Meropenem Dosing for Adults with Osteomyelitis
For adults with osteomyelitis, meropenem should be dosed at 1 gram IV every 8 hours for a minimum of 6 weeks. 1
Dosing Recommendations
- Meropenem 1 gram IV every 8 hours is the standard dosing for Pseudomonas aeruginosa and other gram-negative infections causing osteomyelitis 1
- Extended infusion (over 3 hours) is recommended when treating resistant organisms or when the meropenem MIC is ≥8 mg/L 1, 2
- For carbapenem-resistant Enterobacteriaceae (CRE), extended infusion of meropenem may be used as part of combination therapy 1
- The total treatment duration for osteomyelitis should be at least 6 weeks 1
Clinical Considerations
- Meropenem provides excellent coverage against streptococci, methicillin-sensitive staphylococci, and common aerobic gram-negative pathogens including Pseudomonas 3
- Surgical debridement and drainage of associated soft-tissue abscesses should be performed whenever feasible as an adjunct to antimicrobial therapy 1, 4
- Meropenem has a favorable safety profile with most common adverse events being diarrhea (2.3%), rash (1.4%), nausea/vomiting (1.4%), and injection site inflammation (1.1%) 5
- Therapeutic drug monitoring may be beneficial to ensure adequate serum concentrations, particularly when using extended or continuous infusions 6
Dosage Adjustments
- For patients with renal impairment, dosage adjustment is necessary 7:
- CrCl 26-50 mL/min: 1 g IV every 12 hours
- CrCl 10-25 mL/min: 500 mg IV every 12 hours
- CrCl <10 mL/min: 500 mg IV every 24 hours
Alternative Regimens
- For patients with osteomyelitis caused by MRSA, alternative agents should be considered as meropenem lacks activity against this pathogen 1, 4
- For patients with osteomyelitis caused by Pseudomonas aeruginosa who cannot receive meropenem, cefepime 2 g IV every 8-12 hours or ciprofloxacin 750 mg PO twice daily can be considered 1
- For patients with osteomyelitis caused by Enterobacteriaceae who cannot receive meropenem, ertapenem 1 g IV every 24 hours or ciprofloxacin 500-750 mg PO twice daily can be considered 1
Common Pitfalls
- Resistance to meropenem may emerge during treatment of Pseudomonas aeruginosa infections 3
- Stenotrophomonas maltophilia is typically resistant to meropenem 3
- Indiscriminate use of carbapenems can promote resistance; therefore, they should be reserved for appropriate indications 3
- Meropenem lacks activity against methicillin-resistant Staphylococcus aureus (MRSA), enterococci, and atypical mycobacteria 3