ICU Primary PrepCast # Epi 102 - ICU Primary Snippet - Meropenem pharmacology
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Mar 1, 2026 A concise walkthrough of meropenem pharmacology and how it works at the bacterial cell wall. Clear coverage of what organisms it reliably treats and which it misses. Practical discussion of when to use it empirically in severe infections. PK focus on distribution, renal elimination, dialysis effects and augmented clearance. Dosing tactics emphasizing time>MIC with prolonged or higher infusions in critical care.
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Meropenem Mechanism And Target Proteins
- Meropenem is a carbapenem that inhibits bacterial cell wall synthesis by binding penicillin-binding proteins, especially PBP2 and PBP3.
- This blocks transpeptidation, causing bacterial cell lysis and broad bactericidal activity against many organisms.
Broad Spectrum But Not For MRSA Or Atypicals
- Meropenem has a very broad spectrum including anaerobes, many gram-positives and gram-negatives, ESBL organisms and some CREs.
- It does not reliably cover MRSA, most Staph epidermidis, Stenotrophomonas maltophilia, or atypicals like Mycoplasma.
When To Choose Meropenem Empirically
- Use meropenem for suspected or proven multi-resistant gram-negative infections and specific diseases like melioidosis and drug-resistant enteric fever.
- Empirically consider it in necrotising soft tissue infection, febrile neutropenia, hospital-acquired sepsis, meningitis, or high-risk colonisation.