Meropenem

Drug overview for MEROPENEM (meropenem):

Generic name: MEROPENEM (MER-oh-PEN-em)
Drug class: Beta-Lactams
Therapeutic class: Anti-Infective Agents

Meropenem is a synthetic carbapenem beta-lactam antibiotic

Meropenem should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria to reduce the development of drug resistance and maintain the effectiveness of meropenem. When available, culture and susceptibility patterns should be considered in selecting or modifying antibacterial therapy. Local epidemiology and susceptibility patterns may contribute to empiric selection of antibiotic therapy in the absence of culture and susceptibility data.

DRUG IMAGES

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The following indications for MEROPENEM (meropenem) have been approved by the FDA:

Indications:
Bacterial meningitis
Bacteroides complicated appendicitis
Bacteroides peritonitis
Complicated appendicitis
Complicated skin and skin structure infection
E. coli complicated appendicitis
E. coli peritonitis
H. influenzae meningitis
Infectious disease of abdomen
Intra-abdominal abscess
Klebsiella complicated appendicitis
Klebsiella pneumoniae peritonitis
Meningococcal meningitis
Peptostreptococcus complicated appendicitis
Peptostreptococcus peritonitis
Peritonitis
Pneumococcal meningitis
Pseudomonas aeruginosa complicated appendicitis
Pseudomonas aeruginosa peritonitis
Streptococcal meningitis
Streptococcal peritonitis
Streptococcus complicated appendicitis

Professional Synonyms:
Abdominal abscess
Complicated appendicitis due to bacteroides species
Complicated appendicitis due to E. coli
Complicated appendicitis due to Escherichia coli
Complicated appendicitis due to Klebsiella species
Complicated appendicitis due to Peptostreptococcus
Complicated appendicitis due to Pseudomonas aeruginosa
Complicated appendicitis due to Streptococcus species
Complicated bacterial skin and skin structure infection
Complicated skin and skin soft tissue infection
Complicated skin and skin structure bacterial infection
H. flu meningitis
Haemophilus influenzae meningitis
Influenzae Bacillus meningitis
Intra-abdominal infection
Meningitis due to Haemophilus influenzae
Meningitis due to Hemophilus influenzae
Peritonitis due to Bacteroides
Peritonitis due to Escherichia coli
Peritonitis due to Klebsiella pneumoniae
Peritonitis due to Peptostreptococcus
Peritonitis due to Pseudomonas aeruginosa
Peritonitis due to Streptococcus species
Pfeiffer's Bacillus meningitis
Streptococcus pneumoniae meningitis

The following dosing information is available for MEROPENEM (meropenem):

Dosing
Administration
MEROPENEM
MEROPENEM

For direct intermittent IV injection, add 10 or 20 mL of sterile water for injection to a vial labeled as containing 500 mg or 1 g, respectively, of meropenem to provide a solution containing approximately 50 mg/mL. Shake the vial until dissolution occurs and allow the vial to stand until the solution is clear. Reconstituted solutions should be used promptly, but may be stored for up to 3 hours at 25degreesC or up to 13 hours at 5degreesC.

For IV infusion, add 10, 20, or 40 mL of sterile water for injection to a vial labeled as containing 500 mg, 1 g, or 2 g, respectively, of meropenem to provide a solution containing approximately 50 mg/mL. Shake well to dissolve and allow the vial to stand until the solution is clear. Add the appropriate amount of reconstituted solution to an IV container and further dilute with a compatible IV solution.

Alternatively, vials labeled as containing 500 mg or 1 g of meropenem may be reconstituted directly with a compatible IV solution. Solutions for IV infusion ranging in concentration from 1-20 mg/mL reconstituted with sodium chloride injection 0.9% may be stored for 1 hour at up to 25degreesC or 15 hours at up to 5degreesC (2 hours if a 2 g vial was used to prepare the solution).

Solutions for IV infusion ranging in concentration from 1-20 mg/mL reconstituted with 5% dextrose injection must be used immediately.

Meropenem is commercially available as the trihydrate; potency and dosage of the drug are expressed on the anhydrous basis.

Children weighing >50 kg should receive the usually recommended adult dosage of meropenem.

