Meropenem

INTRODUCTION

Indications

Treatment of Intra-abdominal infections, Bacterial meningitis. Skin and skin structure infections. Unlabeled Use: Febrile neutropenia. Hospital-acquired pneumonia and sepsis.

Action

Binds to bacterial cell wall, resulting in cell death. Meropenem resists the actions of many enzymes that degrade most other penicillins and penicillin-like anti-infectives. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against the following gram-positive organisms: Staphylococcus aureus, Streptococcus pneumoniae, Viridans group streptococci, Enterococcus faecalis. Also active against the following gram-negative pathogens: Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria meningitidis, Pseudomonas aeruginosa, Proteus mirabilis. Active against the following anaerobes: Bacteroides fragilis, B. fragilis group, Peptostreptococcus species.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, headache. Resp: APNEA. GI: PSEUDOMEMBRANOUS COLITIS, constipation, diarrhea, glossitis (increased in children), nausea, thrush (increased in children), vomiting. Derm: moniliasis (children only), pruritus, rash. Local: inflammation at injection site, phlebitis. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Assess respiration, and notify physician immediately if patient exhibits any interruption in respiratory rate (apnea) or other signs of respiratory failure (rapid labored breathing, cyanosis, confusion, irritability, sleepiness, headache, oxygen desaturation).

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucous in stool, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct children and family/caregiver to report signs of thrush and moniliasis, including painful, creamy white lesions on the tongue and inside the mouth.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, skin problems (rash, itching), or GI problems (nausea, vomiting, diarrhea, constipation).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.