Varnem injection is used to treat infections caused by bacteria. It works by killing the bacteria or preventing their growth. Varnem will not work for colds, flu, or other virus infections.
Varnem is to be given only by or under the direct supervision of your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Varnem is used in certain patients with the following medical condition:
Febrile neutropenia (treatment).
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Varnem I.V. and other antibacterial drugs, Varnem I.V. should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Varnem I.V. is useful as presumptive therapy in the indicated condition (e.g., intra-abdominal infections) prior to the identification of the causative organisms because of its broad spectrum of bactericidal activity.
For information regarding use in pediatric patients [seeIndications and Usage (1.1), (1.2), (1.3), Dosage and Administration (2.3), Adverse Reactions (6.1), andClinical Pharmacology (12.3)].
Skin and Skin Structure Infections (Adult Patients and Pediatric Patients 3 Months of Age and Older Only)
Varnem I.V. is indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species.
Intra-abdominal Infections (Adult and Pediatric Patients)
Varnem I.V. is indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species.
Bacterial Meningitis (Pediatric Patients 3 Months of Age and Older Only)
Varnem I.V. is indicated as a single agent therapy for the treatment of bacterial meningitis caused by Streptococcus pneumoniae‡, Haemophilus influenzae, and Neisseria meningitidis.
‡ The efficacy of Varnem as monotherapy in the treatment of meningitis caused by penicillin nonsusceptible isolates of Streptococcus pneumoniae has not been established.
Varnem I.V. has been found to be effective in eliminating concurrent bacteremia in association with bacterial meningitis.
How should I use Varnem?
Use Varnem as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Varnem is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Varnem at home, a health care provider will teach you how to use it. Be sure you understand how to use Varnem. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
Do not use Varnem if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
To clear up your infection completely, use Varnem for the full course of treatment. Keep using it even if you feel better in a few days.
Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
If you miss a dose of Varnem, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
Ask your health care provider any questions you may have about how to use Varnem.
Uses of Varnem in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Use: Labeled Indications
Intra-abdominal infections: Treatment of complicated appendicitis and peritonitis in adult and pediatric patients caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, Bacteroides thetaiotaomicron, and Peptostreptococcus species.
Meningitis, bacterial: Treatment of bacterial meningitis in pediatric patients 3 months and older caused by Haemophilus influenzae, Neisseria meningitidis, and penicillin-susceptible isolates of Streptococcus pneumoniae.
Skin and skin structure infection, complicated: Treatment of complicated skin and skin structure infections in adults and pediatric patients 3 months and older caused by Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), P. aeruginosa, E. coli, Proteus mirabilis, B. fragilis, and Peptostreptococcus species.
Off Label Uses
Based on the Centers for Disease Control and Prevention (CDC) expert panel meetings on prevention and treatment of anthrax, Varnem is an effective and recommended agent for the treatment of anthrax meningitis and an effective and recommended alternative agent for systemic anthrax.
Bite wound infection, treatment, animal or human bite
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTIs), Varnem is an effective and recommended alternative agent for treatment of animal or human bite wounds.
Bloodstream infection (gram-negative bacteremia)
Based on the IDSA guidelines for the diagnosis and management of intravascular catheter-related infection, Varnem is effective and recommended in the management of catheter-related bloodstream infection.
Clinical experience also suggests the utility of Varnem for the treatment of bloodstream infection caused by gram-negative pathogens, including Pseudomonas aeruginosa.
The chemical name of Varnem trihydrate is -Azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid, 3-[[5-[(dimethylamino)carbonyl]-3-pyrrolidinyl]thio]-6-(1-hydroxyethyl)-4-methyl-7-oxo, trihydrate, [4R-[3(3S*,5S*),4α,5β,6β(R*)]]-.(4R,5S,6S)-3-[[(3S,5S)-5-(Dimethylcarbamoyl)-3-pyrrolidinyl]thio] -6-[(1R)-1-hydroxyethyl]-4-methyl-7-oxo-1-azabicyclo[3.2.0]hept-2-ene-carboxylic acid, trihydrate. The molecular formula of Varnem trihydrate is C17H25N3O5S·3H2O and its CAS number is 119478-56-7.
DBL Varnem for Injection is presented as a sterile white to pale yellow crystalline powder containing Varnem trihydrate equivalent to Varnem, 500 mg or 1 g, blended with sodium carbonate anhydrous. DBL Varnem for Injection contains 208 mg sodium carbonate anhydrous and 90.2 mg of sodium for each gram of Varnem (anhydrous potency). It contains no antimicrobial preservative and is for use in one patient on one occasion only..