Meropenem is administered by IV injection or IV infusion. Safety data supporting the administration of a 40 mg/kg (up to a maximum of 2 g) dose via IV injection are limited; administration by IV infusion is recommended for these higher doses. Meropenem is available as a powder for injection in single-dose vials or with 0.9%

sodium chloride in single-dose, dual-chamber containers. The dual-chamber containers should only be used in patients requiring an entire 500 mg or 1 gram dose of meropenem and not any fraction thereof. Store vials of powder for injection at 20-25degreesC. Store unactivated dual-chamber units at 20-25degreesC (excursions permitted between 15-30degreesC); protect from freezing.

Dosing information for MEROPENEM
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
MEROPENEM IV 500 MG VIAL	Maintenance	Adults inject 1 gram over 3-5 minute(s) by intravenous route every 8 hours
MEROPENEM IV 1 GM VIAL	Maintenance	Adults infuse 1 gram over 15-30 minute(s) by intravenous route every 8 hours

Generic dosing information for MEROPENEM
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
MEROPENEM IV 500 MG VIAL	Maintenance	Adults inject 1 gram over 3-5 minute(s) by intravenous route every 8 hours
MEROPENEM IV 1 GM VIAL	Maintenance	Adults infuse 1 gram over 15-30 minute(s) by intravenous route every 8 hours

The following drug interaction information is available for MEROPENEM (meropenem):

Contraindicated
Severe
Moderate

There are 1 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction	Drug Names
Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)	VIVOTIF

Drug Interaction

Drug Names

Live Typhoid Vaccine/Antimicrobials

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)

CLINICAL EFFECTS: Vaccination may be ineffective.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)

DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)

