HEPATOTOXICITY OF MEROPENEM
Meropenem is a broad-spectrum carbapenem antibiotic used in cases of severe infections caused by susceptible bacteria. However, meropenem is also a common cause of mild transient increases in aminotransferases and rarely can lead to clinically apparent cholestatic liver injury. This article will provide additional information on the hepatotoxicity of meropenem to serve as a basis for considering its use and monitoring patients clinically.
1. Risk of hepatic toxicity of meropenem
Elevated serum aminotransferase levels have been reported in 1% to 6% of patients receiving intravenous meropenem for up to 14 days. This increase is usually transient, mild, asymptomatic, and rarely requires dose adjustment. Meropenem has also been associated with some rare cases of cholestatic jaundice, typically occurring 1 to 3 weeks after treatment initiation. Immune-mediated allergic features may appear, but are often nonspecific. Autoantibody reactions are very rare. Most cases are mild and self-resolving; however, there has been a reported case of cholangitis associated with meropenem in a 60-year-old patient. Meropenem has not been reported to cause acute liver failure and is considered a rare cause of clinically apparent liver injury.
The cause of mild, transient liver enzyme elevation during meropenem treatment remains unclear. The rare occurrence of cholestatic hepatitis due to carbapenems may be due to an immune-mediated mechanism and is similar to penicillin and cephalosporin.
2. Consequences and management
Liver injury due to meropenem is usually mild and self-resolving.Rarely, meropenem and other carbapenems can cause clinically apparent and prolonged cholestatic hepatitis that may lead to vanishing bile duct syndrome. In patients with vanishing bile duct syndrome, corticosteroids are often used, but their benefits have not been proven and should ideally be avoided. Some patients may benefit from symptomatic treatment of itching related to cholestasis with antihistamines, ursodiol, or cholestyramine. There is very little information on cross-sensitivity with liver injury among different beta-lactam antibiotics, but patients with clinically apparent liver injury due to meropenem should probably avoid re-exposure to the drug as well as other carbapenems.
Source of information: Meropenem, LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Medline (Access link: https://www.ncbi.nlm.nih.gov/books/NBK547861/, accessed on 11/10/2025)
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