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Meropenem Injection Uses, Dosage, Side Effects & Price | DrugsAtlas

Authoritative Clinical Reference

Therapeutic Class

Antibacterial

Subclass

Carbapenem (β-lactam)

Speciality

Infectious Diseases

Schedule (India)

Schedule H

Routes

Intravenous (IV)

Formulations

Form	Strengths
Powder for injection (lyophilized)	500 mg, 1 g per vial
Pre-mixed IV infusion (limited availability)	500 mg/50 mL, 1 g/100 mL

Combination formulations:

Meropenem + Sulbactam: Limited FDCs available (not widely standardised)
Meropenem + Vaborbactam: NOT AVAILABLE in India

Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Complicated Intra-abdominal Infections

Parameter	Details
Starting dose	1 g IV every 8 hours
Titration	Not routinely required; may increase to 2 g q8h in severely ill patients
Usual maintenance dose	1 g IV every 8 hours
Maximum dose	6 g/day (2 g every 8 hours)
Duration	5–14 days depending on source control and clinical response

Clinical Notes:

Infuse over 15–30 minutes (standard infusion)
Extended infusion (3–4 hours) may be considered in critically ill patients — off-label but practised in Indian ICUs
Source control (surgical/drainage) is essential alongside antibiotic therapy

2. Complicated Urinary Tract Infections (including Pyelonephritis)

Parameter	Details
Starting dose	500 mg–1 g IV every 8 hours
Titration	Not applicable
Usual maintenance dose	1 g IV every 8 hours
Maximum dose	6 g/day
Duration	7–14 days

Clinical Notes:

Reserve for resistant gram-negative organisms or treatment failure with other agents
Step-down to oral therapy based on culture sensitivity when feasible

3. Hospital-Acquired Pneumonia (HAP) / Ventilator-Associated Pneumonia (VAP)

Parameter	Details
Starting dose	1 g IV every 8 hours
Titration	Increase to 2 g IV every 8 hours in critically ill or suspected resistant organisms
Usual maintenance dose	1–2 g IV every 8 hours
Maximum dose	6 g/day
Duration	7–14 days

Clinical Notes:

Combination with aminoglycoside or fluoroquinolone may be considered initially for suspected Pseudomonas or MDR organisms
De-escalate based on culture results
Extended infusion strategy improves pharmacodynamic target attainment in severe infections

4. Bacterial Meningitis (Adults)

Parameter	Details
Starting dose	2 g IV every 8 hours
Titration	Not applicable
Usual maintenance dose	2 g IV every 8 hours
Maximum dose	6 g/day
Duration	10–21 days depending on pathogen

Clinical Notes:

High dose required for adequate CSF penetration
Preferred carbapenem for CNS infections (imipenem has higher seizure risk)
Monitor for neurotoxicity, especially in renal impairment

5. Febrile Neutropenia (Empiric Therapy)

Parameter	Details
Starting dose	1 g IV every 8 hours
Titration	Escalate to 2 g q8h if inadequate response or suspected resistant organism
Usual maintenance dose	1 g IV every 8 hours
Maximum dose	6 g/day
Duration	Until afebrile for 48 hours and ANC recovery (typically 7–14 days)

Clinical Notes:

Specialist (haematology/oncology) supervision recommended
Consider combination therapy if fungal infection or resistant gram-positive suspected
Reassess at 72 hours based on clinical response and microbiological data

Secondary Indications — Adults (Off-label, if any)

Indication	Dose	Duration	Notes
Severe MDR Gram-negative Infections (ESBL, AmpC producers) — OFF-LABEL	2 g IV every 8 hours via extended infusion (3–4 hours)	10–14 days or as guided by clinical response	Specialist only. Evidence: Indian ICU protocols; pharmacodynamic modelling supports extended infusion for organisms with elevated MICs.
CNS Shunt Infections (resistant to third-generation cephalosporins) — OFF-LABEL	2 g IV every 8 hours	10–21 days	Specialist only (Neurosurgery/Infectious Diseases). Evidence: Case series and Indian tertiary centre practice.
Severe Skin and Soft Tissue Infections (necrotising fasciitis, MDR organisms) — OFF-LABEL	1–2 g IV every 8 hours	14–21 days	Specialist only. Usually combined with agents covering gram-positives and anaerobes.

Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

1. Severe Bacterial Infections (Intra-abdominal, UTI, Sepsis)

Neonates:

Age/Weight	Dose	Frequency	Maximum Dose
≤7 days AND ≤2 kg	20 mg/kg IV	Every 12 hours	40 mg/kg/day
≤7 days AND >2 kg	20 mg/kg IV	Every 12 hours	40 mg/kg/day
8–28 days AND ≤2 kg	20 mg/kg IV	Every 12 hours	40 mg/kg/day
8–28 days AND >2 kg	20 mg/kg IV	Every 8 hours	60 mg/kg/day

Infants and Children (≥3 months to 12 years):

Indication	Dose	Frequency	Maximum Dose
Standard infections	20 mg/kg IV	Every 8 hours	1 g per dose (3 g/day)
Severe infections / HAP / VAP	40 mg/kg IV	Every 8 hours	2 g per dose (6 g/day)

2. Bacterial Meningitis

Age ≥3 months:

Parameter	Details
Starting dose	40 mg/kg IV every 8 hours
Titration	Not applicable
Usual maintenance dose	40 mg/kg IV every 8 hours
Maximum dose	2 g per dose (6 g/day)
Duration	10–21 days depending on pathogen

Clinical Notes:

Infuse over 15–30 minutes
High dose essential for adequate CSF penetration
Monitor for seizures, especially in neonates and those with renal impairment

Secondary Indications — Paediatrics (Off-label, if any)

Indication	Age	Dose	Duration	Notes
Febrile Neutropenia (Empiric) — OFF-LABEL	≥3 months	20–40 mg/kg IV every 8 hours (max 2 g/dose)	Until afebrile + ANC recovery	Specialist only (Paediatric oncology). Evidence: Indian paediatric oncology protocols.
Ventilator-Associated Pneumonia — OFF-LABEL	≥3 months	40 mg/kg IV every 8 hours (max 2 g/dose)	7–14 days	Specialist only. Evidence: PICU protocols at tertiary Indian centres.

Age Restriction:
Not recommended in infants below 3 months of age except under paediatric infectious diseases or neonatology specialist supervision. Neonatal dosing requires careful assessment of gestational age, postnatal age, and renal function.

Safety Monitoring (All Paediatric Patients):

Baseline and periodic renal function assessment
Monitor for seizures (especially at high doses or in CNS infections)
Observe for hypersensitivity reactions and GI disturbances
Infuse over 15–30 minutes minimum

Renal Adjustments

eGFR (mL/min/1.73 m²)	Dose Adjustment
>50	No adjustment required
26–50	1 g every 12 hours (or 500 mg q8h for moderate infections)
10–25	500 mg every 12 hours
<10	500 mg every 24 hours

Dialysis Modality	Recommendation
Intermittent Haemodialysis (IHD)	500 mg after each dialysis session
Continuous Renal Replacement Therapy (CRRT)	1 g every 12 hours (individualise based on effluent flow rate)
Peritoneal Dialysis	500 mg every 24 hours

Hepatic adjustment

Contraindications

Known hypersensitivity to meropenem or any other carbapenem antibiotic
History of severe immediate-type (Type I) hypersensitivity reaction to any β-lactam antibiotic (penicillins, cephalosporins)
Intrathecal or intraventricular administration (not approved — risk of severe neurotoxicity)

Cautions

History of seizures or CNS disorders — carbapenems may lower seizure threshold, particularly at high doses or in renal impairment
Elderly patients with reduced renal reserve — increased risk of neurotoxicity
Concurrent use with valproic acid — risk of subtherapeutic valproate levels leading to breakthrough seizures
History of non-immediate β-lactam allergy — use with caution; cross-reactivity is low but monitor for hypersensitivity
Prolonged use may lead to superinfection with resistant organisms or fungi
Clostridioides difficile-associated diarrhoea risk with prolonged or broad-spectrum antibiotic use

Pregnancy

Parameter	Details
Overall safety	Limited human data; animal studies have not shown teratogenic effects
Risk category	Generally considered acceptable when clinically indicated (former FDA Category B equivalent)
Preferred alternatives	Ceftriaxone (for non-Pseudomonal infections), Piperacillin-tazobactam (if susceptible organism) — when appropriate
When to use	May be used when benefit clearly outweighs risk (e.g., life-threatening sepsis, meningitis, MDR gram-negative infections); specialist input advised
Monitoring	Maternal renal function; complete blood count; fetal monitoring in severe sepsis

Lactation

Parameter	Details
Compatibility	Compatible with breastfeeding
Milk levels	Low — minimal excretion into breast milk
Preferred alternatives	Ceftriaxone, amoxicillin (if organism susceptibility allows and clinical situation permits)
Infant monitoring	Observe for diarrhoea, oral thrush (candidiasis), feeding difficulties (all rare)

Elderly

Parameter	Recommendation
Starting dose	No change if renal function is normal
Titration	Adjust dose based on renal function (eGFR); more frequent monitoring required
Special considerations	Increased risk of CNS adverse effects (confusion, myoclonus, seizures). Regularly assess renal function. Elderly often have reduced renal reserve even with "normal" serum creatinine — use eGFR for dosing decisions.