VIVOTIF

There are 4 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Valproic Acid/Carbapenem Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. Carbapenems may inhibit the absorption of valproic acid from the gastrointestinal tract.(1-3) Meropenem may accelerate the renal excretion of valproate.(4) Carbapenems may increase valproic acid intake by erythrocytes.(5,6) Carbapenems may inhibit the metabolite of valproic acid, valproic acid-glucuronide, from being converted back into the active parent form.(7-9) CLINICAL EFFECTS: Concurrent use of carbapenems and valproic acid without supplemental antiepileptic therapy is not recommended because it results in rapid, significant reductions in serum levels of valproic acid to non-therapeutic levels which may result in seizures. Dose escalation of valproic acid formulations does not counteract the decrease in serum levels and patients will require additional antiepileptic therapy. The effects may persist for several days beyond discontinuation of the carbapenem. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid the use of carbapenem antibiotics in patients maintained on valproic acid when possible. If concurrent therapy is warranted, patients will require the addition of a supplemental anti-epileptic agent until valproic acid levels return to therapeutic range. DISCUSSION: In a retrospective review of an 18 month period, charts of 39 patients who received concurrent therapy with valproate and meropenem were examined. A pharmacokinetic interaction was observed in all 39 patients, with an average decrease in valproate levels of 66%. The decrease occurred within 24 hours of the initiation of concurrent therapy. Electroclinical deterioration was seen in 55% of patients.(10) A prospective study evaluated ICU patients given levetiracetam or valproic acid to control seizures. Twenty-four of the 35 patients required meropenem. Each patient that was on valproic acid had valproic acid levels decrease following the addition of meropenum. (13) In a study in 23 healthy male subjects, concurrent doripenem (500 mg every 8 hours) decreased the maximum concentration, (Cmax) area-under-curve (AUC), and minimum concentration (Cmin) of valproic acid by 44.5%, 63% and 77.7%, respectively.(14) There are several case reports of decreased valproic acid levels following the addition of meropenem to therapy.(4,11,12,15-21) Some patients experienced increased seizures.(4 ,11,15,16,20) In some cases, decreased levels persisted despite increased doses of valproic acid.(11,12,15,17,18,21) Others required additional anti-seizure medications during concurrent therapy.(16) Decreased valproic acid levels have also been reported during concurrent ertapenem.(22-25) Seizures were reported in two patients.(22,25) In one patient, valproic acid levels returned to therapeutic levels within three days of discontinuation of ertapenem, despite no change in valproic acid dose.(25) Decreased valproic acid levels have also been reported during concurrent imipenem.(26) A retrospective study evaluated 52 patients given valproic acid and a carbapenem over a five year period. Patients received either ertapenem, imipenem/cilastatin, or meropenem (9, 17, and 26 patients, respectively). The average serum valproic acid concentration before and after carbapenem use was 58.6 +/- 19.2 and 23.7 +/- 16.3 mg/dL, respectively, which represented a decrease of 60% +/- 23% (p<0.001). Valproic acid concentrations were reduced with both intravenous and oral formulations of valproic acid (52% +/- 16% and 61% +/-24%, respectively). Valproic acid serum concentrations were subtherapeutic (<50 mg/L) in 90% of patients during carbapenem concurrent use. Use during ertapenem, imipenem/cilastatin, and meropenem decreased valproic acid concentrations by 72% +/- 17%, 42% +/- 22%, and 67% +/- 19%, respectively.(28) A retrospective study in 54 patients treated with valproic acid for at least three months for seizure control were evaluated for changes in valproic acid with concurrent carbapenem therapy. The mean change in valproic acid levels was 80%, 68%, and 51% in the meropenem, ertapenem, and imipenem group, respectively. During concurrent therapy, 48.1% of patients experienced aggravation of seizures and 25.9% died. Valproic acid levels of those experiencing aggravation of seizures were 17.7 +/- 9.9 mcg/mL versus 17.9 +/- 12.6 mcg/mL in those without aggravation (p=0.944).(29) A retrospective study in 381 neurosurgery inpatients evaluated valproic acid levels with concurrent meropenem therapy. Patients were grouped based on valproic acid dose of 1.2 g/day or 1.6 g/day with and without meropenem. In both 1.2 g/day and 1.6 g/day valproic acid groups, valproic acid levels were decreased after initiation of meropenem (67.3 +/- 4.6 mcg/mL v. 15.3 +/- 1.9 mcg/mL; 78.2% decrease, p<0.001 for 1.2 g/day valproic acid; 67.6 +/- 1.2 mcg/mL v. 18.1 +/- 2.6 mcg/mL; 72.5% decrease, p<0.001 for 1.6 g/day valproic acid. Valproic acid concentrations recovered to levels comparable to valproic acid alone more than seven days after meropenem discontinuation.(30)	DEPAKOTE, DEPAKOTE ER, DEPAKOTE SPRINKLE, DIVALPROEX SODIUM, DIVALPROEX SODIUM ER, SODIUM VALPROATE, VALPROATE SODIUM, VALPROIC ACID
Doripenem; Meropenem/OAT3 Inhibitors SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inhibitors of organic anion transporter 3 (OAT3) may inhibit the renal excretion of doripenem (1) and meropenem(2) by competing with them for active tubular secretion. CLINICAL EFFECTS: Concurrent use of organic anion transporter 3 (OAT3) inhibitors may result in elevated levels of and toxicity from doripenem(1) or meropenem.(2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of doripenem states that concurrent use of organic anion transporter 3 (OAT3) inhibitors is not recommended.(1) The US manufacturer of meropenem states that concurrent use of OAT3 inhibitors is not recommended.(2) DISCUSSION: Probenecid has been shown to increase doripenem half-life (T1/2) and area-under-curve (AUC) by 53% and 75%, respectively.(1) In a study in six subjects, concurrent probenecid increased meropenem T1/2 by 33%.(3) Other studies have shown probenecid to increase the T1/2 of meropenem by 38% and the extent of meropenem systemic exposure by 58%.(2) OAT3 inhibitors linked to this monograph include: cabotegravir, leflunomide, nitisinone, probenecid, teriflunomide, and vadadustat.(4)	APRETUDE, ARAVA, AUBAGIO, CABENUVA, CABOTEGRAVIR ER (CABENUVA), HARLIKU, LEFLUNICLO, LEFLUNOMIDE, NITISINONE, NITYR, ORFADIN, ORLYNVAH, PROBENECID, PROBENECID-COLCHICINE, TERIFLUNOMIDE, VAFSEO, VOCABRIA
Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores.	VOWST
Fecal Microbiota/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota is a suspension of live bacteria, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota. Antibacterial treatment should be completed for 24 to 72 hours before initiating treatment with fecal microbiota. Do not use antibiotics for up to 8 weeks after fecal microbiota.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota.	REBYOTA

There are 0 moderate interactions.

The following contraindication information is available for MEROPENEM (meropenem):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

*Known hypersensitivity to meropenem, other carbapenems, or any ingredient in the formulation. *History of anaphylactic reaction to beta-lactams.

There are 0 contraindications.

