Meropenem Dosing for Patients with eGFR 16 mL/min/1.73m²
For a patient with an eGFR of 16 mL/min/1.73m², the recommended dose of meropenem is 500 mg every 12 hours for complicated skin and skin structure infections, or 1 gram every 12 hours for intra-abdominal infections. 1
Dosing Rationale Based on Renal Function
The FDA-approved meropenem dosing guidelines clearly outline the appropriate dosing adjustments based on creatinine clearance:
| Creatinine Clearance (mL/min) | Dose | 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 |
Since the patient's eGFR is 16 mL/min/1.73m², which falls within the 10-25 mL/min range, the appropriate dosing is one-half the recommended dose every 12 hours 1.
Infection-Specific Dosing
The specific dose depends on the type of infection being treated:
For complicated skin and skin structure infections (cSSSI):
- Standard dose is 500 mg every 8 hours
- For eGFR 16 mL/min: 250 mg every 12 hours
For intra-abdominal infections:
- Standard dose is 1 gram every 8 hours
- For eGFR 16 mL/min: 500 mg every 12 hours
For infections caused by Pseudomonas aeruginosa:
- Standard dose is 1 gram every 8 hours
- For eGFR 16 mL/min: 500 mg every 12 hours
Administration Considerations
- Meropenem should be administered by intravenous infusion over approximately 15-30 minutes
- Alternatively, doses may be administered as an intravenous bolus injection over approximately 3-5 minutes
Important Clinical Considerations
Monitoring
- Regular monitoring of renal function is essential during meropenem therapy in patients with impaired renal function
- Assess for clinical response and potential adverse effects
- Consider therapeutic drug monitoring in critically ill patients if available
Potential Pitfalls
- Using standard dosing in patients with renal impairment can lead to drug accumulation and toxicity
- Underdosing may lead to treatment failure and development of antimicrobial resistance
- The Cockcroft-Gault equation is recommended for estimating creatinine clearance for drug dosing purposes rather than eGFR equations
Special Populations
- For patients on hemodialysis or peritoneal dialysis, the FDA label notes that there is inadequate information regarding meropenem dosing 1
- Some studies suggest that for patients on continuous renal replacement therapies, higher doses may be needed (1 gram every 8-12 hours) 2, 3, 4
Conclusion
The appropriate meropenem dosing for a patient with eGFR 16 mL/min/1.73m² should be one-half the standard dose administered every 12 hours. This equates to 250 mg every 12 hours for skin infections or 500 mg every 12 hours for intra-abdominal infections.