Meropenem Dosing in Renal Impairment
For adult patients with renal impairment, meropenem dosage should be reduced based on creatinine clearance, with patients having CrCl less than 10 mL/min receiving one-half the recommended dose every 24 hours. 1
Standard Adult Dosing
- Standard adult dose is 500 mg every 8 hours for complicated skin and skin structure infections 1
- For intra-abdominal infections, the standard dose is 1 gram every 8 hours 1
- When treating infections caused by Pseudomonas aeruginosa, a dose of 1 gram every 8 hours is recommended 1
- Administration should be via intravenous infusion over 15-30 minutes or as an intravenous bolus injection over 3-5 minutes 1
Renal Impairment Dosing Schedule for Adults
- CrCl >50 mL/min: Standard recommended dose (500 mg for cSSSI or 1 gram for intra-abdominal infections) every 8 hours 1
- CrCl 26-50 mL/min: Standard recommended dose every 12 hours 1
- CrCl 10-25 mL/min: One-half recommended dose every 12 hours 1
- CrCl <10 mL/min: One-half recommended dose every 24 hours 1
Considerations for Dialysis
- The FDA label notes that there is inadequate information regarding the use of meropenem in patients on hemodialysis or peritoneal dialysis 1
- However, research suggests that approximately 50% of meropenem is eliminated by intermittent hemodialysis 2
- For patients receiving continuous renal replacement therapies, elimination varies: 25-50% by continuous venovenous hemofiltration (CVVHF) and 13-53% by continuous venovenous hemodiafiltration (CVVHDF) 2
- Some research suggests that for patients receiving continuous venovenous hemofiltration, the dose should be increased by 100% compared to anuric patients not receiving hemofiltration to avoid underdosing 3
Pediatric Dosing in Renal Impairment
- For pediatric patients 3 months of age and older with normal renal function, dosing ranges from 10-40 mg/kg every 8 hours depending on infection type 1
- The FDA label states there is no experience in pediatric patients with renal impairment 1
Monitoring and Safety Considerations
- Meropenem has an excellent safety profile in elderly and renally impaired patients 4
- Meropenem-related seizures are rare (0.1%), even in patients with renal impairment 4
- Studies have shown large inter- and intra-patient variability in meropenem concentrations in critically ill populations, which may affect target attainment 5
- For infections with pathogens of MIC 2 mg/L, mild renal impairment up to augmented renal function was identified as a risk factor for target non-attainment 5
Common Pitfalls to Avoid
- Underdosing is a significant risk in patients receiving renal replacement therapy due to varying recommendations in the literature 2
- Failure to adjust dosing based on creatinine clearance can lead to drug accumulation in patients with renal impairment 6
- Not considering the specific type of renal replacement therapy when determining dosage adjustments 2
- Overlooking the need for potential dose increases in patients receiving continuous venovenous hemofiltration 3
When treating patients with renal impairment, careful consideration of both the type of infection and the degree of renal dysfunction is essential for appropriate meropenem dosing to ensure optimal clinical outcomes while minimizing toxicity.