Meropenem
| Evidence Level: L4 | Predicted Indications: 7 |
Table of Contents
- Meropenem
Meropenem: Bacterial arthritis
One-Sentence Summary
Meropenem is a broad-spectrum carbapenem antibiotic, originally used for serious bacterial infections such as Pseudomonas aeruginosa infection, bacterial meningitis and peritonitis. The TxGNN model’s top prediction is bacterial arthritis, but the evidence for this is indirect: 0 registered clinical trials and 19 publications, mostly case reports, reviews and susceptibility studies. Among the ten predicted indications, the strongest evidence is for urinary tract infection (9 clinical trials, 20 publications), which is covered at the end of this report.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Bacterial arthritis |
| TxGNN Prediction Score | 0.9992 |
| Evidence Level | L4 |
| Canada Market Status | Marketed (marketed DINs: 16 of 16) |
| Number of DINs | 16 (marketed: 16) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Based on known pharmacology, meropenem is a carbapenem that inhibits bacterial cell wall synthesis by binding penicillin-binding proteins. Its efficacy in serious Gram-negative and Gram-positive infections is established.
Bacterial arthritis (septic arthritis) is caused by organisms that meropenem often covers, including Enterobacterales and some streptococci. The supporting literature is indirect:
- Melioidosis cohorts with osteoarticular involvement, where all isolates were meropenem-susceptible
- A case report of ESBL-producing Klebsiella pneumoniae septic arthritis treated successfully with meropenem plus amikacin
- Pharmacokinetic and tissue penetration studies, and in vitro bone cement elution work
There are no registered trials for this indication. Narrower-spectrum agents are normally preferred where the pathogen is susceptible, so meropenem’s role would be as a reserve option for resistant or polymicrobial disease.
Clinical Trial Evidence
Currently no related clinical trials registered for bacterial arthritis.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 11869242 | 1997 | Review | Clin Microbiol Infect | Overview of sepsis definitions and antibiotic therapy |
| 36804370 | 2023 | Review | Int J Antimicrob Agents | Off-label versus formally recommended antibiotics for multidrug-resistant bacterial infections |
| 36678359 | 2022 | Review | Pathogens | Antibiotics versus phage therapy for melioidosis |
| 35146367 | 2021 | Cohort | Le Infezioni in Medicina | Retrospective cohort of osteoarticular melioidosis |
| 39489417 | 2024 | Retrospective review | Indian J Med Microbiol | 22 musculoskeletal melioidosis cases; all isolates susceptible to meropenem |
| 17433752 | 2007 | Case report | Joint Bone Spine | ESBL Klebsiella septic arthritis treated successfully with meropenem and amikacin plus arthroscopic washout |
| 39380073 | 2024 | Case report | J Med Case Rep | Disseminated melioidosis with septic arthritis, initially misdiagnosed |
| 38375100 | 2024 | Case report | Infect Drug Resist | Suppurative meningitis with arthritis due to Streptococcus suis |
| 37713001 | 2024 | Antibiogram study | Eur J Orthop Surg Traumatol | Antibiogram for empiric therapy of orthopaedic infections including septic arthritis |
| 33857030 | 2021 | In vitro | J Bone Joint Surg Am | Thermal stability and elution of meropenem and other antibiotics in bone cement |
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02378787 | Meropenem for Injection | Not listed | Not listed |
| 02544334 | Meropenem for Injection USP and Sodium Chloride Injection USP | Not listed | Not listed |
| 02415224 | Meropenem for Injection, USP | Not listed | Not listed |
| 02421526 | Taro-Meropenem | Not listed | Not listed |
| 02554151 | Vabomere (meropenem-vaborbactam) | Not listed | Not listed |
All 16 authorizations are valid products; the table lists five of them.
Safety Considerations
- Contraindication-related conditions (from the knowledge graph, not label text): epilepsy, kidney disease, pyoureter, thrombocytopenia, Clostridium difficile colitis, perinatal necrotizing enterocolitis
- Drug Interactions: 14 interactions recorded.
- Major: bupropion, iohexol, iopamidol
- Moderate: picosulfuric acid, polyethylene glycol (3350 with electrolytes), nitisinone, sodium sulfate, lindane, ethinylestradiol, alpelisib, encorafenib, mycophenolic acid, pemetrexed, teriflunomide
Please refer to the package insert for warnings and contraindications.
