What is the dose of meropenem for a patient with meningitis?

From the Guidelines

For bacterial meningitis, the recommended dose of meropenem is 2 grams administered intravenously every 8 hours for adults with normal renal function, as supported by the most recent and highest quality study 1.

Key Considerations

• The duration of treatment typically ranges from 10 to 14 days, depending on the causative organism and clinical response.
• For children, the dosage is not explicitly stated in the most recent study, but according to older studies 1, the dosage is 40 mg/kg (up to a maximum of 2 grams) every 8 hours.
• Meropenem should be administered as a slow intravenous infusion over 15-30 minutes to maximize time above the minimum inhibitory concentration.
• Dose adjustments are necessary for patients with renal impairment; for creatinine clearance 26-50 mL/min, reduce to 1 gram every 12 hours; for 10-25 mL/min, give 500 mg every 12 hours; and for <10 mL/min, give 500 mg every 24 hours.

Efficacy and Safety

• Meropenem is effective against most pathogens causing meningitis including Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and many gram-negative organisms, with excellent CNS penetration through inflamed meninges.
• However, it may not be effective against highly penicillin- and cephalosporin-resistant pneumococcal isolates, as shown in a study 1.

Clinical Application

• Meropenem can be recommended as an alternative to cefotaxime or ceftriaxone for treatment of bacterial meningitis, especially in cases where gram-negative isolates are resistant to standard therapy 1.
• It is essential to consider local antimicrobial resistance patterns and seek specialist advice when using meropenem for bacterial meningitis, as recommended in the guideline 1.

From the FDA Drug Label

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). For pediatric patients weighing over 50 kg administer meropenem for injection at a dose of 500 mg every 8 hours for cSSSI, 1 gram every 8 hours for cIAI and 2 grams every 8 hours for meningitis. Table 2: RecommendedMeropenem for Injection Dosage Schedule for Pediatric Patients 3 Months of Age and Older with Normal Renal Function Type of Infection Dose (mg/kg) Up to a Maximum Dose Dosing Interval Meningitis 40 2 grams Every 8 hours

The dose of meropenem for a patient with meningitis is 40 mg/kg every 8 hours, up to a maximum dose of 2 grams every 8 hours for pediatric patients 3 months of age and older, and 2 grams every 8 hours for pediatric patients weighing over 50 kg 2.

From the Research

Meropenem Dosing for Meningitis

• The dose of meropenem for a patient with meningitis can vary depending on the specific circumstances of the patient and the severity of the infection.
• According to a study published in 1995 3, meropenem was administered at a dose of 40 mg/kg every 8 hours, up to a maximum of 6 g/day, for the treatment of bacterial meningitis in adults.
• Another study published in 2014 4 used a dose of 2 g every 8 hours for Japanese adult patients with bacterial meningitis.
• A study published in 2017 5 investigated the pharmacokinetic profile of meropenem in patients with postneurosurgical meningitis and used dosing regimens of 2 g every 8 hours, 1 g every 8 hours, or 1 g every 6 hours.
• The peak meropenem concentration in blood and CSF varied depending on the dosing regimen, with the highest concentration achieved with the 2 g every 8 hours regimen.
• A population pharmacokinetics study published in 2016 6 recommended a 4-hour infusion of 2 g every 8 hours with CSF drainage of less than 150 ml/day for the treatment of postneurosurgical meningitis.

Key Findings

• Meropenem is an effective and well-tolerated antibiotic for the treatment of bacterial meningitis in adults 3.
• The concentration of meropenem in cerebrospinal fluid exceeded the minimal inhibitory concentration for the detected pathogens in a study of Japanese adult patients with bacterial meningitis 4.
• A higher dose and shorter dosing interval of meropenem may be more useful for clearance of pathogens in patients with postneurosurgical meningitis 5.
• The recommended dosing regimen of 2 g every 8 hours with CSF drainage of less than 150 ml/day provides a high probability of target attainment for MICs of ≤8 mg/liter in blood and of ≤0.5 mg/liter or 0.25 mg/liter in CSF 6.