From the Guidelines
For adult patients with sepsis in the emergency department, the standard meropenem dosage is 1 gram administered intravenously every 8 hours, with consideration of a loading dose of 2 grams in critically ill patients, as supported by the principles of pharmacokinetic/pharmacodynamic optimization in critically ill patients with sepsis and septic shock 1. The infusion should be given over 30 minutes, though extended infusions of 3 hours may improve efficacy for severe infections. Dose adjustments are necessary for renal impairment:
- for creatinine clearance 26-50 mL/min, give 1 gram every 12 hours;
- for 10-25 mL/min, give 500 mg every 12 hours;
- and for <10 mL/min, give 500 mg every 24 hours. Meropenem is a broad-spectrum carbapenem antibiotic effective against most gram-positive, gram-negative, and anaerobic bacteria, making it appropriate for empiric treatment of sepsis before culture results are available. It works by inhibiting cell wall synthesis and has good tissue penetration. Treatment should be initiated as soon as possible after obtaining blood cultures, ideally within the first hour of recognizing sepsis, as part of the sepsis bundle, as recommended by the Surviving Sepsis Campaign guidelines 1. Reassessment within 24-48 hours is essential to consider de-escalation based on culture results and clinical response. The use of meropenem in this context aligns with the principles of antimicrobial stewardship and the optimization of antimicrobial therapy in critically ill patients, as outlined in various guidelines and studies 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION 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.
The FDA drug label does not answer the question regarding the dosage of meropenem in the emergency department for sepsis.
From the Research
Meropenem Dosage in the Emergency Department for Sepsis
- The dosage of meropenem in the emergency department for sepsis can vary depending on the patient's condition and the severity of the infection 2, 3, 4, 5, 6.
- A study published in 2017 found that continuous infusion of meropenem provided significantly shorter treatment duration and a tendency for superior bacteriological efficacy than intermittent administration 2.
- Another study published in 2020 compared the effects of empirical high-dose and low-dose meropenem in critically ill patients with sepsis and septic shock, and found that the high-dose group demonstrated significantly better microbiological cure in patients admitted from the emergency department with a high severity of illness 4.
- A randomized controlled trial published in 2020 found that empirical therapy with high-dose meropenem presented comparable clinical outcomes to standard-dose meropenem in sepsis and septic shock patients, but with superior microbiological cure rate in sepsis or septic shock patients admitted from the emergency department 4.
- A study published in 2023 found that continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28 compared to intermittent administration 5.
- A population pharmacokinetic study published in 2018 defined maximally effective meropenem dosing recommendations for treatment of Acinetobacter baumannii and Pseudomonas aeruginosa infections in patients with septic shock, and found that higher doses were required for empirical treatment of these infections 6.
Dosage Recommendations
- For empirical treatment of Acinetobacter baumannii, a dose of 2000 mg/6 h is recommended by intermittent or prolonged infusion, or 6000 mg/day by continuous infusion 6.
- For empirical treatment of Pseudomonas aeruginosa, a dose of 2000 mg/8 h or 1000 mg/6 h is recommended by intermittent or prolonged infusion 6.
- In patients with a creatinine clearance of ≤100 mL/min, successful concentration targets can be reached with intermittent dosing of 1000 mg/8 h 6.
- 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 6.