(mer oh PEN em)
Bacterial meningitis: Treatment of bacterial meningitis in pediatric patients 3 months and older caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis
Complicated skin and skin structure infections: Treatment of complicated skin and skin structure infections in adults and pediatric patients 3 months and older caused by Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, S. agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species
Intra-abdominal infections: Treatment of complicated appendicitis and peritonitis in adult and pediatric patients caused by viridans group streptococci, E. coli, Klebsiella pneumoniae, P. aeruginosa, B. fragilis, B. thetaiotaomicron, and Peptostreptococcus species
Canadian labeling: Additional indications (not in U.S. labeling): Treatment of lower respiratory tract infections (community-acquired and nosocomial pneumonias), uncomplicated skin and skin structure infections, complicated urinary tract infections, gynecologic infections (excluding chlamydia), and septicemia; treatment of bacterial meningitis in adults caused by S. pneumoniae, H. influenzae, and N. meningitidis (use in adult meningitis based on pediatric data)
Hypersensitivity to meropenem, other drugs in the same class, or any component of the formulation; patients who have experienced anaphylactic reactions to beta-lactams
Usual dosage range: IV: 1.5 to 6 g daily divided every 8 hours
Extended infusion method (off-label dosing): IV: 0.5 to 2 g over 3 hours every 8 hours (Crandon, 2011; Dandekar, 2003). Note: Dosing used at some centers and is based on pharmacokinetic/pharmacodynamic modeling and not clinical efficacy data. Meropenem stability (admixed with NS at a concentration of 20 mg/mL) at room temperature for >1 hour or under refrigeration for >15 hours is not supported by the manufacturer. Data exist supporting stability (admixed with NS at a concentration of 20 mg/mL) at room temperature for ≤4 hours and under refrigeration ≤24 hours (Patel, 1997).
Indication-specific dosing:
Catheter-related bloodstream infections (off-label use): IV: 1 g every 8 hours (Mermel, 2009)
Cholangitis, intra-abdominal infections, complicated: IV: 1 g every 8 hours. Note: 2010 IDSA guidelines recommend treatment duration of 4-7 days (provided source controlled). Not recommended for mild-to-moderate, community-acquired intra-abdominal infections due to risk of toxicity and the development of resistant organisms (Solomkin, 2010).
Cystic fibrosis, pulmonary exacerbation (off-label use): IV: 40 mg/kg every 8 hours; maximum single dose: 2 g (Zobell, 2012)
Febrile neutropenia (off-label use): IV: 1 g every 8 hours (Ohata, 2011; Paul, 2010)
Gynecologic and pelvic inflammatory disease: Canadian labeling (not in U.S. labeling): IV: 500 mg every 8 hours
Melioidosis (Burkholderia pseudomallei) (off-label use): IV: Initial treatment (intensive-phase): 1 g every 8 hours (Cheng 2004; Inglis 2006; Lipsitz 2012). Note: Meropenem is an alternative treatment to ceftazidime for melioidosis; continued treatment with oral antibiotics is recommended after intensive-phase is completed (Lipsitz 2012).
Meningitis: IV:
Off-label use [U.S.]: 2 g every 8 hours; duration of therapy dependent upon pathogen: N. meningitides, H. influenza: 7 days; S. pneumoniae: 10 to 14 days; aerobic gram-negative bacilli: 21 days (Tunkel, 2004)
Canadian labeling (not in U.S. labeling): 2 g every 8 hours
Pneumonia (community-acquired): Canadian labeling (not in U.S. labeling): IV: 500 mg every 8 hours
Pneumonia (hospital-acquired, healthcare-associated, or ventilator-associated) (off-label use): IV: 1 g every 8 hours (ATS/IDSA, 2005)
Pneumonia (nosocomial): Canadian labeling (not in U.S. labeling): IV: 1 g every 8 hours
Prosthetic joint infection, Pseudomonas aeruginosa (off-label use): IV: 1 g every 8 hours for 4 to 6 weeks (consider addition of aminoglycoside) (Osmon, 2013)
Septicemia: Canadian labeling (not in U.S. labeling): IV: 1 g every 8 hours
Skin and skin structure infections:
Complicated: U.S. labeling: IV:
Pseudomonas aeruginosa-suspected or confirmed: 1 g every 8 hours
Pseudomonas aeruginosa not suspected: 500 mg every 8 hours
Uncomplicated: Canadian labeling (not in U.S. labeling): 500 mg every 8 hours
Skin and soft tissue necrotizing infections (off-label use): I.V.: 1 g every 8 hours in combination with an agent effective against MRSA (eg, vancomycin, linezolid, daptomycin) for empiric therapy of polymicrobial (mixed) infections. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens, 2014]).
