Meropenem Dosage for Bacterial Infections
For bacterial infections, meropenem is typically dosed at 1 gram IV every 8 hours for most serious infections, with adjustments based on infection type, severity, and patient factors. 1
Standard Adult Dosing
- For complicated skin and skin structure infections: 500 mg IV every 8 hours (increase to 1 gram every 8 hours if treating Pseudomonas aeruginosa) 1
- For complicated intra-abdominal infections: 1 gram IV every 8 hours 1, 2
- Administration should be via intravenous infusion over 15-30 minutes, or as an intravenous bolus injection over 3-5 minutes 1
Special Populations and Conditions
Renal Impairment (Adults)
- Creatinine clearance >50 mL/min: Standard recommended dose 1
- Creatinine clearance 26-50 mL/min: Standard dose every 12 hours 1
- Creatinine clearance 10-25 mL/min: Half the recommended dose every 12 hours 1
- Creatinine clearance <10 mL/min: Half the recommended dose every 24 hours 1
Pediatric Dosing
Children ≥3 months: 1
- Complicated skin/skin structure infections: 10 mg/kg every 8 hours (max 500 mg/dose)
- Complicated intra-abdominal infections: 20 mg/kg every 8 hours (max 1 gram/dose)
- Meningitis: 40 mg/kg every 8 hours (max 2 grams/dose)
Children <3 months with intra-abdominal infections: 1
- Dosing based on gestational age and postnatal age, ranging from 20-30 mg/kg every 8-12 hours
Special Clinical Scenarios
Carbapenem-Resistant Infections
- For carbapenem-resistant Enterobacteriaceae (CRE): 1 gram IV every 8 hours by extended infusion (3 hours) in combination therapy 3, 2
- Extended infusion (3 hours) is recommended when meropenem MIC ≥8 mg/L 3, 2
- For patients with CRAB (carbapenem-resistant Acinetobacter baumannii) infections with meropenem MIC <8 mg/L, consider carbapenem combination therapy with high-dose extended-infusion 4
Treatment Duration
- For complicated intra-abdominal infections: Typically 5-7 days, individualized based on infection site, source control, and clinical response 2
Clinical Pearls
- Meropenem has excellent activity against most clinically significant aerobic and anaerobic pathogens 5
- For critically ill patients with healthcare-associated infections, consider prolonged or continuous infusions to optimize pharmacodynamic targets 2
- Meropenem is stable to human dehydropeptidase-I (DHP-I) and does not require co-administration with cilastatin (unlike imipenem) 6
- Common adverse events include diarrhea (2.3%), rash (1.4%), nausea/vomiting (1.4%), and injection site inflammation (1.1%) 7
- Meropenem has a favorable safety profile with low seizure risk compared to imipenem 7, 6
Combination Therapy Considerations
- For severe CRAB infections, combination therapy with two in vitro active antibiotics is suggested 4
- Polymyxin-meropenem combination therapy is not recommended for CRAB infections 4
- For necrotizing skin and soft tissue infections, meropenem (1 gram every 8 hours IV) can be used as part of broad empiric coverage 4