Meropenem Dosing in Adults with Normal Renal Function
The standard recommended dose of meropenem for adults with normal renal function is 1 gram every 8 hours administered intravenously over 15 to 30 minutes. 1
Standard Dosing Regimens
- For complicated skin and skin structure infections: 500 mg every 8 hours by intravenous infusion over 15-30 minutes 1
- For intra-abdominal infections: 1 gram every 8 hours by intravenous infusion over 15-30 minutes 1
- When treating infections caused by Pseudomonas aeruginosa: 1 gram every 8 hours is recommended 1, 2
- For severe infections including bloodstream infections with carbapenem-resistant Enterobacterales: 1 gram every 8 hours by extended infusion 3
Administration Methods
- Intravenous infusion: Administer over 15-30 minutes (standard method) 1
- Intravenous bolus injection: Can be given over 3-5 minutes (5-20 mL) 1
- Extended infusion: A 3-hour infusion is suggested for optimizing pharmacokinetic/pharmacodynamic properties when treating resistant organisms with higher MICs 3
Special Clinical Scenarios
- For treatment of multidrug-resistant infections: Extended infusion of meropenem for 3 hours is recommended if the meropenem MIC is ≥ 8 mg/L 3
- In critically ill patients with intra-abdominal infections: 1 gram every 8 hours 3
- When used as part of polymyxin-based combination therapy for carbapenem-resistant infections: 1 gram every 8 hours by extended infusion 3
Pharmacokinetic Considerations
- Meropenem is predominantly excreted unchanged in the urine 4
- Half-life is approximately 1 hour in healthy volunteers 4
- Peak plasma concentrations reach between 53-62 mg/L after administration of 1 gram intravenously to healthy volunteers 4
- The primary parameter associated with therapeutic success is the percentage of time that drug levels remain above the minimum inhibitory concentration (MIC) 5
Monitoring Considerations
- Therapeutic drug monitoring (TDM) is not routinely required for most patients with normal renal function 5
- TDM may be beneficial in critically ill patients to ensure adequate drug exposure and optimize clinical outcomes 5
Common Pitfalls and Caveats
- Dosage adjustment is necessary in patients with renal impairment 1, 4
- Underdosing should be avoided due to the risk of treatment failure and development of antimicrobial resistance 4, 5
- Daily doses may range from 1.5 g (500 mg every 8 hours) to 3 g (1 g every 8 hours) in patients with normal renal function, but can be safely increased to 6 g daily if needed for severe infections 2
- Indiscriminate use can promote resistance, so meropenem should be reserved for appropriate indications 2
Remember that meropenem has an ultra-broad spectrum of activity against gram-positive and gram-negative aerobes and anaerobes, making it particularly useful for severe and polymicrobial infections 6.