Meropenem Dosing for Urinary Tract Infections in Adults
For adults with normal renal function, the recommended dose of meropenem for treating urinary tract infections is 1 gram intravenously every 8 hours for 5-7 days. 1
Dosing Based on Renal Function
Normal Renal Function
- Dose: 1 gram IV every 8 hours
- Duration: 5-7 days for complicated UTIs 1
Impaired Renal Function
- CrCl 26-50 mL/min: 1 gram IV every 12 hours 2
- CrCl 10-25 mL/min: 500 mg IV every 12 hours
- CrCl <10 mL/min: 500 mg IV every 24 hours
Patients on Renal Replacement Therapy
- Continuous Venovenous Hemofiltration (CVVH): 1 gram IV every 8 hours 3
- Continuous Venovenous Hemodiafiltration (CVVHDF): 1 gram IV every 12 hours 4
- Hemodialysis: Administer dose after dialysis session
Clinical Considerations
Indications for Meropenem in UTIs
Meropenem is typically reserved for:
- Complicated UTIs caused by multidrug-resistant organisms
- Severe infections requiring broad-spectrum coverage
- Patients with risk factors for resistant pathogens
Administration
- Intravenous administration over 15-30 minutes
- Extended infusion (3 hours) recommended for isolates with MIC ≥8 mg/L 1
Efficacy
- Clinical efficacy rates of up to 100% have been reported for complicated UTIs 5
- Bacteriological efficacy rates of approximately 89% 5
Special Populations
- Elderly patients (>65 years): Standard dosing can be used with appropriate renal adjustment 2
- The safety profile in elderly patients is similar to younger adults 2
Monitoring
- Assess clinical response within 48-72 hours
- Consider follow-up urine culture in complicated cases
- Monitor renal function during therapy
- If symptoms persist or recur within 2 weeks, obtain repeat urine culture
Alternative Regimens for Complicated UTIs
For carbapenem-resistant Enterobacterales (CRE) causing UTIs, consider:
- Ceftazidime-avibactam 2.5 g IV q8h
- Meropenem-vaborbactam 4 g IV q8h
- Imipenem-cilastatin-relebactam 1.25 g IV q6h
- Aminoglycosides (if susceptible): Gentamicin 5-7 mg/kg/day IV daily or Amikacin 15 mg/kg/day IV daily 1
Common Pitfalls and Caveats
- Avoid underdosing in severe infections
- Remember to adjust dosing based on renal function
- Consider local resistance patterns when selecting empiric therapy
- Meropenem is not recommended for uncomplicated UTIs where narrower-spectrum agents would be appropriate
- Seizure risk is low (0.1%) even in renally impaired patients 2
Meropenem demonstrates excellent penetration into the urinary tract and maintains good activity against many multidrug-resistant pathogens, making it an effective option for complicated UTIs when used at appropriate doses.