Merexide - instructions for use, reviews, analogs and forms of release (powder for the preparation of injections 500 mg and 1000 mg) antibiotic for the treatment of pneumonia, infection of blood, meningitis and other infections in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Merexide. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Merexide in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Merexide in the presence of existing structural analogues.Use for the treatment of pneumonia, infection of blood, meningitis and other infectious and inflammatory diseases in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Mereside - antibiotic class carbapenems for parenteral use. Resistant to dehydropeptidase-1 (DHP-1), does not require additional administration of DHP-1 inhibitor. It acts bactericidal (inhibits the synthesis of the bacterial cell wall), easily penetrates the bacterial cell wall, is resistant to the action of most beta-lactamases, and has a high affinity for proteins that bind penicillin. The minimum bactericidal concentration (MBC) and the minimum inhibitory concentration (MIC) are virtually indistinguishable. It interacts with receptors-specific penicillin-binding proteins on the surface of the cytoplasmic membrane, inhibits the synthesis of the peptidoglycan layer of the cell wall (due to structural similarity), suppresses transpeptidase, promotes the release of autolytic enzymes of the cell wall, which eventually causes its damage and death of bacteria.

Composition

Meropenem trihydrate + auxiliary substances.

Pharmacokinetics

With intravenous administration of 250 mg for 30 minutes, the maximum concentration is about 11 μg per ml, for a dose of 500 mg - about 23 μg per ml, for a dose of 1000 mg - about 49 μg per ml. After 6 hours after intravenous administration of 500 mg, the concentration of meropenem in the blood plasma is reduced to 1 μg per ml or less.

With the administration of 500 mg every 8 hours and 1000 mg every 6 hours, patients with normal renal function of cumulation of meropenem in urine and blood plasma are not observed. In patients with normal renal function, the elimination half-life is approximately 1 hour.

Meropenem penetrates well into most tissues and body fluids, including cerebrospinal fluid in patients with bacterial meningitis, reaching concentrations sufficient to ensure bactericidal action against most bacteria. In small amounts penetrates into breast milk. Meropenem undergoes a slight metabolism in the liver with the formation of a single inactive metabolite.

It is excreted by the kidneys - 70% unchanged for 12 hours. The concentration of meropenem in the urine, exceeding 10 μg per ml, is maintained for 5 hours after the administration of 500 mg.

Indications

• infections of the lower respiratory tract (including pneumonia, including hospital);
• urinary tract infection (including pyelonephritis, pyelitis);
• infections of the skin and soft tissues (including erysipelas, impetigo, secondarily infected dermatoses);
• intra-abdominal infections (complicated appendicitis, peritonitis, pelvioperitonitis);
• septicemia;
• infections of the pelvic organs (including endometritis);
• bacterial meningitis;
• suspicion of bacterial infection in adults with febrile neutropenia (empirical treatment in the form of monotherapy or in combination with antiviral or antifungal agents).

Forms of release

Powder for the preparation of a solution for intravenous administration of 500 mg and 1000 mg in ampoules of 5 ml, 10 ml and 20 ml (injections).

Instructions for use and dosing regimen

Intravenously bolus: in dilution with sterile water for injection 10 ml per 500 mg, 15 mg per 1000 mg for at least 5 minutes.

Intravenously infusion: for 15-30 minutes, diluted to 50-200 ml with a compatible infusion fluid.

Meropenem is compatible with the following liquids: 0.9% sodium chloride solution; 5-10% Dextrose solution (glucose); 5% dextrose (glucose) solution with 0.02%solution of sodium bicarbonate; 5% dextrose (glucose) solution with 0.225% sodium chloride solution; 5% dextrose (glucose) solution with 0.15% potassium chloride solution; 2.5 and 10% solution of mannitol.

Meropenem should not be mixed or added to other medications. The dose and duration of therapy are determined depending on the severity of the infection and the patient's condition.

Adults

With pneumonia, infections of the urinary tract, infections of the pelvic organs, infections of the skin and soft tissues - intravenously by 500 mg every 8 hours.

With hospital pneumonia, peritonitis, septicemia, suspected bacterial infection in patients with neutropenia - intravenously 1000 mg 3 times a day.

When meningitis - 2000 mg every 8 hours.

In case of impaired renal function

The dose is adjusted depending on the creatinine clearance (CK):

• KK 26-50 ml per minute - a single dose from recommended for a corresponding pathology of 100% after 12 hours;
• KK 10-25 ml per minute - a single dose of 50% after 12 hours;
• KK less than 10 ml per minute - 50% after 24 hours.

Meropenem is excreted in hemodialysis. To restore the effective plasma concentration after completion of the hemodialysis procedure, it is necessary to administer a single dose of meropenem recommended for the corresponding pathology.

Children

At the age of 3 months to 12 years (or with a body weight of less than 50 kg), a single dose for intravenous administration is 10-20 mg per kilogram 3 times a day.

Children with a body weight of more than 50 kg are given doses for adults.

When meningitis - 40 mg per kilogram every 8 hours.