Surgical site infection (intestinal or genitourinary tract surgery) (off-label use): IV: 1 g every 8 hours (IDSA [Stevens, 2014])
Urinary tract infections (complicated): Canadian labeling (not in U.S. labeling): IV: 500 mg every 8 hours. Note: Up to 1 g every 8 hours may be administered (Pallett, 2010).
Refer to adult dosing.
Usual dosage range:
Infants <3 months: IV:
Gestational age <32 weeks:
Postnatal age <14 days: 20 mg/kg/dose every 12 hours
Postnatal age ≥14 days: 20 mg/kg/dose every 8 hours
Gestational age ≥32 weeks:
Postnatal age <14 days: 20 mg/kg/dose every 8 hours
Postnatal age ≥14 days: 30 mg/kg/dose every 8 hours
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): IV: 30 to 120 mg/kg/day divided every 8 hours (maximum dose: 6 g daily)
Children and Adolescents (>50 kg): IV: 1.5 to 6 g daily divided every 8 hours
Indication-specific dosing:
Catheter-related blood stream infections (off-label use): IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): IV: 20 mg/kg every 8 hours; maximum single dose: 1,000 mg (Mermel, 2009)
Children and Adolescents (>50 kg): Refer to adult dosing.
Cholangitis, intra-abdominal infections, complicated: IV: Children and Adolescents (>50 kg): Refer to adult dosing.
Cystic fibrosis, pulmonary exacerbation (off-label use): IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): 40 mg/kg every 8 hours; maximum single dose: 2,000 mg (Zobell, 2012)
Children and Adolescents (>50 kg): Refer to adult dosing.
Febrile neutropenia (off-label use): IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): 20 mg/kg every 8 hours (maximum dose: 1,000 mg every 8 hours) (Lehrnbecher, 2012; Yildirim, 2008)
Children and Adolescents (>50 kg): Refer to adult dosing.
Intra-abdominal infections (complicated): IV:
Infants <3 months: IV: Note: Administer as an IV infusion over 30 minutes; do not administer as an IV bolus
Gestational age <32 weeks:
Postnatal age <14 days: 20 mg/kg/dose every 12 hours
Postnatal age ≥14 days: 20 mg/kg/dose every 8 hours
Gestational age ≥32 weeks:
Postnatal age <14 days: 20 mg/kg/dose every 8 hours
Postnatal age ≥14 days: 30 mg/kg/dose every 8 hours
Infants ≥3 months, Children, and Adolescents: 20 mg/kg every 8 hours (maximum dose: 1,000 mg every 8 hours) (Solomkin, 2010)
Melioidosis (Burkholderia pseudomallei) (off-label use): IV:
Infants ≥6 months, Children, and Adolescents ( ≤40 kg): Initial treatment (intensive-phase): 25 mg/kg (up to 1 g) every 8 hours (Cheng 2004). Note: Meropenem is an alternative treatment to ceftazidime for melioidosis; continued treatment with oral antibiotics is recommended after intensive-phase is completed (Lipitz 2012).
Children and Adolescents (>50 kg): Refer to adult dosing.
Meningitis: IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): 40 mg/kg every 8 hours (maximum dose: 2,000 mg every 8 hours)
Children and Adolescents (>50 kg): 2 g every 8 hours
Pneumonia (community-acquired): IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): Canadian labeling (not in U.S. labeling): 10 to 20 mg/kg every 8 hours (maximum dose: 1,000 mg every 8 hours)
Children and Adolescents (>50 kg): Refer to adult dosing.
Pneumonia (hospital-acquired, health care-associated, or ventilator-associated) (off-label use): IV: Children and Adolescents (>50 kg): Refer to adult dosing.
Prosthetic joint infection, Pseudomonas aeruginosa(off-label use): Children and Adolescents (>50 kg): Refer to adult dosing.
Skin and skin structure infections: IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg):
Complicated: U.S. labeling:
Pseudomonas aeruginosa-suspected or confirmed: 20 mg/kg every 8 hours
Pseudomonas aeruginosa not suspected: 10 mg/kg every 8 hours (maximum dose: 500 mg every 8 hours)
Uncomplicated: Canadian labeling (not in U.S. labeling): 10 to 20 mg/kg every 8 hours (maximum dose: 1,000 mg every 8 hours)
Children and Adolescents (>50 kg): Refer to adult dosing.