Adults: The recommended dose of Varnem injection of 500 mg is given every 8 hours for a skin and skin structure infections when treating infections caused by Pseudomonas aeruginosa, dose of 1 gram every 8 hours is recommended, and 1 gram given every 8 hours for intra-abdominal infections. Varnem injection should be administered by intravenous infusion over approximately 15 to 30 minutes. Doses of 1 gram every 8 hours may also be administered as an intravenous bolus injection (5 to 20 mL) over approximately 3-5 minutes.
Renal Impairment:Dosage should be reduced in patients with creatinine clearance less than 51 mL/min.
When only serum creatinine is available, the following formula (Cockroft and Gault equation) may be used to estimate creatinine clearance.
There is inadequate information regarding the use of Varnem in patients on hemodialysis. There is no experience with peritoneal dialysis.
Hepatic Impairment: No dosage adjustment is necessary in patients with impaired hepatic function.
Elderly: No dosage adjustment is required for elderly patients with creatinine clearance values above 50 mL/min.
Children: For pediatric patients from 3 months of age and older, the Varnem injection, dose is 10, 20 or 40 mg/kg every 8 hours (maximum dose is 2 g every 8 hours), depending on the type of infection (complicated skin and skin structure infections, intra-abdominal or meningitis). Pediatric patients weighing over 50 kg should be administered Varnem injection at a dose of 500 mg every 8 hours for complicated skin and skin structure infections, 1 g every hour for intra-abdominal infections and 2 g every 8 hours for meningitis. Varnem injection, should be given as intravenous infusion over approximately 15 to 30 minutes or as an intravenous bolus injection (5 to 20 mL) infusion over approximately 3-5 minutes. There is limited safety data available to support the administration of a 40 mg/kg (up to a maximum of 2 g) bolus dose.
Probenecid competes with Varnem for active tubular secretion and thus inhibits the renal excretion, with the effect of increasing the elimination half-life and plasma concentration of Varnem. As the potency and duration of action of Varnem dosed without probenecid are adequate, the co-administration of probenecid with Varnem is not recommended.
The potential effect of Varnem on the protein-binding of other drugs or metabolism has not been studied. The protein binding of Varnem is low (approximately 2%) and, therefore, no interactions with other compounds based on displacement from plasma proteins would be expected.
Varnem may reduce serum valproic acid levels. Subtherapeutic levels may be reached in some patients.
Varnem has been administered concomitantly with other medications without adverse pharmacological interactions. However, no specific data regarding potential drug interactions is available (apart from probenecid as previous;y mentioned).
Decreases in blood levels of valproic acid have been reported when it is co-administered with carbapenem agents resulting in a 60-100% decrease in valproic acid levels in about 2 days. Due to the rapid onset and the extent of the decrease, co-administration of Varnem in patients stabilised on valproic acid is not considered to be manageable and therefore should be avoided.
Simultaneous administration of antibiotics with warfarin may augment its anticoagulant effects. There have been many reports of increases in the anticoagulant effects of orally administered anticoagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents. The risk may vary with the underlying infection, age and general status of the patient so that the contribution of the antibiotic to the increase in international normalised ratio (INR) is difficult to assess. It is recommended that the INR should be monitored frequently during and shortly after co-administration of antibiotics with an oral anticoagulant agent.
Incompatibilities: Varnem must not be mixed with other medicinal products except those mentioned in Cautions for Usage.
Adult Patients: During reported clinical investigations, 2,904 immunocompetent adult patients were treated for infections outside the CNS with Varnem (500 or 1,000 mg every 8 hrs). Deaths in 5 patients were assessed as possibly related to Varnem; 36 patients (1.2%) had Varnem discontinued because of adverse events. Many patients in these reported trials were severely ill and had multiple background diseases, physiological impairments, and were receiving multiple other drug therapies in the seriously ill patient population, it was not possible to determine the relationship between observed adverse events and therapy with Varnem.
Local Adverse Reaction: Local adverse reactions that were reported irrespective of the relationship to therapy with Varnem were as follows: Inflammation at the injection site (2.4%), injection site reaction (0.9%), phlebitis/thrombophlebitis (0.8%), pain at the injection site (0.4%), edema at the injection site (0.2%).
