Indications for MERREM:
Susceptible infections including complicated skin and skin structure infections (SSSI), intraabdominal infections, bacterial meningitis.
Give by IV infusion over 15–30mins or IV bolus over 3–5mins (for doses = 1g). SSSI: 500mg every 8hrs. P. aeruginosa associated SSSI, intraabdominal: 1g every 8hrs. Renal impairment: CrCl 26–50mL/min: give recommended dose every 12hrs; CrCl 10–25mL/min: give ½ of recommended dose every 12hrs; CrCl <10mL/min: give ½ of recommended dose every 24hrs.
<3mos: give by IV infusion over 30mins. Intraabdominal: <32 weeks gestational age (GA) and <2 weeks postnatal age (PNA): 20mg/kg every 12hrs; <32 weeks GA and ≥2 weeks PNA or ≥32 weeks GA and <2 weeks PNA: 20mg/kg every 8hrs; ≥32 weeks GA and ≥2 weeks PNA: 30mg/kg every 8hrs. ≥3mos: give by IV infusion over 15–30mins or IV bolus over 3–5mins. SSSI: 10mg/kg (>50kg: max 500mg) every 8hrs. P. aeruginosa associated SSSI, intraabdominal: 20mg/kg (>50kg: max 1g) every 8hrs. Meningitis: 40mg/kg (>50kg: max 2g) every 8hrs. >50kg: give max dosing per indication.
CNS disorders. History of seizures. Discontinue if severe skin reactions (eg, SJS, TEN, DRESS) occur; consider alternatives. Renal impairment. Hemodialysis or peritoneal dialysis. Pregnancy (Cat.B). Nursing mothers.
Potentiated by probenecid: not recommended. Avoid concomitant valproic acid; if needed, consider supplemental anticonvulsant.
Headache, nausea, constipation, diarrhea, anemia, vomiting, rash (may be severe); C. difficile-associated diarrhea, possible neuromotor impairment (eg, seizures, delirium, paresthesias), hypersensitivity reactions, superinfection (with prolonged use).