Skin and soft tissue necrotizing infections (off-label use): I.V.: 20 mg/kg every 8 hours in combination with an agent effective against MRSA (eg, vancomycin, linezolid, daptomycin) for empiric therapy of polymicrobial (mixed) infections. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens, 2014])
Urinary tract infection (complicated): IV:
Infants ≥3 months, Children, and Adolescents ( ≤50 kg): Canadian labeling (not in U.S. labeling): 10 mg/kg every 8 hours (maximum dose: 500 mg every 8 hours)
Children and Adolescents (>50 kg): Refer to adult dosing
Adults:
Manufacturer 's labeling:
CrCl >50 mL/minute: No dosage adjustment necessary.
CrCl 26 to 50 mL/minute: Administer recommended dose based on indication every 12 hours
CrCl 10 to 25 mL/minute: Administer one-half recommended dose based on indication every 12 hours
CrCl <10 mL/minute: Administer one-half recommended dose based on indication every 24 hours
Alternative recommendations (off-label dosing) :
GFR 10 to 50 mL/minute: Administer recommended dose (based on indication) every 12 hours (Aronoff, 2007)
GFR <10 mL/minute: Administer recommended dose (based on indication) every 24 hours (Aronoff, 2007)
Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Meropenem and its metabolite are readily dialyzable: 500 mg every 24 hours (Heintz, 2009). Note: Dosing dependent on the assumption of 3 times weekly, complete IHD sessions.
Peritoneal dialysis (off-label dose): Administer recommended dose (based on indication) every 24 hours (Aronoff, 2007).
Continuous renal replacement therapy (CRRT) (Heintz, 2009; Trotman, 2005): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment:
CVVH: Loading dose of 1 g followed by either 500 mg every 8 hours or 1,000 mg every 12 hours
CVVHD/CVVHDF: Loading dose of 1 g followed by either 500 mg every 6 to 8 hours or 1 g every 8 to 12 hours
Note: Consider giving patients receiving CVVHDF dosages of 750 mg every 8 hours or 1.5 g every 12 hours (Heintz, 2009). Substantial variability exists in various published recommendations, ranging from 1 to 3 g daily in 2 to 3 divided doses. One gram every 12 hours achieves a target trough of ~4 mg/L.
Children:
Manufacturer 's labeling: There are no dosage adjustments provided in the manufacturer 's labeling (has not been studied)
Alternate recommendations (off-label dosing; Aronoff, 2007):
GFR 30 to 50 mL/minute: Administer 20 to 40 mg/kg every 12 hours
GFR 10 to 29 mL/minute: Administer 10 to 20 mg/kg every 12 hours
GFR <10 mL/minute: Administer 10 to 20 mg/kg every 24 hours
Intermittent hemodialysis (IHD): 10 to 20 mg/kg every 24 hours administer after hemodialysis on dialysis days)
Peritoneal dialysis (PD): 10 to 20 mg/kg every 24 hours
Continuous renal replacement therapy (CRRT): 20 to 40 mg/kg every 12 hours
No dosage adjustment necessary.
Meropenem infusion vials may be reconstituted with SWFI. The 500 mg vials should be reconstituted with 10 mL, and 1 g vials with 20 mL. May be further diluted with compatible solutions for infusion. Consult detailed reference/product labeling for compatibility.
Duplex: Unlatch side tab, unfold, remove foil strip from drug chamber. Point set port in downward direction, fold container just below the diluent meniscus, and squeeze the diluent chamber until the seal between the diluent and drug powder opens. Agitate until dissolved.
IV:
Infants <3 months: Administer as an IV infusion over 30 minutes
Infants ≥3 months, Children, Adolescents, and Adults: Administer IV infusion over 15 to 30 minutes; IV bolus injection (5 to 20 mL) over 3 to 5 minutes
Extended infusion administration (off-label dosing): Adults: Administer over 3 hours (Crandon 2011; Dandekar, 2003). Note: Must consider meropenem 's limited room temperature stability if using extended infusions
Some products may contain sodium.
Freshly prepared solutions should be used. However, constituted solutions maintain satisfactory potency under the conditions described below. Solutions should not be frozen.
Store intact vials and unactivated Duplex containers at 20 ‚ °C to 25 ‚ °C (68 ‚ °F to 77 ‚ °F). Unactivated duplex units with foil strip removed from the drug chamber must be protected from light and used within 7 days at room temperature. Once activated, must be used within 1 hour if stored at room temperature or within 15 hours if stored under refrigeration. Do not freeze.
Dry powder should be stored at controlled room temperature 20 ‚ °C to 25 ‚ °C (68 ‚ °F to 77 ‚ °F).
