Meropenem Dosing for Complicated UTI
For complicated urinary tract infections, the recommended dose of meropenem (Merrem) is 1 gram intravenously every 8 hours for 5-7 days. 1
Dosing Considerations
Standard Dosing
- Meropenem 1 gram IV every 8 hours is the standard dose for complicated UTIs in patients with normal renal function 1, 2
- Administration should be via intravenous infusion over 3 hours for optimal efficacy 2
- Duration of therapy should be 5-7 days, though this may be individualized based on clinical response, source control, and underlying comorbidities 1
Renal Dose Adjustments
Dosing should be adjusted based on creatinine clearance:
- CrCl ≥50 mL/min: Standard dosing (1g q8h)
- CrCl 26-49 mL/min: 1g q12h 3
- CrCl 10-25 mL/min: 500mg q12h 3
- For patients on continuous renal replacement therapy: 1g q12h may be appropriate 4
Clinical Evidence
The efficacy of meropenem for complicated UTIs has been well-established with clinical success rates of approximately 98.4% 5. A study evaluating meropenem in severe complicated UTIs demonstrated both clinical and bacteriological efficacy of 88.9% 2.
Alternative Options for Complicated UTIs
If the infection is suspected to be caused by carbapenem-resistant Enterobacterales (CRE), consider these alternatives:
- Ceftazidime/avibactam 2.5g IV q8h (2D evidence level)
- Meropenem/vaborbactam 4g IV q8h (2C evidence level)
- Imipenem/cilastatin/relebactam 1.25g IV q6h (2C evidence level)
- Aminoglycosides (for susceptible organisms):
- Gentamicin 5-7 mg/kg/day IV daily
- Amikacin 15 mg/kg/day IV daily
- Plazomicin 15 mg/kg IV q12h 1
Safety Profile
Meropenem is generally well-tolerated with the most common adverse effects being:
- Diarrhea (2.3%)
- Rash (1.4%)
- Nausea/vomiting (1.4%)
- Injection site inflammation (1.1%)
- Laboratory abnormalities: thrombocytosis (1.6%) and elevated hepatic enzymes (1.5-4.3%) 6
Important Clinical Considerations
- Obtain cultures before initiating therapy to guide targeted treatment
- Extended infusion (over 3 hours) may be beneficial, particularly for organisms with higher MICs
- Monitor renal function throughout therapy and adjust dosing as needed
- The risk of seizures with meropenem is low (0.08% in non-meningitis patients) 6
- For patients with multiorgan failure requiring CVVHDF, a dose of 1g IV q12h has been shown to maintain adequate drug levels 4
Remember that treatment duration should be guided by clinical response, with most patients requiring 5-7 days of therapy for complicated UTIs 1.