From the FDA Drug Label
Dosage should be reduced in adult patients with renal impairment. Recommended meropenem for injection Dosage Schedule for Adult Patients with Renal Impairment Creatinine Clearance (mL/min) Dose (2) (dependent on type of infection) (2) Dosing Interval Greater than 50Recommended dose (500 mg cSSSI and 1 gram Intra-abdominal)Every 8 hours 26 to 50Recommended doseEvery 12 hours 10 to 25One-half recommended doseEvery 12 hours Less than 10One-half recommended doseEvery 24 hours
For an eGFR of 40, the patient falls into the 26 to 50 mL/min category.
- The recommended dose for complicated skin and skin structure infections (cSSSI) is 500 mg every 12 hours.
- The recommended dose for intra-abdominal infections is 1 gram every 12 hours. 1
From the Research
For a patient with an eGFR of 40 mL/min, the recommended meropenem dose is 1 gram every 12 hours, as supported by the most recent and highest quality study 2. This dosing adjustment is crucial because meropenem is primarily eliminated by the kidneys, with approximately 70% of the drug excreted unchanged in urine. When kidney function is reduced, as indicated by an eGFR of 40, the drug's clearance decreases, potentially leading to accumulation and increased risk of toxicity if not appropriately adjusted. Some key points to consider when administering meropenem to patients with renal impairment include:
- Monitoring renal function regularly during treatment, as further dose adjustments may be necessary if kidney function changes 3.
- Being aware of potential side effects, including gastrointestinal disturbances, headache, rash, and superinfections 4.
- Considering therapeutic drug monitoring (TDM) to guide therapy, especially in critically ill patients and those with impaired renal function 2.
- Recognizing that meropenem has an excellent safety profile and is suitable for use in elderly and/or renally impaired patients, with a low risk of seizures even in patients with renal impairment 4.