There are 6 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Chronic kidney disease stage 3A (moderate) GFR 45-59 ml/min
Chronic kidney disease stage 3B (moderate) GFR 30-44 ml/min
Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
Chronic kidney disease stage 5 (failure) GFr<15 ml/min
Clostridioides difficile infection
Kidney disease with likely reduction in glomerular filtration rate (GFr)

There are 4 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Cerebral lesions
Lower seizure threshold
Seizure disorder
Thrombocytopenic disorder

The following adverse reaction information is available for MEROPENEM (meropenem):

Overview
Severe
Less Severe

Adverse reaction overview.

Adverse effects reported in <=2% of patients receiving meropenem include headache, nausea, constipation, diarrhea, anemia, vomiting, and rash.

There are 48 severe adverse reactions.

More Frequent	Less Frequent
Anemia	Apnea Injection site sequelae Shock

Rare/Very Rare
Abnormal hepatic function tests Acute generalized exanthematous pustulosis Acute myocardial infarction Agranulocytosis Anaphylaxis Angioedema Asthma Bradycardia Cardiac arrest Clostridioides difficile infection DRESS syndrome Drug-induced hepatitis Epistaxis Erythema multiforme Gastrointestinal hemorrhage Heart failure Hemolytic anemia Hepatic failure Hyperbilirubinemia Hypertension Hypotension Hypoxia Ileus Increased alanine transaminase Increased aspartate transaminase Kidney disease with reduction in glomerular filtration rate (GFr) Leukopenia Neutropenic disorder Nontraumatic hemoperitoneum Obstructive hyperbilirubinemia Pleural effusions Pulmonary edema Pulmonary thromboembolism Renal failure Rhabdomyolysis Seizure disorder Skin ulcer Stevens-johnson syndrome Syncope Tachycardia Thrombocytopenic disorder Thrombophlebitis Toxic epidermal necrolysis Urticaria

Rare/Very Rare

Abnormal hepatic function tests
Acute generalized exanthematous pustulosis
Acute myocardial infarction
Agranulocytosis
Anaphylaxis
Angioedema
Asthma
Bradycardia
Cardiac arrest
Clostridioides difficile infection
DRESS syndrome
Drug-induced hepatitis
Epistaxis
Erythema multiforme
Gastrointestinal hemorrhage
Heart failure
Hemolytic anemia
Hepatic failure
Hyperbilirubinemia
Hypertension
Hypotension
Hypoxia
Ileus
Increased alanine transaminase
Increased aspartate transaminase
Kidney disease with reduction in glomerular filtration rate (GFr)
Leukopenia
Neutropenic disorder
Nontraumatic hemoperitoneum
Obstructive hyperbilirubinemia
Pleural effusions
Pulmonary edema
Pulmonary thromboembolism
Renal failure
Rhabdomyolysis
Seizure disorder
Skin ulcer
Stevens-johnson syndrome
Syncope
Tachycardia
Thrombocytopenic disorder
Thrombophlebitis
Toxic epidermal necrolysis
Urticaria

There are 36 less severe adverse reactions.

More Frequent	Less Frequent
Constipation Diarrhea Headache disorder Nausea Skin rash Vomiting	Glossitis Oral candidiasis Pruritus of skin

Rare/Very Rare
Abdominal distension Acute abdominal pain Agitation Back pain Black tarry stools Candidiasis Chest pain Cough Delirium Dizziness Drowsy Dyspepsia Dyspnea Dysuria Fever Flatulence General weakness Hallucinations Hyperhidrosis Hypervolemia Insomnia Nervousness Pain Paresthesia Pelvic pain Peripheral edema Urinary incontinence

The following precautions are available for MEROPENEM (meropenem):

Pediatric
Pregnant
Lactation
Geriatric

Safety and efficacy of meropenem have been established in children >=3 months of age with complicated skin and skin structure infections and bacterial meningitis. Safety and efficacy of meropenem have been established for the treatment of intra-abdominal infections in pediatric patients of all ages.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

Data on meropenem use during pregnancy are insufficient to establish a drug-associated risk of birth defects or miscarriage. Fetal toxicity and malformations were not reported in pregnant rats and monkeys when IV meropenem was administered during organogenesis at doses up to 2.4 and 2.3

times the maximum recommended human dose (MRHD) based on body-surface area (BSA), respectively. Additionally, no adverse effects were reported in rat offspring when meropenem was administered at doses 3.2 times the MRHD during late pregnancy and lactation.