Systemic Adverse Reactions: Systematic adverse clinical reactions that were reported irrespective of the relationship to Varnem occurring in >1% of the patients were diarrhea (4.8%), nausea/vomiting (3.6%), headache (2.3%), rash (1.9%), sepsis (1.6%), constipation (1.4%), apnea (1.3%), shock (1.2%) and pruritus (1.2%).
Additional adverse systemic clinical reactions that were reported irrespective of relationship to therapy with Varnem and occurring in ≤1% but >0.1% of the patients are listed as follows within each body system in order of decreasing frequency: Bleeding Events were Seen as Follows: Gastrointestinal hemorrhage (0.5%), melena (0.3%), epistaxis (0.2%), hemoperitoneum (0.2%), summing to 1.2%.
Body as a Whole: Pain, abdominal pain, chest pain, fever, back pain, abdominal enlargement chills, pelvic pain.
Adverse Laboratory Changes: Adverse Laboratory Changes that were Reported Irrespective of Relationship to Varnem and Occurring in >0.2% of the Patients Were as Follows: Hepatic: Increased serum glutamic-pyruvic transaminase (SGPT), alanine transaminase (ALT), serum glutamic-oxaloacetic transaminase (SGOT), aspartate transaminase (AST), alkaline phosphatase, lactate dehydrogenase (LDH), and bilirubin. Hematologic increased platelets, increased eosinophils, decreased platelets, decreased hemoglobin, decreased hematocrit, decreased whole blood count (WBC), shortened prothrombin time and shortened partial thromboplastin time, leukocytosis, hypokalemia.
Urinalysis: Presence of red blood cells.
Renal: Increased creatinine and increased blood urea nitrogen (BUN).
Note: For patients with varying degrees of renal impairment, the incidence of head failure, kidney failure, seizure and shock reported irrespective of relationship to Varnem increased in patients with moderately severe renal impairment CrC >10-26 mL/min.
Complicated Skin and Skin Structure Infection: In a reported study of complicated skin and skin structure infection, the type of clinical adverse reactions were similar to those listed as mentioned previously. The patients with the most common adverse events with an incidence of >5% were: Headache (7.8%), nausea (7.8%), constipation (7%), diarrhea (7%), anemia (5.5%) and pain (5.1 %). Adverse events with an incidence of >1%, and not listed as mentioned previously, include: Pharyngitis, accidental injury gastrointestinal disorder; hypoglycemia; peripheral vascular disorder and pneumonia.
Pediatric Patients: Varnem was studied in 515 pediatric patients (>3 months to <13 years) with serious bacterial infections (excluding meningitis) at dosages of 10-20 mg/kg every 8 hrs. The types of clinical adverse events seen in these patients are similar to the adults, with the most common adverse events reported as possibly, probably or definitely related to Varnem and their rates of occurrence as follows: Diarrhea (3.5%), rash (1.6%), nausea and vomiting (0.8%).
Meropem was studied in 321 pediatric patients (>3 months to <17 years) with meningitis at a dosage of 40 mg/kg every 8 hrs. The types of clinical adverse events seen in these patients are similar to the adults, with the most common adverse events reported as possibly, probably or definitely related to Varnem and their rates of occurrence as follows: Diarrhea (4.7%), rash (most diaper area moniliasis) (3.1%), oral moniliasis (1.9%), glossitis (1%).
In the meningitis studies the rates of seizure activity during therapy were comparable between patients with no CNS abnormalities who received Varnem and those who received comparator agents (either cefotaxime or ceftriaxone). In the Varnem treated group, 12/15 patients with seizures had late onset seizures (defined as occurring or later) versus 7,120 in the comparator arm.
Adverse Laboratory Changes: Laboratory abnormalities seen in the pediatric-aged patients in both the pediatric and the meningitis studies are similar to those reported in adult patients. There is no experience in pediatric patients with renal impairment.
Post-Marketing Experience: World wide post-marketing adverse events not previously listed in the product label and reported as possibly, probably or definitely drug related are listed within each body system in order of decreasing severity.
Hematology: Agranulocytosis, neutropenia and leukopenia; a positive Coombs' test and hemolytic anemia toxic epidermal necrolysis, Stevens-Johnson syndrome (SJS), angioedema and erythema multiform.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For Varnem, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to Varnem or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
DailyMed. "MEROPENEM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
The results of a survey conducted on ndrugs.com for Varnem are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Varnem. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.
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