Major drug interactions

Interacting Drug	Mechanism / Effect	Recommendation
Valproic Acid / Sodium Valproate	Meropenem drastically reduces valproate serum levels (by 60–90%) within 24–48 hours via unknown mechanism	Avoid combination — high risk of breakthrough seizures. If meropenem essential, switch to alternative antiepileptic (levetiracetam, phenytoin).
Probenecid	Inhibits renal tubular secretion of meropenem, increasing plasma levels and half-life	Avoid concurrent use; if unavoidable, consider dose reduction and enhanced monitoring
Ganciclovir / Valganciclovir	Additive risk of CNS toxicity including seizures	Avoid combination if possible; if essential, monitor closely for neurotoxicity
Live Oral Typhoid Vaccine (Ty21a)	Antibiotics may reduce vaccine efficacy	Avoid concurrent use; complete antibiotic course at least 3 days before administering live vaccine

Moderate drug interactions

Interacting Drug	Effect	Recommendation
Aminoglycosides (amikacin, gentamicin)	Additive nephrotoxicity; synergistic antibacterial activity	May be used together for serious infections but monitor renal function closely
Loop Diuretics (furosemide)	Potential increased risk of nephrotoxicity	Monitor renal function and hydration status
Warfarin	Antibiotic-induced alteration of gut flora may affect vitamin K metabolism and alter INR	Monitor INR when starting or stopping meropenem; adjust warfarin dose as needed
Cyclosporine	Possible additive nephrotoxicity	Monitor renal function and cyclosporine levels

Common Adverse effects

Diarrhoea
Nausea, vomiting
Headache
Injection site reactions (phlebitis, pain, inflammation)
Rash (maculopapular)
Elevated hepatic transaminases (transient)

Serious Adverse effects

Adverse Effect	Clinical Notes
Seizures	Risk increased with high doses, renal impairment, CNS pathology. Reduce dose if renal dysfunction; consider alternative in seizure-prone patients.
Anaphylaxis / severe hypersensitivity	Discontinue immediately; emergency management required
Clostridioides difficile-associated diarrhoea (CDAD)	Suspect if severe or persistent diarrhoea; discontinue and treat appropriately
Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)	Rare; immediate discontinuation and hospitalisation required
Haematological toxicity	Neutropenia, thrombocytopenia, agranulocytosis (rare); monitor CBC in prolonged therapy
Hepatotoxicity	Elevated LFTs, cholestatic jaundice (rare); monitor in prolonged courses

Monitoring requirements

Baseline:

Serum creatinine and eGFR
Liver function tests (AST, ALT, bilirubin)
Complete blood count
Allergy history (β-lactam antibiotics)

During therapy:

Renal function: Every 2–3 days in critically ill or elderly patients
Neurological status: Monitor for confusion, myoclonus, or seizures — particularly if dose >2 g every 8 hours or in renal impairment
Clinical response: Assess fever, inflammatory markers, source control

Prolonged therapy (>7 days):

Weekly complete blood count
Weekly liver function tests
Monitor for signs of superinfection (candidiasis, resistant organisms)
Reassess need for continued therapy and potential de-escalation

Brands in India

Brand Name	Manufacturer
Meronem	Pfizer
Merocrit	Cipla
Merofast	Aristo
Merotrol	FDC Ltd
Merocide	Alkem
Merowin	Mankind
Merosure	Lupin
Ronem	Ranbaxy/Sun Pharma

Multiple generic formulations available from various Indian manufacturers.

Price range (INR)

Formulation	Approximate Price
500 mg vial	₹180–350
1 g vial	₹300–600

Regulatory status: Meropenem is included in NLEM 2022. Available through Jan Aushadhi stores at subsidised rates. Private market prices vary by brand.

Clinical pearls

Antimicrobial stewardship essential — Reserve meropenem for confirmed or strongly suspected resistant gram-negative infections (ESBL, AmpC producers). Avoid empiric use for mild-to-moderate infections to prevent carbapenem resistance emergence.
Extended infusion improves outcomes — For critically ill patients or infections caused by organisms with elevated MICs, consider 3–4 hour extended infusion (off-label but widely practised in Indian ICUs) to optimise pharmacodynamic target attainment.
Preferred carbapenem for CNS infections — Meropenem has lower seizure potential compared to imipenem; use high-dose (2 g q8h) for meningitis to ensure adequate CSF penetration.
Valproate interaction is critical — Never use meropenem with valproic acid without switching antiepileptic. Valproate levels drop dramatically, leading to seizure breakthrough within 24–48 hours.
Renal dosing is crucial — Most meropenem toxicity (particularly neurotoxicity) occurs in patients with unrecognised or under-dosed renal impairment. Use eGFR-based dosing consistently.
Nephrotoxicity is minimal as monotherapy — Meropenem has low intrinsic nephrotoxicity, but risk increases significantly when combined with aminoglycosides or other nephrotoxins.

Version

RxIndia v1.0 — 25 Apr 2025

Reference

- CDSCO approved prescribing information
- Indian Pharmacopoeia
- NLEM 2022
- API Textbook of Medicine, 11th Edition
- AIIMS Antimicrobial Policy 2023
- ICMR Antimicrobial Resistance Guidelines
- IAP Guidelines (Paediatric Infectious Diseases)
- MoHFW National Treatment Guidelines
- Harrison's Principles of Internal Medicine (supportive reference)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics (pharmacology reference)
- Published pharmacodynamic studies on extended infusion protocols (supporting off-label infusion strategy)

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Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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