Meropenem is excreted into breast milk; however, no information is available on the effects of meropenem on the breast-fed child or the effects on milk production. The developmental and health benefits of breast-feeding should be considered along with the mother's clinical need for the drug and the potential for any adverse effects on the breast-fed child from the drug or from the underlying maternal condition.

In clinical studies of meropenem, approximately 1100 patients (30%) were >=65 years of age and 400 patients (11%) were >=75 years of age. No substantial differences in safety and efficacy were identified relative to younger adults, but increased sensitivity cannot be ruled out. A pharmacokinetic study in geriatric patients showed that the reduction in the plasma clearance of meropenem correlates with age-associated reductions in creatinine clearance.

The following icd codes are available for MEROPENEM (meropenem)'s list of indications:

Bacterial meningitis
G00.9	Bacterial meningitis, unspecified
G01	Meningitis in bacterial diseases classified elsewhere
G04.2	Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified
Bacteroides complicated appendicitis
B96.6	Bacteroides fragilis [b. fragilis] as the cause of diseases classified elsewhere
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis
Bacteroides peritonitis
B96.6	Bacteroides fragilis [b. fragilis] as the cause of diseases classified elsewhere
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
T85.71	Infection and inflammatory reaction due to peritoneal dialysis catheter
T85.71xA	Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
Complicated appendicitis
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.890	Other acute appendicitis without perforation or gangrene
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis
Complicated skin and skin structure infection
H00.03	Abscess of eyelid
H00.031	Abscess of right upper eyelid
H00.032	Abscess of right lower eyelid
H00.033	Abscess of eyelid right eye, unspecified eyelid
H00.034	Abscess of left upper eyelid
H00.035	Abscess of left lower eyelid
H00.036	Abscess of eyelid left eye, unspecified eyelid
H00.039	Abscess of eyelid unspecified eye, unspecified eyelid
H60.0	Abscess of external ear
H60.00	Abscess of external ear, unspecified ear
H60.01	Abscess of right external ear
H60.02	Abscess of left external ear
H60.03	Abscess of external ear, bilateral
H60.1	Cellulitis of external ear
H60.10	Cellulitis of external ear, unspecified ear
H60.11	Cellulitis of right external ear
H60.12	Cellulitis of left external ear
H60.13	Cellulitis of external ear, bilateral
J34.0	Abscess, furuncle and carbuncle of nose
K61	Abscess of anal and rectal regions
K61.0	Anal abscess
K61.1	Rectal abscess
K61.2	Anorectal abscess
K61.3	Ischiorectal abscess
K61.4	Intrasphincteric abscess
L02	Cutaneous abscess, furuncle and carbuncle
L02.0	Cutaneous abscess, furuncle and carbuncle of face
L02.01	Cutaneous abscess of face
L02.03	Carbuncle of face
L02.1	Cutaneous abscess, furuncle and carbuncle of neck
L02.11	Cutaneous abscess of neck
L02.13	Carbuncle of neck
L02.2	Cutaneous abscess, furuncle and carbuncle of trunk
L02.21	Cutaneous abscess of trunk
L02.211	Cutaneous abscess of abdominal wall
L02.212	Cutaneous abscess of back [any part, except buttock and flank]
L02.213	Cutaneous abscess of chest wall
L02.214	Cutaneous abscess of groin
L02.215	Cutaneous abscess of perineum
L02.216	Cutaneous abscess of umbilicus
L02.217	Cutaneous abscess of flank
L02.219	Cutaneous abscess of trunk, unspecified
L02.23	Carbuncle of trunk
L02.231	Carbuncle of abdominal wall
L02.232	Carbuncle of back [any part, except buttock]
L02.233	Carbuncle of chest wall
L02.234	Carbuncle of groin
L02.235	Carbuncle of perineum
L02.236	Carbuncle of umbilicus
L02.239	Carbuncle of trunk, unspecified
L02.3	Cutaneous abscess, furuncle and carbuncle of buttock
L02.31	Cutaneous abscess of buttock
L02.33	Carbuncle of buttock
L02.4	Cutaneous abscess, furuncle and carbuncle of limb
L02.41	Cutaneous abscess of limb
L02.411	Cutaneous abscess of right axilla
L02.412	Cutaneous abscess of left axilla
L02.413	Cutaneous abscess of right upper limb
L02.414	Cutaneous abscess of left upper limb
L02.415	Cutaneous abscess of right lower limb
L02.416	Cutaneous abscess of left lower limb
L02.419	Cutaneous abscess of limb, unspecified
