From the Guidelines
Meropenem is typically dosed at 1 gram intravenously every 8 hours for most serious infections in adults with normal renal function, as recommended by the most recent guidelines 1. The dosage may vary depending on the severity of the infection and the susceptibility of the organism. For severe infections like meningitis or infections caused by less susceptible organisms, the dose may be increased to 2 grams every 8 hours.
- In children, the standard dose is 20-40 mg/kg every 8 hours, with higher doses used for meningitis, as seen in the guidelines for pediatric patients 1.
- Dose adjustments are necessary for patients with renal impairment; for creatinine clearance 26-50 mL/min, reduce to 1g every 12 hours; for 10-25 mL/min, give 500mg every 12 hours; and for <10 mL/min, give 500mg every 24 hours.
- Meropenem is a carbapenem antibiotic that works by inhibiting bacterial cell wall synthesis and is effective against a broad spectrum of gram-positive, gram-negative, and anaerobic bacteria, including many multidrug-resistant organisms, as stated in the guidelines for the treatment of infections due to multidrug-resistant organisms 1.
- The drug is generally administered over 15-30 minutes for regular infusions, though extended infusions over 3 hours may be used in critical care settings to optimize pharmacodynamic properties, as suggested by the European Society of Clinical Microbiology and Infectious Diseases guidelines 1.
From the FDA Drug Label
- 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.
- 3 Use in Pediatric Patients Pediatric Patients 3 Months of Age and Older For pediatric patients 3 months of age and older, the meropenem for injection dose is 10 mg/kg, 20 mg/kg or 40 mg/kg every 8 hours (maximum dose is 2 grams every 8 hours), depending on the type of infection (cSSSI, cIAI, intra-abdominal infection or meningitis).
The recommended meropenem dose is:
- For adult patients:
- 500 mg every 8 hours for skin and skin structure infections
- 1 gram every 8 hours for intra-abdominal infections
- For pediatric patients 3 months of age and older:
- 10 mg/kg, 20 mg/kg or 40 mg/kg every 8 hours (maximum dose is 2 grams every 8 hours)
- depending on the type of infection (cSSSI, cIAI, intra-abdominal infection or meningitis) 2
From the Research
Meropenem Dosing
- The dosing of meropenem is not explicitly stated in the provided studies, but its pharmacokinetic and pharmacodynamic properties are discussed 3.
- Meropenem undergoes primarily renal elimination, and dosage adjustment is required for patients with renal impairment 3.
- The drug has time-dependent bactericidal activity, and the percentage of time that free-drug concentrations are higher than the minimum inhibitory concentration (%T>MIC) best characterizes its pharmacodynamic profile 3.
- A bactericidal target of approximately 40%T>MIC is suggested for meropenem 3.
Clinical Efficacy and Tolerability
- Meropenem has shown efficacy in the treatment of complicated skin and skin-structure infections, complicated intra-abdominal infections, and bacterial meningitis 4, 5.
- The drug is well tolerated by children and adults and has an acceptable safety profile 4, 5.
- Alternative meropenem dosing strategies for the optimization of outcomes are under investigation 4.
Specific Infections and Dosing
- For the treatment of complicated skin and soft tissue infections, meropenem 500 mg every 8 hours has been shown to be effective and well tolerated 6.
- Higher doses (e.g., 1 g every 8 hours) should be considered for treatment of complicated skin and soft tissue infections in higher-risk patients where Pseudomonas aeruginosa is a suspected or documented pathogen 6.
- In a subgroup analysis of patients with diabetes mellitus, meropenem 500 mg every 8 hours was found to be efficacious and well tolerated for the treatment of complicated skin and skin-structure infections 7.