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meropenem (Rx)Merrem IV

Dosage Forms & Strengths


powder for injectable solution

500mg/vial

1g/vial

Complicated Skin/Skin Structure Infections


Indicated as a single agent therapy for the treatment of complicated skin and skin structure
infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus
pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis
(vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus
mirabilis, Bacteroides fragilis, and Peptostreptococcus species
500 mg IV q8hr; not to exceed 2 g IV q8hr

Complicated Intra-abdominal Infections


Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis
caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas
aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species
1 g IV q8hr; not to exceed 2 g IV q8hr

Community-Acquired Pneumonia (Off-label)


500 mg IV q8hr for 5 days in combination with fluoroquinolone

Febrile Neutropenia (Off-label)


1 g IV q8hr

Dosage Modifications
Renal impairment

CrCl >50 mL/min: 0.5-1 g IV q8hr

CrCl 26-50 mL/min: 0.5-1 g IV q12hr

CrCl 10-25 mL/min: 0.25-0.5 g IV q12hr

CrCl <10 mL/min: 0.25-0.5 g IV q24hr

Pediatric

Dosage Forms & Strengths


powder for injectable solution

500mg/vial

1g/vial

Bacterial Meningitis
Indicated as a single agent therapy for the treatment of bacterial meningitis caused by
Streptococcus pneumoniae (penicillin susceptible isolates), Haemophilus influenzae, and
Neisseria meningitidis
3 months: 40 mg/kg IV q8hr; not to exceed 2 g IV q8hr

Complicated Intra-abdominal Infections


Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis
caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas
aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species
3 months: 20 mg/kg IV q8hr; not to exceed 1 g q8hr
<3 months

Infants <32 weeks GA and PNA <2 weeks: 20 mg/kg IV q12hr

Infants <32 weeks GA and PNA 2 weeks: 20 mg/kg IV q8hr

Infants 32 weeks GA and PNA <2 weeks: 20 mg/kg IV q8hr

Infants 32 weeks GA and PNA 2 weeks: 30 mg/kg IV q8hr

Infuse IV over 30 min

Complicated Skin/Skin Structure Infections

Indicated as a single agent therapy for the treatment of complicated skin and skin structure
infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus
pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis
(vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus
mirabilis, Bacteroides fragilis, and Peptostreptococcus species
3 months: 10 mg/kg IV q8hr; not to exceed 500 mg IV q8hr

metronidazole topical (Rx)


Dosage Forms & Strengths
topical gel

1% (MetroGel)

topical cream

0.75% (MetroCream)

1% (Noritate)

topical lotion

0.75% (MetroLotion)

Rosacea
Indicated for the topical treatment of inflammatory lesions of rosacea
1%: Apply topically qDay to affected area(s)
0.75%: Apply topically BID to affected area(s)

Administration
Cleanse treated areas prior to application
Apply thin film and rub into skin
Cosmetics may be applied 5 minutes after application

amoxicillin (Rx)Amoxil, Moxatag, Trimox


Dosage Forms & Strengths
Ear, Nose, & Throat Infections
Mild to moderate infections

500 mg PO q12hr or 250 mg PO q8hr for 10-14 days

Severe infections

875 mg PO q12hr or 500 mg PO q8hr for 10-14 days

Tonsillitis/pharyngitis

Moxatag: 775 mg PO qDay for 10 days, taken within 1 hour after finishing a meal

Spectrum of action

- and -hemolytic Strep, S pneumoniae, Staph spp, H influenzae

Genitourinary Tract Infections


Mild to moderate infections

500 mg PO q12hr or 250 mg PO q8hr

Severe infections

875 mg PO q12hr or 500 mg PO q8hr

Spectrum of action

E coli, P mirabilis, or E faecalis

Skin & Skin Structure Infections


Mild to moderate infections

500 mg PO q12hr or 250 mg PO q8hr

Severe infections

875 mg PO q12hr or 500 mg PO q8hr

Spectrum of action

- and -hemolytic Strep, Staph spp, E coli

Tonsilitis
775 mg (ER tabs) PO qDay for 10 days

Lower Respiratory Tract Infections


875 mg PO q12hr or 500 mg PO q8hr for 10-14 days
Spectrum of action

- and -hemolytic Strep, S pneumoniae, Staph spp, H influenzae

Helicobacter Pylori
H pylori infection and active or 1-year history of duodenal ulcer
Triple therapy