L02.43	Carbuncle of limb
L02.431	Carbuncle of right axilla
L02.432	Carbuncle of left axilla
L02.433	Carbuncle of right upper limb
L02.434	Carbuncle of left upper limb
L02.435	Carbuncle of right lower limb
L02.436	Carbuncle of left lower limb
L02.439	Carbuncle of limb, unspecified
L02.5	Cutaneous abscess, furuncle and carbuncle of hand
L02.51	Cutaneous abscess of hand
L02.511	Cutaneous abscess of right hand
L02.512	Cutaneous abscess of left hand
L02.519	Cutaneous abscess of unspecified hand
L02.53	Carbuncle of hand
L02.531	Carbuncle of right hand
L02.532	Carbuncle of left hand
L02.539	Carbuncle of unspecified hand
L02.6	Cutaneous abscess, furuncle and carbuncle of foot
L02.61	Cutaneous abscess of foot
L02.611	Cutaneous abscess of right foot
L02.612	Cutaneous abscess of left foot
L02.619	Cutaneous abscess of unspecified foot
L02.63	Carbuncle of foot
L02.631	Carbuncle of right foot
L02.632	Carbuncle of left foot
L02.639	Carbuncle of unspecified foot
L02.8	Cutaneous abscess, furuncle and carbuncle of other sites
L02.81	Cutaneous abscess of other sites
L02.811	Cutaneous abscess of head [any part, except face]
L02.818	Cutaneous abscess of other sites
L02.83	Carbuncle of other sites
L02.831	Carbuncle of head [any part, except face]
L02.838	Carbuncle of other sites
L02.9	Cutaneous abscess, furuncle and carbuncle, unspecified
L02.91	Cutaneous abscess, unspecified
L02.93	Carbuncle, unspecified
L03	Cellulitis and acute lymphangitis
L03.0	Cellulitis and acute lymphangitis of finger and toe
L03.01	Cellulitis of finger
L03.011	Cellulitis of right finger
L03.012	Cellulitis of left finger
L03.019	Cellulitis of unspecified finger
L03.02	Acute lymphangitis of finger
L03.021	Acute lymphangitis of right finger
L03.022	Acute lymphangitis of left finger
L03.029	Acute lymphangitis of unspecified finger
L03.03	Cellulitis of toe
L03.031	Cellulitis of right toe
L03.032	Cellulitis of left toe
L03.039	Cellulitis of unspecified toe
L03.04	Acute lymphangitis of toe
L03.041	Acute lymphangitis of right toe
L03.042	Acute lymphangitis of left toe
L03.049	Acute lymphangitis of unspecified toe
L03.1	Cellulitis and acute lymphangitis of other parts of limb
L03.11	Cellulitis of other parts of limb
L03.111	Cellulitis of right axilla
L03.112	Cellulitis of left axilla
L03.113	Cellulitis of right upper limb
L03.114	Cellulitis of left upper limb
L03.115	Cellulitis of right lower limb
L03.116	Cellulitis of left lower limb
L03.119	Cellulitis of unspecified part of limb
L03.12	Acute lymphangitis of other parts of limb
L03.121	Acute lymphangitis of right axilla
L03.122	Acute lymphangitis of left axilla
L03.123	Acute lymphangitis of right upper limb
L03.124	Acute lymphangitis of left upper limb
L03.125	Acute lymphangitis of right lower limb
L03.126	Acute lymphangitis of left lower limb
L03.129	Acute lymphangitis of unspecified part of limb
L03.2	Cellulitis and acute lymphangitis of face and neck
L03.21	Cellulitis and acute lymphangitis of face
L03.211	Cellulitis of face
L03.212	Acute lymphangitis of face
L03.22	Cellulitis and acute lymphangitis of neck
L03.221	Cellulitis of neck
L03.222	Acute lymphangitis of neck
L03.3	Cellulitis and acute lymphangitis of trunk
L03.31	Cellulitis of trunk
L03.311	Cellulitis of abdominal wall
L03.312	Cellulitis of back [any part except buttock]
L03.313	Cellulitis of chest wall
L03.314	Cellulitis of groin
L03.315	Cellulitis of perineum
L03.316	Cellulitis of umbilicus
L03.317	Cellulitis of buttock
L03.319	Cellulitis of trunk, unspecified
L03.31A	Cellulitis of flank
L03.32	Acute lymphangitis of trunk
L03.321	Acute lymphangitis of abdominal wall
L03.322	Acute lymphangitis of back [any part except buttock]
L03.323	Acute lymphangitis of chest wall
L03.324	Acute lymphangitis of groin
L03.325	Acute lymphangitis of perineum
L03.326	Acute lymphangitis of umbilicus
L03.327	Acute lymphangitis of buttock
L03.329	Acute lymphangitis of trunk, unspecified
L03.32A	Acute lymphangitis of flank
L03.8	Cellulitis and acute lymphangitis of other sites
L03.81	Cellulitis of other sites
L03.811	Cellulitis of head [any part, except face]
L03.818	Cellulitis of other sites
L03.89	Acute lymphangitis of other sites
L03.891	Acute lymphangitis of head [any part, except face]
L03.898	Acute lymphangitis of other sites
L03.9	Cellulitis and acute lymphangitis, unspecified
L03.90	Cellulitis, unspecified
L03.91	Acute lymphangitis, unspecified
