Maximum Daily Dose of Meropenem
The maximum daily dose of meropenem for adults is 6 grams per day, typically administered as 2 grams every 8 hours. 1
Standard Dosing Guidelines
Meropenem dosing varies based on the type of infection being treated:
- Skin and skin structure infections: 500 mg IV every 8 hours 1
- Intra-abdominal infections: 1 gram IV every 8 hours 1
- Complicated skin and skin structure infections caused by P. aeruginosa: 1 gram IV every 8 hours 1
- Bacterial meningitis (pediatric patients): 40 mg/kg (up to maximum 2 grams) every 8 hours 1
For severe infections, particularly those caused by less susceptible organisms, higher doses up to the maximum of 2 grams every 8 hours may be required.
Administration Methods
Meropenem can be administered by:
- Intravenous infusion over 15-30 minutes (standard method)
- Intravenous bolus injection over 3-5 minutes (for doses of 1 gram or less) 1
Dosage Adjustments
Renal Impairment
Dosage adjustment is necessary for patients with reduced renal function:
| Creatinine Clearance (mL/min) | Dose | Dosing Interval |
|---|---|---|
| >50 | Standard dose | Every 8 hours |
| 26-50 | Standard dose | Every 12 hours |
| 10-25 | Half standard dose | Every 12 hours |
| <10 | Half standard dose | Every 24 hours |
Special Populations
- Elderly patients: May require dose reduction due to age-related decline in renal function 1
- Patients on CVVH: 1 gram every 8 hours has been suggested 2
- Critically ill patients: May require higher doses or extended infusion times to achieve therapeutic targets 3
Common Pitfalls and Caveats
Underdosing in severe infections: For severe infections or less susceptible organisms, using the maximum dose of 2 grams every 8 hours may be necessary to achieve adequate therapeutic levels.
Failure to adjust for renal function: Meropenem is primarily eliminated by the kidneys, so dosage adjustment is crucial in patients with renal impairment to prevent toxicity.
Ignoring residual diuresis: In patients on continuous renal replacement therapy, residual diuresis can significantly impact meropenem clearance and should be considered when determining dosing regimens 4.
Inadequate CNS penetration: For CNS infections, higher doses may be required as meropenem penetration into cerebrospinal fluid can be variable 3.
Inappropriate infusion time: Extended infusion (over 3-4 hours) may improve efficacy for less susceptible organisms by increasing the time above MIC without increasing the daily dose.
When treating serious infections, particularly in critically ill patients or those with multidrug-resistant organisms, the maximum daily dose of 6 grams should be considered to optimize therapeutic outcomes while monitoring for potential adverse effects.