Meropenem Dosing in Children
The recommended dose of meropenem in children is 60 mg/kg/day divided into three doses (20 mg/kg every 8 hours), with a maximum of 2 grams per dose depending on the type of infection. 1
Age-Specific Dosing Recommendations
Children 3 Months and Older
- Complicated skin and skin structure infections: 10 mg/kg every 8 hours (maximum 500 mg per dose) 1
- Complicated intra-abdominal infections: 20 mg/kg every 8 hours (maximum 1 gram per dose) 1
- Bacterial meningitis: 40 mg/kg every 8 hours (maximum 2 grams per dose) 1
- Pseudomonas aeruginosa infections: 20 mg/kg every 8 hours (maximum 1 gram per dose for children weighing over 50 kg) 1
Children Less Than 3 Months of Age
For complicated intra-abdominal infections, dosing is based on gestational age (GA) and postnatal age (PNA):
- Infants <32 weeks GA and PNA <2 weeks: 20 mg/kg every 12 hours 1
- Infants <32 weeks GA and PNA ≥2 weeks: 20 mg/kg every 8 hours 1
- Infants ≥32 weeks GA and PNA <2 weeks: 20 mg/kg every 8 hours 1
- Infants ≥32 weeks GA and PNA ≥2 weeks: 30 mg/kg every 8 hours 1
Administration Methods
- Standard infusion: Administer over 15-30 minutes 1
- IV bolus injection: Can be given over 3-5 minutes (5-20 mL) 1
- Extended infusion: Consider for severe infections, especially with high MIC pathogens 2
Renal Dosing Adjustments
For children with renal impairment, dose adjustments should follow adult guidelines, though specific pediatric data are limited:
- CrCl >50 mL/min: Standard dose every 8 hours
- CrCl 26-50 mL/min: Standard dose every 12 hours
- CrCl 10-25 mL/min: Half standard dose every 12 hours
- CrCl <10 mL/min: Half standard dose every 24 hours 1
Clinical Considerations and Caveats
Efficacy Concerns
Recent research suggests that standard dosing regimens may fail to achieve therapeutic targets in some children, particularly those over 3 months of age with Pseudomonas infections or pathogens with higher MICs 3. Only 68.4% of children older than 3 months weighing <50 kg achieved target exposures for organisms with MICs of 2 mg/L, and this dropped to 41.7% for MICs of 4 mg/L 3.
Extended Infusion Benefits
For serious infections, especially those caused by less susceptible organisms:
- Extended infusion (3-4 hours) may improve clinical outcomes 2
- A dose of 40 mg/kg given by extended infusion results in higher mid-dose and trough concentrations compared to standard intermittent bolus administration 4
Monitoring Recommendations
- Assess clinical response within 48-72 hours of initiating therapy
- Monitor renal function regularly during treatment
- Consider therapeutic drug monitoring in critically ill patients if available 2
Treatment Duration
For intra-abdominal infections with adequate source control, a treatment duration of 4-7 days is typically sufficient, though this should be tailored to clinical response 2.
Important Safety Note
Limited safety data is available to support the administration of a 40 mg/kg bolus dose (up to maximum of 2 grams), so caution should be exercised with higher doses 1.