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. 1 gram every 8 hours by intravenous infusion over 15 minutes to 30 minutes for intra-abdominal infections for adult patients. 1 gram every 8 hours by intravenous bolus injection (5 mL to 20 mL) over 3 minutes to 5 minutes for adult patients. 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 50 Recommended dose (500 mg cSSSI and 1 gram Intra-abdominal) Every 8 hours 26 to 50 Recommended dose Every 12 hours 10 to 25 One-half recommended dose Every 12 hours Less than 10 One-half recommended dose Every 24 hours
The recommended dose of meropenem for patients with varying degrees of renal function and infection severity is as follows:
- For adult patients with normal renal function, the recommended dose is 500 mg every 8 hours for complicated skin and skin structure infections and 1 gram every 8 hours for intra-abdominal infections.
- For adult patients with renal impairment, the dose should be reduced based on the creatinine clearance:
- Greater than 50 mL/min: recommended dose every 8 hours
- 26 to 50 mL/min: recommended dose every 12 hours
- 10 to 25 mL/min: one-half recommended dose every 12 hours
- Less than 10 mL/min: one-half recommended dose every 24 hours
- For pediatric patients 3 months of age and older with normal renal function, the recommended 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.
- For pediatric patients less than 3 months of age with normal renal function and complicated intra-abdominal infections, the recommended dose is based on gestational age and postnatal age. 1
From the Research
Meropenem dosing should be adjusted based on both renal function and infection severity, with the most recent and highest quality study suggesting a dose of 1 gram every 8 hours for most serious infections in patients with normal renal function 2. For patients with normal renal function (creatinine clearance >50 mL/min), the standard dose is 1 gram every 8 hours for most serious infections, while severe infections like meningitis or respiratory infections in cystic fibrosis patients may require 2 grams every 8 hours.
- For moderate renal impairment (creatinine clearance 26-50 mL/min), reduce to 1 gram every 12 hours.
- With severe renal impairment (creatinine clearance 10-25 mL/min), use 500 mg every 12 hours.
- For patients with creatinine clearance <10 mL/min, administer 500 mg every 24 hours.
- Hemodialysis patients should receive a supplemental dose after dialysis sessions. Meropenem is a broad-spectrum carbapenem antibiotic that works by inhibiting bacterial cell wall synthesis, and proper dosing ensures adequate bacterial killing while minimizing toxicity risks, as shown in a study comparing different dosing regimens 3. The drug is primarily eliminated by the kidneys, which is why dosage adjustments are necessary in renal impairment to prevent accumulation and potential adverse effects while maintaining therapeutic efficacy, as demonstrated by a study on pharmacokinetics and dosing regimens in critically ill patients receiving continuous venovenous hemofiltration 4. Additionally, a study on meropenem dosing in critically ill patients with sepsis and without renal dysfunction found that continuous infusion maintains higher median trough concentrations in both plasma and subcutaneous tissue compared to intermittent bolus administration 5. However, the most recent study 2 provides the most relevant guidance for meropenem dosing in clinical practice.