Meropenem Dosage Guidelines for Adults
For adults with normal renal function, meropenem should be administered at 1 gram every 8 hours by intravenous infusion over 15 to 30 minutes for intra-abdominal infections, and 500 mg every 8 hours for complicated skin and skin structure infections. 1
Standard Dosing for Adults with Normal Renal Function
- Complicated skin and skin structure infections: 500 mg every 8 hours IV
- Intra-abdominal infections: 1 gram every 8 hours IV
- Infections caused by Pseudomonas aeruginosa: 1 gram every 8 hours IV 1
- Administration method:
- Intravenous infusion over 15-30 minutes (standard)
- Extended infusion of 3-4 hours recommended for severe infections 2
Dosage Adjustments for Renal Impairment
Meropenem requires dose adjustment based on creatinine clearance:
| 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 and Considerations
Critically Ill Patients
- Consider extended infusion (3-4 hours) to improve clinical and microbiological efficacy, especially for bacteria with high MICs 2
- Higher doses (up to 6 g/day) may be required for critically ill patients with augmented renal clearance 3
- Therapeutic drug monitoring is recommended when available 2
Elderly Patients
- For patients over 59 years with compromised renal function, consider reducing the dose 2
- Monitor renal function closely as elderly patients may have reduced clearance 4
Administration Methods
- Standard infusion: 15-30 minutes
- Extended infusion: 3-4 hours (recommended for severe infections)
- Bolus injection: 3-5 minutes (5-20 mL) 1
Clinical Pearls and Pitfalls
Common Pitfalls
- Underdosing in severe infections: Standard dosing may be inadequate for critically ill patients with augmented renal clearance
- Failure to adjust for renal function: Meropenem is primarily eliminated by the kidneys, making dose adjustment essential in renal impairment
- Inadequate duration of infusion: Short infusions may not achieve optimal time above MIC for resistant organisms
Monitoring Recommendations
- Monitor renal function regularly during therapy
- Assess clinical response (temperature, heart rate, blood pressure, respiratory rate)
- Consider therapeutic drug monitoring in critically ill patients 2
Treatment Duration
- Treatment can be discontinued when the patient is afebrile for 48 hours, clinical stability is achieved, source control has been accomplished, and appropriate total duration for the specific infection has been completed 2
- For intra-abdominal infections with adequate source control: 4-7 days 2
- For urosepsis: 7-14 days, with consideration for shorter duration (5-7 days) if rapid clinical improvement occurs 2
Meropenem's pharmacokinetic profile shows a half-life of approximately 1 hour in patients with normal renal function, with predominantly extracellular distribution 4. This necessitates the frequent dosing schedule to maintain adequate concentrations above the minimum inhibitory concentration (MIC) for targeted pathogens.