How to use Meropenem (Carbapenem antibiotic) in patients with Chronic Kidney Disease (CKD)?

Meropenem Dosing in Chronic Kidney Disease (CKD)

Meropenem dosage must be adjusted based on creatinine clearance in patients with CKD, with dose reductions of 50-100% and extended dosing intervals as renal function declines. 1

Pharmacokinetics in CKD

• Meropenem is primarily excreted unchanged by the kidneys (approximately 70% of the dose) 1
• Plasma clearance of meropenem correlates directly with creatinine clearance 1
• The elimination half-life increases from approximately 1 hour in patients with normal renal function to up to 6.8 hours in patients with end-stage renal disease 2
• Meropenem is hemodialyzable, with approximately 50% eliminated during hemodialysis sessions 3

Dosage Recommendations Based on Renal Function

For Adults:

• Normal renal function: 500 mg to 1 g IV every 8 hours 1
• Creatinine clearance 30-50 mL/min: 1 g IV every 12 hours 1, 4
• Creatinine clearance 10-29 mL/min: 500 mg IV every 12 hours 1, 5
• Creatinine clearance <10 mL/min: 500 mg IV every 24 hours 1, 5

For Patients on Hemodialysis:

• Administer 500 mg IV after each hemodialysis session 5
• For severe infections, consider 1 g after dialysis 3
• Administer the dose after dialysis to avoid premature removal of the drug 3

For Patients on Continuous Renal Replacement Therapy (CRRT):

• Dosage should be increased by approximately 100% compared to anuric patients not on CRRT 6
• For CVVHF/CVVHDF: 500 mg IV every 8-12 hours depending on infection severity 3, 6

Clinical Considerations

• The risk of underdosing is significant in CKD patients, especially those with serious infections 3
• Meropenem has an excellent safety profile, making it preferable to err on the side of higher dosing when treating severe infections 3
• Unlike aminoglycosides, meropenem does not have significant nephrotoxic effects, making it a safer choice for patients with renal impairment 7
• For critically ill patients with severe infections, consider using the higher end of the dosing range within the constraints of renal adjustment 6

Monitoring

• Regular assessment of renal function is essential during meropenem therapy in CKD patients 1
• Monitor clinical response and consider therapeutic drug monitoring in complicated cases 4
• Be alert for signs of drug accumulation, although meropenem is generally well-tolerated even in patients with renal impairment 3

Special Considerations

• For elderly patients with renal impairment, be aware that plasma clearance may be further reduced due to age-associated reduction in creatinine clearance 1
• In patients with both hepatic and renal impairment, no additional dose adjustments beyond renal adjustments are typically needed 1