Meropenem Dosage for Adults with Normal and Impaired Renal Function
The recommended dosage of meropenem for adults with normal renal function is 1 gram every 8 hours for most serious infections, while dosage should be reduced based on creatinine clearance for patients with renal impairment. 1, 2
Standard Dosing for Adults with Normal Renal Function
- For most serious infections including intra-abdominal infections and infections caused by Pseudomonas aeruginosa, the recommended dose is 1 gram every 8 hours 1, 2
- For complicated skin and skin structure infections, a lower dose of 500 mg every 8 hours may be sufficient 1
- Administration should be via intravenous infusion over 15-30 minutes, or via intravenous bolus injection over 3-5 minutes 1
- Extended infusion of meropenem for 3 hours is beneficial when treating resistant organisms with higher MICs 2
Dosing for Adults with Renal Impairment
Dosage should be adjusted based on creatinine clearance as follows:
- Creatinine clearance >50 mL/min: Standard recommended dose (500 mg for cSSSI or 1 gram for other infections) every 8 hours 1
- Creatinine clearance 26-50 mL/min: Standard recommended dose every 12 hours 1
- Creatinine clearance 10-25 mL/min: One-half recommended dose every 12 hours 1
- Creatinine clearance <10 mL/min: One-half recommended dose every 24 hours 1
Clinical Considerations
- For severe infections including bloodstream infections with carbapenem-resistant Enterobacterales, extended infusion is recommended to optimize pharmacokinetic/pharmacodynamic properties 2
- In critically ill patients with intra-abdominal infections, 1 gram every 8 hours is the recommended regimen 3, 2
- The half-life of meropenem (approximately 1 hour in healthy volunteers) can be prolonged up to 13.7 hours in anuric patients with end-stage renal disease 4
- Patients receiving renal replacement therapy may require specific dosing adjustments, as approximately 50% of meropenem is eliminated by intermittent hemodialysis 4
Important Considerations for Optimal Therapy
- Inadequate levels of meropenem can lead to therapeutic failure and increase the possibility of microbial resistance 5
- The primary pharmacodynamic parameter associated with therapeutic success is the percentage of time that drug levels remain above the minimum inhibitory concentration (MIC) 5
- Therapeutic drug monitoring may be beneficial for critically ill patients and those with impaired renal function to ensure optimal dosing 5
- For treatment of multidrug-resistant infections, extended infusion is particularly important if the meropenem MIC is ≥ 8 mg/L 2
Common Pitfalls and Caveats
- Underdosing should be avoided due to the risk of treatment failure and development of resistance 4, 5
- Meropenem is relatively stable to hydrolysis by dehydropeptidase I (DHP-I), unlike imipenem, so it does not require co-administration with cilastatin 6
- When treating infections caused by Pseudomonas aeruginosa, the higher dose of 1 gram every 8 hours should be used rather than the lower 500 mg dose 1
- Resistance to meropenem may emerge during treatment of Pseudomonas aeruginosa infections, similar to other beta-lactam agents 7