There is an impending shortage of meropenem (Merrem®) that will start affecting acute care hospitals in the coming weeks. This is due a production problem at one of the world’s largest manufacturing plants. It is predicted that this shortage will be severe and protracted with a resolution date in early 2016.
Meropenem is one of the broadest antibiotics used in medicine today. It has a wide spectrum of activity including gram positive pathogens (Streptococcus species, Methicillin sensitive Staphylococci), gram negative pathogens ( Pseudomonas aeruginosa, Acinetobacter sp, ESBL producing bacteria [i.e. E. coli, K. pneumoniae, Proteus sp], Citrobacter sp, Serratia sp, Enterobacter sp) and almost all clinically significant anaerobes (Bacteriodies sp, Prevotella sp).
At this point, we are not restricting use beyond current practice or changing our formulary carbapenem. Instead, the clinical pharmacy program at the facility will be reviewing each order of meropenem for appropriateness and communicating with providers for change in agent if clinically appropriate.
In general, empiric meropenem should be reserved for the patients with1
- Patients with the highest severity of illness (i.e. ICU admission, mechanical ventilation, vasopressors)
- presence of >1 risk factors for MDR pathogens
- previous history of MDR pathogens
- patients with all of the above in addition to severe allergy to penicillin
Keep in mind, there are other alternatives for nosocomial pathogens including Pseudomonas that can be substituted based on clinical situation (piperacillin-tazobactam, cefepime). Please consult the inpatient pharmacy for further recommendations.
For definitive use, the following situations will be considered appropriate due to the following:
Severe infections (i.e. bacteremia, pneumonia, intra-abdominal abscesses, meningitis, osteomyelitis) due to:
- ESBL producing pathogens (i.e. E.coli, Klebsiella pneumonia) causing)
- Multidrug resistant pathogens (highly resistant Pseudomonas, Acinetobacter baumannii, Serratia sp, Proteus sp, Citrobacter sp, Enterobacter sp, etc)
We understand that there will be situations where there is no substitute for meropenem. Our hope is that with enhanced stewardship of meropenem early in the shortage period, we will be able to keep a supply of drug for patients who truly need it through the busy winter season. However, as time goes on, we may have to consider restricting meropenem further based on supply.