Meropenem Dosing for Adults with Normal Renal Function
The recommended dose of meropenem for adults with normal renal function is 1 gram every 8 hours administered by intravenous infusion over 15 to 30 minutes. 1
Standard Dosing Recommendations
The FDA-approved dosing for meropenem varies based on the type of infection:
- Complicated skin and skin structure infections (cSSSI): 500 mg every 8 hours 1
- Intra-abdominal infections: 1 gram every 8 hours 1
- Infections caused by Pseudomonas aeruginosa: 1 gram every 8 hours 1
- For critically ill patients: 1 gram every 8 hours 2
Administration Methods
Meropenem can be administered in two ways:
- Standard infusion: Over 15 to 30 minutes 1
- IV bolus injection: Over 3 to 5 minutes (5 mL to 20 mL) 1
- Extended infusion: For critically ill patients or when treating bacteria with high MICs, extended infusion over 3-4 hours may improve clinical and microbiological efficacy 3
Considerations for Special Populations
Renal Impairment
Dosage adjustment is required for patients with renal impairment:
| 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 |
Elderly Patients
- For patients over 59 years old, especially those with compromised renal function, consider monitoring renal function more closely 3, 4
- Meropenem is generally well-tolerated in elderly patients with a safety profile similar to younger adults 4
Clinical Efficacy and Spectrum of Activity
Meropenem is a carbapenem antibiotic with broad-spectrum activity against:
- Gram-positive bacteria (streptococci, methicillin-sensitive staphylococci)
- Gram-negative bacteria (including Pseudomonas aeruginosa)
- Anaerobes
- Common aerobic gram-negative nosocomial pathogens 5
Monitoring During Treatment
- Regular monitoring of renal function is recommended throughout treatment 3
- Assess clinical response through monitoring of vital signs (temperature, heart rate, blood pressure, respiratory rate) 3
- Consider therapeutic drug monitoring in critically ill patients if available 3
Common Pitfalls and Caveats
Resistance development: Resistance to meropenem may emerge during treatment of P. aeruginosa infections. Avoid indiscriminate use to prevent resistance development 5
Dosing errors in renal impairment: Failing to adjust dosage in patients with renal impairment can lead to drug accumulation and potential toxicity 6, 7
Underdosing in critically ill patients: Critically ill patients, especially those with sepsis, may have altered pharmacokinetics requiring optimized dosing strategies 8
Residual diuresis impact: In patients receiving continuous renal replacement therapy, residual diuresis can significantly impact meropenem clearance and should be considered when determining dosing regimens 8
Meropenem is generally well-tolerated with fewer neurotoxic effects compared to imipenem, making it a preferred carbapenem in many clinical scenarios 5, 7.