[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Carbapenems](https://durgical.com/en/pharmacology/classes/carbapenems/) › Meropenem

[Pharmacology](https://durgical.com/en/pharmacology/) · [Carbapenems](https://durgical.com/en/pharmacology/classes/carbapenems/)

# Meropenem

A broad-spectrum intravenous carbapenem for serious hospital infections, intra-abdominal sepsis and meningitis; it can drop valproate levels.

Updated 2026-11-01

- Class: [Carbapenems](https://durgical.com/en/pharmacology/classes/carbapenems/)
- Enzyme: Penicillin-binding proteins (bacterial transpeptidases)
- ATC code: J01DH02
- WHO Model List of Essential Medicines

✂**Penicillin-binding proteins (bacterial transpeptidases)**Meropenem

ⓘ The figure shows meropenem bound to penicillin-binding protein 3 of Pseudomonas aeruginosa, one of its main targets.

**Target in 3D:** Penicillin-binding proteins (bacterial transpeptidases). PDB structure 3PBR (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3PBR) · Drag to rotate · pinch to zoom

## Mechanism of action

Meropenem crosses the bacterial envelope and acylates penicillin-binding proteins (in Escherichia coli and Pseudomonas aeruginosa mainly PBP2, PBP3 and PBP4). Cross-linking of the wall stops and the bacterium lyses. It resists most β-lactamases, including ESBL, but is destroyed by carbapenemases.

- Crosses porins of the outer membrane
- Acylates PBPs and stops wall cross-linking
- Resists ESBL; destroyed by carbapenemases
- The wall fails and the bacterium lyses

## Pharmacokinetics

**Absorption**
Intravenous only.

**Distribution**
Very low protein binding; reaches the cerebrospinal fluid well enough to treat meningitis.

**Elimination**
Mostly by the kidney; probenecid blocks its secretion.

**Half-life**
About 1 hour with normal kidney function.

## Indications

- Complicated intra-abdominal infections such as complicated appendicitis and peritonitis. [Peritonitis →](https://durgical.com/en/conditions/peritonitis/)
- Bacterial meningitis in children. [Bacterial meningitis →](https://durgical.com/en/conditions/bacterial-meningitis/)
- Complicated skin and soft-tissue infections.
- Serious hospital-onset infections when resistant gram-negatives (such as ESBL producers) are suspected. [Hospital-acquired and ventilator-associated pneumonia →](https://durgical.com/en/conditions/hospital-acquired-and-ventilator-associated-pneumonia/)

## Adverse effects

### Common

- Diarrhoea, nausea, vomiting
- Headache, rash, itching
- Inflammation at the injection site

### Serious (rare, important)

- Anaphylaxis and severe skin reactions
- Seizures and other CNS effects (less often than with imipenem)
- Clostridioides difficile diarrhoea
- Thrombocytopenia in kidney impairment

## Contraindications

- Hypersensitivity to meropenem or other drugs of the class
- Anaphylaxis to any β-lactam

## Key interactions

**Valproic acid / divalproex**
Valproate levels fall below the therapeutic range and seizures may return; the combination is generally avoided.

**Probenecid**
Blocks renal excretion and raises meropenem levels; not recommended.

## What is monitored

- Kidney function (to adjust the regimen)
- Neurological status in patients with CNS disease or kidney failure
- Valproate levels if the combination cannot be avoided
- Platelets in kidney impairment

## Administration and safety

- Intravenous infusion or slow injection after reconstitution; the prepared solution is used within the stability time on the label.
- Some protocols use prolonged infusions to keep levels above the MIC longer.
- Look-alike names with other «-penems»: check the exact carbapenem ordered.

## Nursing care

- Before the first dose: ask about β-lactam allergy and whether the patient takes valproic acid.
- Watch for allergic reactions during the first doses.
- Watch for confusion, myoclonus or seizures, especially with kidney failure.
- Teaching: report watery or bloody diarrhoea, rash, and that it may affect alertness.

## Pregnancy and breastfeeding

Human data are insufficient to define a risk; animal studies showed no malformations. It is used in pregnancy when clearly needed.

## Memory aid

MEROpenem is the «MEnin-gitis-safe» carbapenem: fewer seizures than imipenem. But every «-penem» robs valproate.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is meropenem preferred over imipenem when a carbapenem is needed for meningitis?

It is less likely to cause seizures while reaching the cerebrospinal fluid well.

## How do carbapenems lower valproic acid levels?

They are thought to block the hydrolysis of valproate glucuronide back to valproic acid, so the active drug falls quickly.

## Which killing parameter best predicts meropenem efficacy?

The percentage of the dosing interval that the free drug stays above the MIC (time-dependent killing).

## Does meropenem cover MRSA?

No. It covers methicillin-susceptible staphylococci only; MRSA needs a drug such as vancomycin or linezolid.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/meropenem/)

## Related drugs

- [Imipenem–cilastatin](https://durgical.com/en/pharmacology/imipenem-cilastatin/)
- [Ertapenem](https://durgical.com/en/pharmacology/ertapenem/)
- [Valproic acid](https://durgical.com/en/pharmacology/valproic-acid/)
- [Ceftriaxone](https://durgical.com/en/pharmacology/ceftriaxone/)

## Related conditions

- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)
- [Bacterial meningitis](https://durgical.com/en/conditions/bacterial-meningitis/)
- [Hospital-acquired and ventilator-associated pneumonia](https://durgical.com/en/conditions/hospital-acquired-and-ventilator-associated-pneumonia/)

[← Back to the class: Carbapenems](https://durgical.com/en/pharmacology/classes/carbapenems/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - MEROPENEM injection, powder, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8a2a545e-b336-416a-be73-9e0a7ccf6177) (DailyMed (U.S. National Library of Medicine), 2026); [Meropenem Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a696038.html) (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 58 (McGraw Hill, 2023); [RCSB PDB - 3PBR: Crystal structure of PBP3 complexed with meropenem](https://www.rcsb.org/structure/3PBR) (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.

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