Side effect

• skin rash (including erythematous rashes);
• itching of the skin;
• multiforme exudative erythema;
• malignant exudative erythema;
• hives;
• angioedema;
• anaphylactic shock;
• headache;
• dizziness;
• paresthesia (burning, tingling, "crawling");
• agitation (excited state);
• impaired consciousness;
• epileptiform seizures;
• convulsions;
• pain in the upper abdomen;
• nausea, vomiting;
• diarrhea, constipation;
• anorexia (lack of appetite);
• jaundice;
• Candidiasis of the oral mucosa (fungal infection);
• pseudomembranous colitis (acute inflammatory bowel disease caused by the microorganism Clostridium difficile);
• inflammation, phlebitis (inflammation of the venous wall), thrombophlebitis (inflammation of the venous walls with the formation of thrombi in the lumen of the inflamed vein), tenderness at the injection site;
• anemia (reduced concentration of hemoglobin);
• hypervolemia (increase in the volume of circulating blood and plasma);
• vaginal candidiasis (a kind of vaginal fungal infection).

Contraindications

• Children under 3 months of age (no data on efficacy and tolerability);
• hypersensitivity to any of the components of the drug.

Carefully

• simultaneous administration with nephrotoxic drugs;
• patients with colitis.

Application in pregnancy and lactation

Use of Merexide during pregnancy is only possible when the intended benefit to the mother exceeds the potential risk to the fetus.

If you need to use the drug during lactation, you should decide whether to stop breastfeeding.

Use in children

It is forbidden to use Mereside for children under 3 months. Experience in the use of the drug in children with neutropenia, with primary or secondary immunodeficiency is not.

special instructions

Patients who have a history of hypersensitivity to carbapenems, penicillins or other beta-lactam antibiotics may exhibit hypersensitivity to meropenem.

Treatment of patients with liver disease should be conducted under careful monitoring of hepatic transaminase activity and bilirubin concentration.

In the course of treatment, the development of resistance of pathogens is possible, and therefore prolonged treatment is carried out under the constant control of the distribution of resistant strains.

In individuals with gastrointestinal complaints, especially in patients with colitis, it is necessary to consider the possibility of developing pseudomembranous colitis (the toxin produced by Clostridium difficile is one of the main causes of colitis associated with antibiotics), the first symptom of which may be the development of diarrhea against the background of treatment.

When monotherapy of a known or suspected infection of the lower respiratory tract of severe course caused by Pseudomonas aeruginosa, a regular determination of the sensitivity of the pathogen to meropenem is recommended.

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period, care must be taken when driving vehicles and engaging in potentially dangerous activities that require a high concentration of attention and speed of psychomotor reactions.

Drug Interactions

Drugs that block tubular secretion, slow down excretion and increase the concentration of meropenem in the plasma.

Meropenem can reduce the concentration of valproic acid in plasma.

Analogues of the drug Merexide

Structural analogs for the active substance:

• Jenham;
• Mepenem;
• Meronem;
• Meronoxol;
• Meropenabol;
• Meropenem;
• Nerinam;
• Penemera;
• Let us propinem;
• Cyronome.

Analogues on the pharmacological group (synthetic antibacterial agents):

• Abaktal;
• Avelox;
• Avrazor;
• Adisord;
• Amicon;
• Apputol;
• Afenoxin;
• Bactrim;
• Basijen;
• Betaciprol;
• Biseptol;
• Vagisept;
• Vagiphereon;
• Vigamox;
• Gynocaps;
• Gramurin;
• Grosseptol;
• Daraprim;
• Dixin;
• Dioxydin;
• Zanotsin;
• Zofloks;
• Isoniazid;
• Imidil;
• Intetriks;
• Kanesten;
• Canison;
• Clion;
• Clotrimazole;
• Xenacvin;
• Lebel;
• Levomekol;
• Levoflox;
• Levofloxacin;
• Leflobact;
• Lidaprim;
• Lomacin;
• Lotrimin;
• Macroside;
• Maksakvin;
• Mannitol;
• Moxigram;
• Nyfural;
• Noroksin;
• Ornidazole;
• Ofloxacin;
• Oflomak;
• Renor;
• Reefater;
• Rosamet;
• Septrin;
• Sofazine;
• Sulotrim;
• Sulphadimezine;
• Sulfanilamide;
• Sulfacil
• Sumetrolim;
• Tanflomed;
• Taricin;
• Terizidone;
• Tizamide;
• Tysidone;
• Trimezol;
• Trimethoprim;
• Trichopol;
• Uropimide;
• Urofuragin;
• Fenazide;
• Floracid;
• Phthalazole;
• Phtivazide;
• Furagin;
• Furadonin;
• Furamag;
• Furasol.

Response of infectious diseases physician

Mereside is an effective antibiotic that has a harmful effect on most pathogenic bacteria. Assign it to bacterial pneumonia and other infections of the lower respiratory tract. This is an excellent tool for the treatment of bacterial meningitis, blood infection, complicated by infections of appendicitis, peritonitis, infected dermatoses. Mereside can be used as an independent drug (monotherapy), and in combination with other antifungal and antiviral drugs for polymicrobial infections. He has few contraindications, the therapy, as a rule, does not cause serious side effects.

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