What is the recommended dose of meropenem for a patient with impaired renal function (GFR of 30)?

Meropenem Dosing for Patients with GFR of 30 mL/min

For patients with a GFR of 30 mL/min, the recommended dose of meropenem is the standard dose (500 mg for skin/soft tissue infections or 1 gram for intra-abdominal infections) administered every 12 hours. 1

Dosage Adjustment Based on Renal Function

Meropenem is primarily excreted unchanged through the kidneys, making dose adjustment necessary in patients with impaired renal function. The FDA-approved dosing guidelines provide clear recommendations based on creatinine clearance:

• GFR >50 mL/min: Standard dose every 8 hours
• GFR 26-50 mL/min: Standard dose every 12 hours
• GFR 10-25 mL/min: Half the standard dose every 12 hours
• GFR <10 mL/min: Half the standard dose every 24 hours 1

With a GFR of 30 mL/min, the patient falls into the 26-50 mL/min category, requiring the standard dose administered every 12 hours.

Infection-Specific Dosing

The standard dose of meropenem varies depending on the type of infection:

• For complicated skin and skin structure infections: 500 mg
• For intra-abdominal infections: 1 gram
• For infections caused by Pseudomonas aeruginosa: 1 gram 1

Administration Method

Meropenem should be administered by:

• Intravenous infusion over 15-30 minutes (preferred method), or
• Intravenous bolus injection over 3-5 minutes (for 1 gram doses) 1

Monitoring Considerations

When administering meropenem to patients with renal impairment:

1. Monitor for signs of central nervous system toxicity, including seizures, which may occur more frequently in patients with renal impairment 2
2. Consider therapeutic drug monitoring in critically ill patients, especially when treating resistant organisms
3. Evaluate renal function regularly during treatment
4. Monitor for adverse effects, which may include headache, nausea, constipation, diarrhea, anemia, vomiting, and rash 1

Special Considerations

• For patients on hemodialysis, additional dosing after dialysis sessions may be required as meropenem is removed by hemodialysis 3
• For patients with severe infections caused by less susceptible organisms (MIC 2-4 mg/L), more aggressive dosing may be necessary 4
• In Asian patients with lower body mass index, consider using the lower end of the dosing range due to potential increased risk of adverse effects 2

Practical Application

1. Determine the type of infection to select the appropriate standard dose
2. Confirm the patient's GFR is 30 mL/min
3. Administer the standard dose every 12 hours
4. Monitor renal function and clinical response throughout treatment
5. Adjust dosing if renal function changes significantly during treatment

By following these guidelines, you can ensure appropriate meropenem dosing for patients with moderate renal impairment while minimizing the risk of toxicity and maintaining therapeutic efficacy.