What is the proper dosing for Meropenem (Meropenem) in a patient with Impaired renal function?

From the Guidelines

Meropenem should be dosed at 2 g every 8 hours for patients with normal renal function. This recommendation is based on the guidelines for the management and prevention of Acinetobacter baumannii infections in the ICU, as outlined in the study published in Intensive Care Medicine 1. The study provides a table with recommended doses of antimicrobials for A. baumannii infections, which includes meropenem at a dose of 2 g every 8 hours.

• It is essential to note that high doses of meropenem are associated with seizures, as mentioned in the study 1.
• The study also emphasizes the importance of considering the dosing regimen for other antimicrobials, such as polymyxin B and colistin, which may be used in combination with meropenem for certain infections.
• Additionally, the study highlights the need for a loading dose of colistin to achieve optimal plasma concentrations, but this does not apply to meropenem, as it does not require a loading dose 1.
• It is crucial to monitor renal function regularly during meropenem therapy, as dose adjustments may be necessary for patients with renal impairment.
• The duration of meropenem therapy typically ranges from 7-14 days, depending on the infection site and severity.

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 dosing for Meropenem is 500 mg every 8 hours for skin and skin structure infections and 1 gram every 8 hours for intra-abdominal infections. For infections caused by P. aeruginosa, the dose is 1 gram every 8 hours. The administration method is by intravenous infusion over 15-30 minutes or intravenous bolus injection over 3-5 minutes 2.

• Key considerations:
  • Dose adjustment for renal impairment
  • Administration method
  • Infection type
• Important administration instructions:
  • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
  • For intravenous bolus administration, reconstitute injection vials with sterile water for injection.
  • For infusion, injection vials may be directly reconstituted with a compatible infusion fluid. 2

From the Research

Meropenem Dosing

• Meropenem is a broad-spectrum antibacterial agent of the carbapenem family, indicated for empirical therapy prior to the identification of causative organisms, or for disease caused by single or multiple susceptible bacteria in both adults and children with a broad range of serious infections 3.
• The dosing of meropenem is not explicitly stated in the provided studies, but its pharmacokinetic profile makes possible parenteral administration every 8 hours 4.
• Meropenem has a broad spectrum of in vitro activity against Gram-positive and Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae 3.

Comparison with Other Antibiotics

• Meropenem has similar efficacy to comparator antibacterial agents, including imipenem/cilastatin, clindamycin plus tobramycin or gentamicin, cefotaxime plus metronidazole, cefepime and ceftazidime plus amikacin 3.
• Piperacillin/tazobactam is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity, and has been shown to be effective in the treatment of various infections, including lower respiratory tract infections, intra-abdominal infections, and febrile neutropenia 5, 6.
• The carbapenems, including meropenem, have an exceptionally broad spectrum of activity, and are stable to most beta-lactamases, including AmpC beta-lactamases and extended-spectrum beta-lactamases 7.

Clinical Use

• Meropenem is approved for use in complicated intra-abdominal infection, complicated skin and skin structure infection, and bacterial meningitis, among other indications 3.
• Piperacillin/tazobactam is effective and well-tolerated in patients with moderate to severe bacterial infections, and has been shown to have clinical and economic advantages over standard antibacterial regimens in certain indications 6.
• The choice of antibiotic, including meropenem and piperacillin/tazobactam, should be based on the specific clinical scenario and local resistance patterns 3, 5, 6.