Meropenem Dosing in Patients with Impaired Renal Function
For patients with impaired renal function, meropenem dosage should be reduced based on creatinine clearance, with patients having creatinine clearance <10 mL/min receiving one-half the recommended dose every 24 hours. 1
Dosage Recommendations Based on Renal Function
The FDA-approved meropenem dosing guidelines provide clear recommendations for patients with varying degrees of renal impairment:
| Creatinine Clearance (mL/min) | Dose (dependent on infection type) | Dosing Interval |
|---|---|---|
| Greater than 50 | Recommended dose | Every 8 hours |
| 26 to 50 | Recommended dose | Every 12 hours |
| 10 to 25 | One-half recommended dose | Every 12 hours |
| Less than 10 | One-half recommended dose | Every 24 hours |
The recommended dose depends on the type of infection:
- 500 mg for complicated skin and skin structure infections
- 1 gram for intra-abdominal infections
- 2 grams for meningitis (pediatric patients)
Administration Method
Meropenem should be administered by:
- Intravenous infusion over approximately 15-30 minutes
- Alternatively, doses of 1 gram may be administered as an intravenous bolus injection over approximately 3-5 minutes 1
Special Considerations for Renal Replacement Therapy
The FDA label notes that there is inadequate information regarding meropenem use in patients on hemodialysis or peritoneal dialysis 1. However, research studies provide additional guidance:
For patients on continuous renal replacement therapy (CRRT), meropenem clearance is significantly affected, with approximately 25-50% eliminated by continuous venovenous hemofiltration (CVVHF) and 13-53% by continuous venovenous hemodiafiltration (CVVHDF) 2
In critically ill anuric patients undergoing continuous venovenous hemofiltration, approximately 47% of the dose is removed through the procedure, suggesting that the recommended dose should be increased by 100% compared to standard renal dosing to avoid underdosing 3
Monitoring Recommendations
For patients with renal impairment receiving meropenem:
- Monitor serum creatinine before each dose
- Assess clinical response to therapy
- Consider therapeutic drug monitoring in critically ill patients with impaired renal function to optimize dosing 4
Common Pitfalls to Avoid
Underdosing: There is a significant risk of underdosing patients on renal replacement therapy due to enhanced drug clearance through these procedures 2, 3
Failure to adjust based on infection severity: For severe infections, particularly those caused by less susceptible organisms, higher doses within the recommended range may be necessary even with renal adjustment
Not considering residual renal function: In patients with acute kidney injury, residual renal function may contribute to drug clearance and should be considered when determining dosage
Overlooking patient-specific factors: Research indicates that patient type (septic vs. polytraumatized) can significantly influence meropenem pharmacokinetics and should be considered when determining optimal dosing 5
Safety Profile in Renally Impaired Patients
Meropenem has demonstrated an excellent safety profile in patients with renal impairment, with adverse event patterns similar to those in patients with normal renal function 6. This favorable safety profile supports the use of appropriate dose adjustments rather than avoiding the medication altogether in patients with renal dysfunction.