Meropenem Use and Challenges in Treating Severe Infections in Pakistan Amid Antimicrobial Resistance

Meropenem is a broad-spectrum carbapenem antibiotic essential for treating serious infections including urinary tract infections, pneumonia, sepsis, and meningitis. This narrative review examines meropenem resistance trends and prescribing practices for severe infections in Pakistan highlighting how inappropriate use drives local antimicrobial resistance. Relevant literature was identified through a structured search of PubMed, Scopus, Web of Science, and Google Scholar using predefined keywords. Antimicrobial resistance (AMR) is a global health crisis that complicates treatment of infections caused by multidrug-resistant Gram-negative pathogens, including Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli. Pharmacokinetic studies of meropenem show extensive tissue penetration, time-dependent bactericidal activity, and rapid renal clearance, which contribute to its effectiveness. In critically ill patients, specialized dosing strategies like continuous or extended infusions are recommended to maintain adequate drug levels. Emerging evidence also supports combination therapies (e.g., pairing meropenem with fosfomycin) to improve outcomes against carbapenem-resistant strains. In Pakistan, these concerns are especially acute: many key pathogens show high resistance rates due to widespread antibiotic overuse and misuse. Regional surveillance indicates that E. coli often remains relatively sensitive to meropenem, whereas Acinetobacter species exhibit alarmingly low susceptibility. Such resistance largely stems from the spread of extended-spectrum beta-lactamases (ESBLs) and carbapenemase-producing organisms, posing serious challenges to clinicians. This underscores the need for data-driven, context-specific strategies to guide therapy. Robust surveillance systems are needed to guide empirical therapy, and real-time resistance monitoring can help prevent treatment failures. The review emphasizes targeted antimicrobial strategies and judicious meropenem use. Ongoing education for healthcare providers and coordinated stewardship programs at local and national levels are also essential to preserve the antibiotic's clinical utility. Ultimately, sustaining meropenem's effectiveness in the face of rising AMR requires combined public health efforts, including tailored dosing protocols and localized resistance management, to keep meropenem a reliable option worldwide for treating life-threatening infections.