What is the recommended dosage of Meropenem (generic name) in the emergency department?

From the Guidelines

The recommended meropenem dosage in the emergency department is 1 g IV q8h by extended infusion, as suggested for the treatment of carbapenem-resistant Enterobacterales (CRE) infections, including bloodstream infections, complicated urinary tract infections, and complicated intra-abdominal infections 1.

Key Considerations

• The dosage may vary based on the type of infection, renal function, and susceptibility of the organism, with extended-infusion of meropenem for 3 h suggested if meropenem MIC is ≥ 8 mg/L 1.
• For patients with renal impairment, dose adjustment is necessary: for creatinine clearance 26-50 mL/min, give 1 gram every 12 hours; for clearance 10-25 mL/min, give 500 mg every 12 hours; and for clearance less than 10 mL/min, give 500 mg every 24 hours.
• Meropenem is effective against many gram-positive, gram-negative, and anaerobic bacteria, making it suitable for empiric therapy in severe infections, including intra-abdominal infections, complicated pneumonia, and sepsis.

Administration Guidelines

• Each dose should be administered as an intravenous infusion over 15-30 minutes, though it can be given as a bolus injection over 3-5 minutes in emergent situations.
• Extended infusions over 3 hours may improve efficacy in critically ill patients.

Important Notes

• The choice of combination antimicrobial therapy should be based on susceptibility tests, and combinations of tigecycline with polymyxin or meropenem are suggested in clinically unstable patients 1.
• Definite treatment duration should be individualized according to infection sites, source control, underlying comorbidities, and initial response to therapy.

From the FDA Drug Label

2.1 Adult Patients The recommended dose of meropenem for injection is 500 mg given every 8 hours for skin and skin structure infections and 1 gram given every 8 hours for intra-abdominal infections. When treating complicated skin and skin structure infections caused by P. aeruginosa, a dose of 1 gram every 8 hours is recommended Meropenem for injection should be administered by intravenous infusion over approximately 15 minutes to 30 minutes. Doses of 1 gram may also be administered as an intravenous bolus injection (5 mL to 20 mL) over approximately 3 minutes to 5 minutes.

The recommended meropenem dosage in the emergency department for adult patients is:

• 500 mg every 8 hours for skin and skin structure infections
• 1 gram every 8 hours for intra-abdominal infections
• 1 gram every 8 hours for complicated skin and skin structure infections caused by P. aeruginosa 2

From the Research

Meropenem Dosage in the Emergency Department

• The dosage of meropenem in the emergency department can vary depending on the type of infection and the patient's renal function 3, 4, 5, 6, 7.
• For empirical treatment of Acinetobacter baumannii, a dose of 2000 mg every 6 hours by intermittent or prolonged infusion, or 6000 mg/day by continuous infusion may be required 3.
• For Pseudomonas aeruginosa, a dose of 2000 mg every 8 hours or 1000 mg every 6 hours may be required for both empirical and targeted treatment 3.
• In patients with a creatinine clearance of ≤100 mL/min, successful concentration targets could be reached with intermittent dosing of 1000 mg every 8 hours 3.
• In patients with septic shock and possible augmented renal clearance, doses should be increased and/or administration should be performed by prolonged or continuous infusion to increase the likelihood of achieving therapeutic drug concentrations 3, 5, 7.
• Standard dosing regimens may be inadequate in many critically ill patients, and serum concentrations often do not exceed recommended concentration targets even for moderately sensitive organisms 4.
• Meropenem concentration monitoring may be necessary in critically ill patients to ensure adequate drug concentrations and to adjust the dosing regimen as needed 4, 7.
• High meropenem dosage, up to 12 g/day, may be required to treat multidrug-resistant Pseudomonas aeruginosa septic shock 7.
• The mode of meropenem administration, such as intermittent or continuous infusion, can be critical for the combination to be maximally effective against carbapenem-resistant Pseudomonas aeruginosa 5.