Injection reconstitution: Stability in vial when constituted (up to 50 mg/mL) with:
SWFI:
U.S. labeling: Stable for up to 3 hours at up to 25 ‚ °C (77 ‚ °F) or for up to 13 hours at up to 5 ‚ °C (41 ‚ °F).
Canadian labeling: Stable for up to 3 hours at 15 ‚ °C to 25 ‚ °C (59 ‚ °F to 77 ‚ °F) or for up to 16 hours at 2 ‚ °C to 8 ‚ °C (36 ‚ °F to 46 ‚ °F).
Infusion admixture (1 to 20 mg/mL): Solution is stable when diluted in NS for 1 hour at up to 25 ‚ °C (77 ‚ °F) or 15 hours at up to 5 ‚ °C (41 ‚ °F). Solutions constituted with dextrose injection 5% should be used immediately. Note: Meropenem stability (admixed with NS at a concentration of 20 mg/mL) at room temperature for >1 hour or under refrigeration for >15 hours is not supported by the manufacturer. Data exist supporting stability (admixed with NS at a concentration of 20 mg/mL) at room temperature for ≤4 hours and under refrigeration ≤24 hours (Patel, 1997).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous:
Merrem: 500 mg (1 ea); 1 g (1 ea)
Generic: 500 mg (1 ea); 1 g (1 ea)
Stable in NS for 1 hour at controlled room temperature and up to 15 hours refrigerated. Duplex container: Do not admix with other drugs.
Y-site administration: Incompatible with amphotericin B, diazepam, metronidazole, pantoprazole.
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Probenecid: May increase the serum concentration of Meropenem. Avoid combination
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Valproate Products: Carbapenems may decrease the serum concentration of Valproate Products. Management: Concurrent use of carbapenem antibiotics with valproic acid is generally not recommended. Alternative antimicrobial agents should be considered, but if a concurrent carbapenem is necessary, consider additional anti-seizure medication. Consider therapy modification
Perform culture and sensitivity testing prior to initiating therapy. Monitor for signs of anaphylaxis during first dose. During prolonged therapy, monitor renal function, liver function, CBC.
Positive Coombs [direct]
1% to 10%:
Cardiovascular: Peripheral vascular disease (>1%), shock (1%), bradycardia ( ≤1%), cardiac arrest ( ≤1%), cardiac failure ( ≤1%), chest pain ( ≤1%), hypertension ( ≤1%), hypotension ( ≤1%), myocardial infarction ( ≤1%), peripheral edema ( ≤1%), pulmonary embolism ( ≤1%), syncope ( ≤1%), tachycardia ( ≤1%)
Central nervous system: Headache (2% to 8%), convulsions (neonates and infants <3 months: 5%), pain ( ≤5%), agitation ( ≤1%), anxiety ( ≤1%), chills ( ≤1%), confusion ( ≤1%), delirium ( ≤1%), depression ( ≤1%), dizziness ( ≤1%), drowsiness ( ≤1%), hallucination ( ≤1%), insomnia ( ≤1%), nervousness ( ≤1%), paresthesia ( ≤1%), seizure ( ≤1%)
Dermatologic: Skin rash (2% to 3%, includes diaper-area moniliasis in infants), pruritus (1%), dermal ulcer ( ≤1%), diaphoresis ( ≤1%), urticaria ( ≤1%)
Endocrine & metabolic: Hypoglycemia (>1%), hypervolemia ( ≤1%)
Gastrointestinal: Nausea ( ≤8%), diarrhea (4% to 7%), constipation (1% to 7%), vomiting ( ≤4%), oral candidiasis ( ≤2%), gastrointestinal disease (>1%), glossitis (1%), abdominal pain ( ≤1%), anorexia ( ≤1%), dyspepsia ( ≤1%), enlargement of abdomen ( ≤1%), flatulence ( ≤1%), intestinal obstruction ( ≤1%)
Genitourinary: Dysuria ( ≤1%), pelvic pain ( ≤1%), urinary incontinence ( ≤1%), vulvovaginal candidiasis ( ≤1%)
Hematologic & oncologic: Anemia ( ≤6%), hypochromic anemia ( ≤1%)
Hepatic: Hyperbilirubinemia (conjugated; neonates and infants <3 months: 5%), cholestatic jaundice ( ≤1%), hepatic failure ( ≤1%), jaundice ( ≤1%)
Infection: Sepsis (2%)
Local: Inflammation at injection site (2%)
Neuromuscular & skeletal: Back pain ( ≤1%), weakness ( ≤1%)
Renal: Renal failure ( ≤1%)
Respiratory: Pharyngitis (>1%), pneumonia (>1%), apnea (1%), asthma ( ≤1%), cough ( ≤1%), dyspnea ( ≤1%), hypoxia ( ≤1%), pleural effusion ( ≤1%), pulmonary edema ( ≤1%), respiratory tract disease ( ≤1%)
Miscellaneous: Accidental injury (>1%), fever ( ≤1%)