Other Predicted Indications
| Rank | Indication | Score | Evidence Level | Decision | Comment |
|---|---|---|---|---|---|
| 1 | Bacterial arthritis | 0.9992 | L4 | Hold | Indirect evidence only |
| 2 | Epiglottitis | 0.9991 | L4 | Hold | Case reports; narrower agents are first-line |
| 4 | Laryngitis | 0.9959 | L5 | Hold | Mostly viral; literature unrelated |
| 5 | Paratyphoid fever | 0.9957 | L4 | Hold | Reserve option for XDR enteric fever; surveillance data only |
| 7 | Lyme disease | 0.9946 | L5 | Hold | In vitro data only |
| 9 | Gonococcal urethritis | 0.9933 | L5 | Hold | No clinical data; ceftriaxone established |
| 10 | Ureaplasma urethritis | 0.9933 | L5 | Hold | No cell wall, so likely a false positive |
Strongest Evidence: Urinary Tract Infection
Clinical trials (9 of 10 are shown; the 10th is listed for completeness in the registry data but is a Phase 1 PK study)
| Trial Number | Phase | Status | Enrollment | Key Findings |
|---|---|---|---|---|
| NCT03840148 | Phase 3 | Completed | 661 | Cefepime/VNRX-5133 versus meropenem in complicated UTI |
| NCT03477422 | Phase 3 | Completed | 230 | CSE-1034 versus meropenem in ESBL/MBL gram-negative infections including cUTI |
| NCT03891433 | Phase 4 | Suspended | 198 | Piperacillin/tazobactam versus carbapenems in ESBL UTI |
| NCT02142751 | Phase 3 | Completed | 161 | Fosfomycin versus meropenem or ceftriaxone in bacteraemic multidrug-resistant E. coli UTI |
| NCT03230838 | Phase 2 | Completed | 134 | Ceftolozane/tazobactam versus meropenem in paediatric cUTI |
| NCT01970371 | Phase 3 | Completed | 69 | Plazomicin versus colistin (with meropenem or tigecycline) in carbapenem-resistant Enterobacteriaceae infections |
| NCT03543436 | Phase 3 | Completed | 29 | Temocillin versus a carbapenem in ESBL UTI |
| NCT03174795 | Phase 1 | Completed | 20 | Pharmacokinetics of RO7079901 with meropenem in cUTI |
| NCT00771316 | Phase 3 | Terminated | 6 | MK0826 versus meropenem in cUTI; uninformative |
Meropenem is mostly the comparator in these trials, so arm-specific results should be confirmed.
Key literature
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 29486041 | 2018 | RCT | JAMA | TANGO I: meropenem-vaborbactam versus piperacillin-tazobactam in cUTI |
| 30270406 | 2018 | RCT | Infect Dis Ther | TANGO II: meropenem-vaborbactam versus best available therapy in CRE infections |
| 33058798 | 2021 | RCT | Lancet Infect Dis | Cefiderocol versus high-dose extended-infusion meropenem in nosocomial pneumonia |
| 32094128 | 2020 | Cohort | Antimicrob Agents Chemother | Meropenem-vaborbactam versus ceftazidime-avibactam in CRE infections |
| 39817442 | 2025 | Network meta-analysis | J Comp Eff Res | Treatment options for cUTI and acute pyelonephritis |
| 18416587 | 2008 | Review | Drugs | Review of meropenem in serious bacterial infections |
Conclusion and Next Steps
Decision: Hold (for the top-ranked indication, bacterial arthritis)
Rationale:
- The prediction is mechanistically plausible, but support is limited to case reports, cohort data and susceptibility studies. There are no registered trials, so the evidence level is L4.
- Urinary tract infection is the only predicted indication with strong evidence (L1, Proceed with Guardrails), but it is largely an established use and the evidence comes mostly from comparator-arm data.
To proceed, the following is needed:
- Health Canada package insert warnings and contraindications (a blocking gap for safety screening)
- Detailed mechanism of action data
- For urinary tract infection: meropenem-specific arm results from each trial, restriction to documented or suspected resistant pathogens, and carbapenem stewardship
- For bacterial arthritis: comparative clinical data or bone and joint penetration studies before any further consideration
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.