From the Guidelines
The recommended dose of meropenem for patients with normal renal function is 1 g every 8 hours. This dosage is based on the guidelines for the diagnosis and management of complicated intra-abdominal infection in adults and children, as outlined in the Clinical Infectious Diseases journal 1. For patients with impaired renal function, dose adjustment is necessary to prevent drug accumulation and potential toxicity.
- When creatinine clearance (CrCl) is 26-50 mL/min, the dose remains the same but is given every 12 hours.
- For CrCl 10-25 mL/min, half the normal dose is given every 12 hours.
- When CrCl is less than 10 mL/min, half the normal dose is administered every 24 hours.
- Patients on hemodialysis should receive a dose after each dialysis session. It is essential to note that meropenem is primarily eliminated by the kidneys, and inadequate dose reduction in renal impairment can lead to drug accumulation and potential toxicity, while insufficient dosing may result in treatment failure 1. Meropenem should be administered as a slow intravenous infusion over 15-30 minutes or as a bolus injection over 3-5 minutes to maximize efficacy and minimize side effects. The dosage recommendations are based on the assumption of normal hepatic function, and adjustments may be necessary in patients with hepatic impairment.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 500 mg every 8 hours by intravenous infusion over 15 to 30 minutes for complicated skin and skin structure infections (cSSSI) for adult patients. When treating infections caused by Pseudomonas aeruginosa, a dose of 1 gram every 8 hours is recommended. (2. 1) 1 gram every 8 hours by intravenous infusion over 15 minutes to 30 minutes for intra-abdominal infections for adult patients. (2.1) 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
The recommended dose of meropenem for patients with normal renal function is:
- 500 mg every 8 hours for complicated skin and skin structure infections (cSSSI)
- 1 gram every 8 hours for intra-abdominal infections
- 1 gram every 8 hours for infections caused by Pseudomonas aeruginosa For patients with impaired renal function, the dose should be reduced as follows:
- Creatinine clearance 26-50 mL/min: recommended dose every 12 hours
- Creatinine clearance 10-25 mL/min: one-half recommended dose every 12 hours
- Creatinine clearance less than 10 mL/min: one-half recommended dose every 24 hours 2
From the Research
Meropenem Dosing Recommendations
The recommended dose of meropenem varies depending on the patient's renal function.
- For patients with normal renal function, the typical dose is 0.5-1g every 8 hours 3, 4.
- For patients with impaired renal function, dosage adjustments are necessary to avoid underdosing or overdosing 3, 5.
- The dose of meropenem should be adjusted based on the patient's creatinine clearance (CLCR) and the presence of continuous renal replacement therapy (CRRT) 5, 6.
Renal Impairment Considerations
- In patients with renal impairment, the half-life of meropenem is prolonged, and the drug is eliminated more slowly 3.
- The recommended dose for patients with CLCR <60 mL/min is 0.5-1g every 8-12 hours 5, 6.
- For patients with CLCR ≥90 mL/min, a higher dose or more frequent administration may be necessary to achieve optimal exposure 6.
Continuous Renal Replacement Therapy (CRRT)
- CRRT can affect the elimination of meropenem, and the dose should be adjusted accordingly 3, 5.
- The recommended dose for patients undergoing CRRT is 0.5-1g every 8 hours, with the possibility of adjusting the infusion time based on residual diuresis 5.