<1% (Limited to important or life-threatening): Agranulocytosis, angioedema, anorexia, asthma, bradycardia, cardiac arrest, cardiac failure, change in platelet count, cholestatic jaundice, Clostridium difficile associated diarrhea, confusion, decreased hematocrit, decreased hemoglobin, decreased partial thromboplastin time, decreased prothrombin time, decreased white blood cell count, delirium, depression, dermal ulcer, eosinophilia, erythema multiforme, gastrointestinal hemorrhage, hallucination, hematuria, hemolytic anemia, hemoperitoneum, hepatic failure, hypertension, hypervolemia, hypochromic anemia, hypokalemia, hypotension, hypoxia, increased blood urea nitrogen, increased lactate dehydrogenase, increased serum alkaline phosphatase, increased serum ALT, increased serum AST, increased serum bilirubin, increased serum creatinine, ileus, intestinal obstruction, jaundice, leukocytosis, leukopenia, myocardial infarction, neutropenia, peripheral edema, pleural effusion, positive direct Coombs test, pulmonary edema, pulmonary embolism, renal failure, seizure, Stevens-Johnson syndrome, tachycardia, toxic epidermal necrolysis, urinary incontinence, vulvovaginal candidiasis
Cl correlates with CrCl in patients with renal impairment.
A reduction in plasma Cl correlates with age-associated reduction in CrCl (Craig 1997)
Concerns related to adverse effects:
- Anaphylaxis/hypersensitivity reactions: Serious hypersensitivity reactions, including anaphylaxis, have been reported (some without a history of previous allergic reactions to beta-lactams).
- CNS effects: Carbapenems have been associated with CNS adverse effects, including confusional states and seizures (myoclonic); use caution with CNS disorders (eg, brain lesions and history of seizures) and adjust dose in renal impairment to avoid drug accumulation, which may increase seizure risk. Outpatient use may result in paresthesias, seizures, or headaches that can impair neuromotor function and alertness; patients should not operate machinery or drive until it is established that meropenem is well tolerated.
- Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
- Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required in patients with moderate-to-severe renal dysfunction. Increased seizure risk and thrombocytopenia have been reported in patients with renal dysfunction.
Concurrent drug therapy issues:
- Drug-drug interactions. Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Special populations:
- Elderly: Lower doses (based upon renal function) are often required in the elderly.
B
Adverse events were not observed in animal reproduction studies. Incomplete transplacental transfer of meropenem was found using an ex vivo human perfusion model.
Inhibits bacterial cell wall synthesis by binding to several of the penicillin-binding proteins, which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis; bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested
Penetrates into most tissues and body fluids including urinary tract, peritoneal fluid, bone, bile, lung, bronchial mucosa, muscle tissue, heart valves (Craig 1997), and CSF (CSF penetration: Neonates and Infants ≤3 months: 70%)
Vd:
Neonates and Infants ≤3 months: Median: ~0.47 L/kg (Smith 2011)
Children: 0.3-0.4 L/kg (Blumer 1995)
Adults: 15 to 20 L
Hepatic; hydrolysis of beta-lactam bond to open beta-lactam form (inactive) (Craig, 1997)
Urine (~70% as unchanged drug; ~28% inactive metabolite); feces (2%)
Clearance: Neonates and Infants ≤3 months: 0.12 L/hour/kg (Smith 2011); Infants and Children: 0.26-0.37 L/hour/kg (Blumer 1995)
Tissue: ~1 hour following infusion except in bile, lung, and muscle; CSF: 2 to 3 hours with inflamed meninges
Neonates and Infants ≤3 months: Median: 2.7 hours; range: 1.6- 3.8 hours (Smith 2011)
Infants and Children 3 months to 2 years: 1.5 hours
Children 2-12 years and Adults: 1 hour
~2%
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience headache, nausea, vomiting, diarrhea, or constipation. Have patient report immediately to prescriber seizures, muscle rigidity, tremors, abnormal movements, burning or numbness feeling, severe loss of strength and energy, or signs of Clostridium difficile (C. diff)-associated diarrhea (stomach pain or cramps, very loose or watery stools, or bloody stools) (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.