1 g PO q12hr for 14 days with lansoprazole (30 mg) and clarithromycin (500 mg)

Dual therapy

1 g PO q8hr for 14 days with lansoprazole (30 mg) in patients intolerant of, or resistant
to, clarithromycin

Anthrax

Postexposure inhalational prophylaxis


500 mg PO q8hr

Infective Endocarditis
Prophylaxis
2 g PO 30-60 min before procedure
Dosing considerations

AHA guidelines recommend prophylaxis only in high-risk patients undergoing invasive


procedures who have a history of cardiac conditions that predispose them to a risk of
infection

Lyme Disease (Off-label)


Erythema migrans and other symptoms of early dissemination
500 mg PO q8hr (depending on size of patient) for 3-4wk
50 mg/kg/day q8hr in divided doses; maximum 500 mg/dose

Chlamydial Infection in Pregnant Women (Off-label)


First trimester: 500 mg PO q8hr for 7 days
Dosing considerations

First trimester: Test to document chlamydial eradication and retest for infection 3 months
after treatment

Second or third trimester: Test to document chlamydial eradication

Administration
Take without regard to meals

Dosing Modifications
Renal impairment: Patients with impaired renal function do not generally require dose reduction
unless impairment is severe; do not administer extended-release product in patients with CrCl
<30 mL/min

GFR <30 mL/min: Should not receive 875 mg (immediate release) or 775 mg (extended release)
GFR 10-30 mL/min: 250-500 mg q12hr, depending on severity of infection
GFR <10 mL/min: 250-500 mg q24hr depending on severity of infection
Hemodialysis patients: 250-500 mg q24hr, depending on severity of infection; patients should
receive additional dose during and at completion of dialysis; do not administer extended-release
product or 875 mg immediate release

Contraindications
Documented hypersensitivity to penicillins, cephalosporins, imipenem

Cautions
Anaphylaxis has been reported rarely but is more likely to occur following parenteral therapy
with penicillins
Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all
antibacterial agents; severity may range from mild diarrhea to fatal colitis; CDAD may occur
over 2 months after discontinuation of therapy; if CDAD is suspected or confirmed, discontinue
immediately and begin appropriate fluid and electrolyte management, protein supplementation,
antibiotic treatment of C difficile, and surgical evaluation
Do not administer in patients with infectious mononucleosis because of risk of development of
erythematous skin rash
Do not administer to patients in the absence of a proven or suspected bacterial infection because
of risk of development of drug-resistant bacteria
Superinfections with bacterial or fungal pathogens may occur during therapy; if suspected,
discontinue immediately and begin appropriate treatment

Adverse Effects
Frequency Not Defined
Anaphylaxis
Anemia
AST/ALT elevation
Mucocutaneous candidiasis

Diarrhea
Headache
Nausea
Vomiting
Rash
Pseudomembranous colitis
Serum sickness-like reactions

Postmarketing Reports
Mucocutaneous candidiasis
Gastrointestinal (eg, black hairy tongue and hemorrhagic/pseudomembranous colitis, which may
occur during or after treatment)
Hypersensitivity reactions (eg, anaphylaxis, serum sicknesslike reactions, erythematous
maculopapular rashes, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis,
toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity
vasculitis, urticaria)
Moderate increase in AST and/or ALT; hepatic dysfunction (eg, cholestatic jaundice, hepatic
cholestasis and acute cytolytic hepatitis have been reported)
Renal (eg, crystalluria)
Anemia (eg, hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia,
leukopenia, agranulocytosis)
CNS reactions (eg, reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions,
behavioral changes, dizziness)
Tooth discoloration (brown, yellow, or gray staining); may be reduced or eliminated with
brushing or dental cleaning