From the Guidelines
Merrem (meropenem) should be infused every 8 hours for most adult patients with normal renal function. The standard dosing regimen is 1 gram every 8 hours, with each dose infused over 15 to 30 minutes, as recommended by the most recent guidelines 1. For severe infections or those caused by less susceptible organisms, extended infusion of meropenem for 3 hours is suggested if the meropenem MIC is ≥ 8 mg/L 1. Patients with impaired kidney function require dosage adjustments, with extended intervals between infusions based on creatinine clearance.
The 8-hour frequency is optimal for maintaining effective antimicrobial concentrations in the bloodstream and tissues, as meropenem has a relatively short half-life of approximately 1 hour in patients with normal renal function. This dosing schedule helps ensure that the drug concentration remains above the minimum inhibitory concentration (MIC) for susceptible bacteria throughout the treatment period, maximizing bacterial killing while minimizing the risk of developing resistance.
Some key points to consider when administering meropenem include:
- The dose may be increased to 2 grams every 8 hours for severe infections or those caused by less susceptible organisms
- Extended infusion of meropenem for 3 hours is suggested if the meropenem MIC is ≥ 8 mg/L 1
- Patients with impaired kidney function require dosage adjustments, with extended intervals between infusions based on creatinine clearance
- The treatment duration should be individualized according to infection sites, source control, the underlying comorbidities, and the initial response to therapy 1.
It's worth noting that the guidelines from 2022 1 provide the most up-to-date recommendations for the use of meropenem, and these should be followed in clinical practice. The earlier guidelines from 2014 1 may not reflect the current best practices for meropenem administration.
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 typical infusion frequency of Merrem (meropenem) is every 8 hours for adult patients and pediatric patients 3 months of age and older, with specific dosing recommendations based on the type of infection being treated 2.
- For adult patients, the dose is 500 mg every 8 hours for skin and skin structure infections and 1 gram every 8 hours for intra-abdominal infections.
- For pediatric patients 3 months of age and older, the dose ranges from 10 mg/kg to 40 mg/kg every 8 hours, depending on the type of infection.
From the Research
Infusion Frequency of Merrem (Meropenem)
The typical infusion frequency of Merrem (meropenem) can vary depending on the patient's condition and renal function. Here are some key points to consider:
- For patients with sepsis, a study 3 recommends a dosing regimen of 1 g every 8 hours as a 3-hour prolonged infusion for patients with creatinine clearance (CCr) 85-130 mL/min, and 1 g every 8 hours as an 8-hour continuous infusion for patients with CCr ≥ 130 mL/min.
- In elderly and renally impaired patients, meropenem can be administered at a dosage of 0.5 or 1.0 g every 8 hours, with no significant difference in adverse events compared to younger and non-renally impaired patients 4.
- For critically ill patients with acute renal failure undergoing continuous venovenous hemofiltration, a study 5 suggests that the recommended dose of meropenem should be increased by 100% to avoid potential underdosing.
- A randomized controlled trial 6 compared continuous versus intermittent application of meropenem in critically ill patients and found that continuous infusion provided equal clinical outcome, superior bacteriological efficacy, and a shorter duration of meropenem therapy.
- Another study 7 is investigating the comparison of empirical high-dose and low-dose meropenem in critically ill patients with sepsis and septic shock, with patients receiving either 1 g or 2 g of meropenem every 8 hours.
Key Considerations
- Renal function, as measured by creatinine clearance, plays a significant role in determining the appropriate dosing regimen for meropenem.
- The choice of infusion frequency and dosage should be individualized based on the patient's condition, renal function, and the severity of the infection.
- Continuous infusion of meropenem may offer advantages over intermittent bolus administration in terms of bacteriological efficacy and duration of therapy.