L05.0	Pilonidal cyst and sinus with abscess
L05.01	Pilonidal cyst with abscess
L05.02	Pilonidal sinus with abscess
L08.0	Pyoderma
L08.89	Other specified local infections of the skin and subcutaneous tissue
L08.9	Local infection of the skin and subcutaneous tissue, unspecified
M72.6	Necrotizing fasciitis
N48.21	Abscess of corpus cavernosum and penis
N48.22	Cellulitis of corpus cavernosum and penis
N75.1	Abscess of bartholin's gland
N76.4	Abscess of vulva
N76.82	Fournier disease of vagina and vulva
O91	Infections of breast associated with pregnancy, the puerperium and lactation
O91.0	Infection of nipple associated with pregnancy, the puerperium and lactation
O91.01	Infection of nipple associated with pregnancy
O91.011	Infection of nipple associated with pregnancy, first trimester
O91.012	Infection of nipple associated with pregnancy, second trimester
O91.013	Infection of nipple associated with pregnancy, third trimester
O91.019	Infection of nipple associated with pregnancy, unspecified trimester
O91.02	Infection of nipple associated with the puerperium
O91.03	Infection of nipple associated with lactation
O91.1	Abscess of breast associated with pregnancy, the puerperium and lactation
O91.11	Abscess of breast associated with pregnancy
O91.111	Abscess of breast associated with pregnancy, first trimester
O91.112	Abscess of breast associated with pregnancy, second trimester
O91.113	Abscess of breast associated with pregnancy, third trimester
O91.119	Abscess of breast associated with pregnancy, unspecified trimester
O91.12	Abscess of breast associated with the puerperium
O91.13	Abscess of breast associated with lactation
E. coli complicated appendicitis
B96.2	Escherichia coli [e. coli ] as the cause of diseases classified elsewhere
B96.20	Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere
B96.29	Other escherichia coli [e. coli] as the cause of diseases classified elsewhere
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis
E. coli peritonitis
B96.2	Escherichia coli [e. coli ] as the cause of diseases classified elsewhere
B96.20	Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere
B96.29	Other escherichia coli [e. coli] as the cause of diseases classified elsewhere
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
T85.71	Infection and inflammatory reaction due to peritoneal dialysis catheter
T85.71xA	Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
H. influenzae meningitis
G00.0	Hemophilus meningitis
Infectious disease of abdomen
A51.1	Primary anal syphilis
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.200	Acute appendicitis with generalized peritonitis, without perforation or abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.209	Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.890	Other acute appendicitis without perforation or gangrene
K35.891	Other acute appendicitis without perforation, with gangrene
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
Intra-abdominal abscess
D73.3	Abscess of spleen
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K50.014	Crohn's disease of small intestine with abscess
K50.114	Crohn's disease of large intestine with abscess
K50.814	Crohn's disease of both small and large intestine with abscess
K50.914	Crohn's disease, unspecified, with abscess
K51.014	Ulcerative (chronic) pancolitis with abscess
K51.214	Ulcerative (chronic) proctitis with abscess
K51.314	Ulcerative (chronic) rectosigmoiditis with abscess
K51.414	Inflammatory polyps of colon with abscess
K51.514	Left sided colitis with abscess
K51.814	Other ulcerative colitis with abscess
K51.914	Ulcerative colitis, unspecified with abscess
K57.0	Diverticulitis of small intestine with perforation and abscess
K57.00	Diverticulitis of small intestine with perforation and abscess without bleeding
K57.01	Diverticulitis of small intestine with perforation and abscess with bleeding
K57.2	Diverticulitis of large intestine with perforation and abscess
K57.20	Diverticulitis of large intestine with perforation and abscess without bleeding
K57.21	Diverticulitis of large intestine with perforation and abscess with bleeding
K57.4	Diverticulitis of both small and large intestine with perforation and abscess
K57.40	Diverticulitis of both small and large intestine with perforation and abscess without bleeding
