudomonas infections. Merck Manual Consumer Version.
Fish, D. N. (2006). Meropenem in the treatment of complicated skin and soft tissue infections. Therapeutics and Clinical Risk Management.
Gupta, K., et al. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases.
McFarland, L. V., et al. (2016). Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World Journal of Gastroenterology.
MedlinePlus. (2022). Bacteria culture test.
National Heart, Lung, and Blood Institute. (2022). Thrombocytopenia.
Norris, A. H., et al. (2018). 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clinical Infectious Diseases.
Pandey, N., et al. (2023). Beta-lactam antibiotics. StatPearls.
Papp-Wallace, K. M., et al. (2011). Carbapenems: Past, present, and future. Antimicrobial Agents and Chemotherapy.
Sartelli, M., et al. (2017). Management of intra-abdominal infections: Recommendations by the WSES 2016 consensus conference. World Journal of Emergency Surgery.
Stevens, D. L., et al. (2014). Executive summary: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases.
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