Meropenem Associated Prolonged Cholestasis in the Newborn: A Report of Two Cases

Abstract

Meropenem is one of the new carbapenem antibacterial agent with wide spectrum of activity against Gram-negative, Gram-positive and anerobic organisms. It has greatest utility in the treatment of children hospitalized with serious bacterial infections. Despite its usefulness and relative safety, adverse events have been documented with an overall incidence of 1%. We report two cases of cholestasis in neonates of gestational ages 36 weeks and 32 weeks respectively who had septicaemia and received meropenem for 14 days. These infants developed cholestasis and deranged liver transaminases several days after the discontinuation of therapy with meropenem. Meropenem has also been linked to rare cases of cholestatic jaundice that usually arises after 1 to 3 weeks of therapy. Most cases are mild and self-limited, but at least one instance of vanishing bile duct syndrome related to meropenem therapy has been published. Aims/Objectives: This report is to create awareness about this uncommon adverse effect of meropenem. This is also important because of the increasing use of drugs such as meropenem as a result of the problem of increasing resistance of microorganisms to commonly used antibiotics. Methods: A descriptive report of the cases. Results: Both neonates developed cholestasis with deranged liver enzymes. Resolution occurred gradually over six weeks. Conclusion: Meropenem remains a useful antimicrobial agent in the treatment of severe infections with a good safety profile. However, it must be noted that although the liver injury due to this drug may be mild and self-limiting, it may also cause a clinically apparent and protracted cholestatic hepatitis that is self-limiting but may lead to vanishing bile duct syndrome.