K57.41	Diverticulitis of both small and large intestine with perforation and abscess with bleeding
K57.8	Diverticulitis of intestine, part unspecified, with perforation and abscess
K57.80	Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding
K57.81	Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding
K63.0	Abscess of intestine
K65.1	Peritoneal abscess
K68.1	Retroperitoneal abscess
K68.11	Postprocedural retroperitoneal abscess
K68.12	Psoas muscle abscess
K68.19	Other retroperitoneal abscess
K75.0	Abscess of liver
N15.1	Renal and perinephric abscess
N34.0	Urethral abscess
N41.2	Abscess of prostate
Klebsiella complicated appendicitis
B96.1	Klebsiella pneumoniae [k. pneumoniae] as the cause of diseases classified elsewhere
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis
Klebsiella pneumoniae peritonitis
B96.1	Klebsiella pneumoniae [k. pneumoniae] as the cause of diseases classified elsewhere
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
T85.71	Infection and inflammatory reaction due to peritoneal dialysis catheter
T85.71xA	Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
Meningococcal meningitis
A39.0	Meningococcal meningitis
Peptostreptococcus complicated appendicitis
B96.89	Other specified bacterial agents as the cause of diseases classified elsewhere
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis
Peptostreptococcus peritonitis
B96.89	Other specified bacterial agents as the cause of diseases classified elsewhere
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
T85.71	Infection and inflammatory reaction due to peritoneal dialysis catheter
T85.71xA	Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
Peritonitis
K65	Peritonitis
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
K65.9	Peritonitis, unspecified
Pneumococcal meningitis
G00.1	Pneumococcal meningitis
Pseudomonas aeruginosa complicated appendicitis
B96.5	Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis
Pseudomonas aeruginosa peritonitis
B96.5	Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
T85.71	Infection and inflammatory reaction due to peritoneal dialysis catheter
T85.71xA	Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
Streptococcal meningitis
G00.1	Pneumococcal meningitis
G00.2	Streptococcal meningitis
Streptococcal peritonitis
B95.0	Streptococcus, group a, as the cause of diseases classified elsewhere
B95.1	Streptococcus, group b, as the cause of diseases classified elsewhere
B95.3	Streptococcus pneumoniae as the cause of diseases classified elsewhere
B95.4	Other streptococcus as the cause of diseases classified elsewhere
B95.5	Unspecified streptococcus as the cause of diseases classified elsewhere
K65.0	Generalized (acute) peritonitis
K65.2	Spontaneous bacterial peritonitis
T85.71	Infection and inflammatory reaction due to peritoneal dialysis catheter
T85.71xA	Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
Streptococcus complicated appendicitis
B95.0	Streptococcus, group a, as the cause of diseases classified elsewhere
B95.1	Streptococcus, group b, as the cause of diseases classified elsewhere
B95.3	Streptococcus pneumoniae as the cause of diseases classified elsewhere
B95.4	Other streptococcus as the cause of diseases classified elsewhere
B95.5	Unspecified streptococcus as the cause of diseases classified elsewhere
K35	Acute appendicitis
K35.2	Acute appendicitis with generalized peritonitis
K35.20	Acute appendicitis with generalized peritonitis, without abscess
K35.201	Acute appendicitis with generalized peritonitis, with perforation, without abscess
K35.21	Acute appendicitis with generalized peritonitis, with abscess
K35.210	Acute appendicitis with generalized peritonitis, without perforation, with abscess
K35.211	Acute appendicitis with generalized peritonitis, with perforation and abscess
K35.219	Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation
K35.3	Acute appendicitis with localized peritonitis
K35.30	Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31	Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32	Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess
K35.33	Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess
K35.8	Other and unspecified acute appendicitis
K35.80	Unspecified acute appendicitis
K35.89	Other acute appendicitis
K35.891	Other acute appendicitis without perforation, with gangrene
K36	Other appendicitis
K37	Unspecified appendicitis