Meropenem
| Evidence Level: L4 | Predicted Indications: 7 |
Table of Contents
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 predicts it may be effective for bacterial arthritis, but no clinical trials are registered for this use. The 19 publications retrieved are mostly case reports, retrospective cohorts, susceptibility surveys and laboratory studies, so this is indirect, low-level evidence.
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 |
| India Market Status | Listed in a compiled Indian medicine price dataset (at least 20) – CDSCO approval status is not included in this data |
| Number of Listed Products | at least 20 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the data compiled for this report. Meropenem is a carbapenem, a class that kills bacteria by binding penicillin-binding proteins and blocking cell wall synthesis. Its efficacy in serious Gram-negative and mixed bacterial infections is established, and mechanistically it may be applicable to joint infections caused by susceptible organisms.
Bacterial arthritis is also a bacterial infection, so the new indication is close to meropenem’s original uses. The literature supports this plausibility indirectly:
- In a retrospective review of musculoskeletal melioidosis (22 cases), all isolates were susceptible to meropenem.
- Two cases of septic arthritis due to ESBL-producing Klebsiella pneumoniae were treated successfully with meropenem plus amikacin and early arthroscopic washout.
This is a plausible mechanistic link rather than demonstrated clinical benefit. No registered trial tests meropenem in bacterial arthritis, and the evidence consists of reports in specific pathogens and settings.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
No randomised trials or meta-analyses were found for this indication. The table lists the most relevant publications, with case-level and observational data ranked first.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 35146367 | 2021 | Retrospective cohort | Le Infezioni in Medicina | Characterised patients with osteoarticular melioidosis, a rare form of bone and joint involvement |
| 39489417 | 2024 | Retrospective review | Indian J Med Microbiol | 22 culture-confirmed musculoskeletal melioidosis cases (9 septic arthritis, 12 osteomyelitis, 4 both); all isolates meropenem-susceptible |
| 36678359 | 2022 | Review | Pathogens | Antibiotic versus phage therapy options for melioidosis, a condition that can cause localised abscesses and joint disease |
| 36804370 | 2023 | Review | Int J Antimicrob Agents | Off-label use versus formal recommendations of antibiotics for multidrug-resistant bacterial infections |
| 17433752 | 2007 | Case report | Joint Bone Spine | Two immunocompromised adults with ESBL Klebsiella pneumoniae septic arthritis treated successfully with meropenem plus amikacin and arthroscopic washout |
| 39380073 | 2024 | Case report | J Med Case Rep | Disseminated melioidosis with septic arthritis, initially misdiagnosed as tuberculosis |
| 38375100 | 2024 | Case report | Infect Drug Resist | Suppurative meningitis complicated by arthritis due to Streptococcus suis |
| 39193962 | 2024 | Cohort | Clin Lab | Pathogen distribution and antimicrobial resistance in bone and joint infections in children under four |
| 37713001 | 2024 | Antibiogram study | Eur J Orthop Surg Traumatol | Antibiogram to guide empiric antibiotic choice in non-spinal orthopaedic infections, including septic arthritis |
| 33857030 | 2021 | In vitro study | J Bone Joint Surg Am | Thermal stability and elution of meropenem and other antibiotics from PMMA bone cement |
India Market Information
Meropenem has 20 valid single-ingredient registrations, all injectable. The table lists five of them.
| Authorization Number | Product Name | Dosage Form | Manufacturer |
|---|---|---|---|
| Registration No. 248135 | Zaxter 125mg Injection | Vial of 1 ml injection | Alkem Laboratories Ltd |
| Registration No. 159280 | Nosopenam 1gm Injection | Vial of 1 injection | Wockhardt Ltd |
| Registration No. 10767 | Azopen 1000mg Injection | Vial of 1 injection | RPG Life Sciences Ltd |
| Registration No. 146279 | Meroclass 1000mg Injection | Vial of 1 injection | Impact Healthcare Pvt Ltd |
| Registration No. 136204 | Merocrit Baby 125mg Injection | Vial of 5 ml injection | Cipla Ltd |
Safety Considerations
- Disease associations flagged in the knowledge graph (not taken from label text): epilepsy, kidney disease, pyoureter, thrombocytopenia, Clostridium difficile colitis, and perinatal necrotizing enterocolitis.
- Drug interactions: 14 interactions were identified.
- 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 label-based warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction score is very high (0.9992), but the supporting evidence is indirect: no registered trials, and literature limited to case reports, retrospective series, susceptibility surveys and laboratory studies. Meropenem is also a reserve carbapenem, so stewardship considerations argue against broad use for joint infections without stronger evidence.
To proceed, the following is needed:
- Clinical data in bacterial arthritis, such as prospective or comparative studies versus standard therapy, ideally pathogen-specific (for example ESBL-producing Enterobacterales or melioidosis).
- Label-based warnings and contraindications from the India package insert, plus detailed mechanism of action data.
- Joint and bone penetration and dosing data, and a stewardship plan defining the patients for whom a carbapenem is justified.
Note: another predicted indication for meropenem, complicated urinary tract infection, has considerably stronger evidence (several completed Phase 3 trials, mostly with meropenem as comparator or in combination with vaborbactam). It may merit separate evaluation.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.