Objective To evaluate the efficacy and safety of biapenem in treatment of bacterial infections of the respiratory and urinary systems. Methods A total of 288 patients with infections of the respiratory and urinary system were included in this multicenter, blinded, randomized, and parallel controlled trial. The patients were randomly assigned to receive biapenem(experimental group, n=144) or meropenem (control group, n=144). Results The clinical curative rates of the experimental group and control group were 95.10%(136/143) and 92.25%(131/142), respectively, with those for respiratory system infection being 93.06%(67/72) and 94.29%(66/70) and those for urinary infection being 97.18%(69/71) and 90.28%(65/72), respectively. The bacterial eradication rates in the experimental group and control group were 88.00%(66/75) and 92.65%(63/68), respectively, with those for the respiratory infection being 83.33%(30/36) and 90.62%(29/32) and those for urinary infection being 92.31%(36/39) and 94.44%(34/36), respectively. There were no significant differences between the two groups regarding the clinical curative rates or bacterial eradication rates (P>0.05).The side-effect rate was 2.08%(3/144) in the experimental group and 8.33%(12/144) in the control group, with significant differences found between the two groups (P=0.030 6). Conclusion Compared to meropenem, biapenem has similar efficacy in treatment of respiratory and urinary system infection, but with study