From the Guidelines
For pediatric patients with Urinary Tract Infections (UTIs), the recommended dose of Meropenem is 20 mg/kg/dose every 8 hours intravenously. This dosing recommendation is based on the guidelines for the treatment of various infections, including those caused by multidrug-resistant organisms 1. It's essential to note that Meropenem should be reserved for serious infections or when first-line therapies have failed, due to its broad-spectrum activity as a carbapenem antibiotic.
When considering the treatment of pediatric UTIs with Meropenem, several factors come into play:
- The dosage of 20 mg/kg/dose every 8 hours is specified for pediatric patients beyond the neonatal period 1.
- The maximum adult dose is 1 g every 8 hours, but for pediatric patients, the dose is weight-based, not to exceed the maximum adult dose per kilogram of body weight.
- Treatment duration typically ranges from 7-14 days, depending on the complexity of the infection and the patient's response to therapy.
- Renal dose adjustments are crucial for children with impaired kidney function to prevent accumulation of the drug and potential toxicity.
- Before initiating Meropenem, it's crucial to obtain urine cultures to confirm the causative organism and its susceptibility to the antibiotic, ensuring the most effective treatment regimen.
Key considerations in the use of Meropenem for pediatric UTIs include:
- Monitoring for side effects such as gastrointestinal symptoms, rash, and seizures, particularly in patients with CNS disorders or renal impairment.
- Understanding the mechanism of action of Meropenem, which involves inhibiting bacterial cell wall synthesis, making it effective against a wide range of gram-positive, gram-negative, and anaerobic bacteria, including ESBL-producing organisms.
- Recognizing the importance of reserving Meropenem for cases where its use is justified by the severity of the infection or the resistance pattern of the causative organism, to minimize the development of antibiotic resistance.
From the FDA Drug Label
2.3 Use in Pediatric Patients Pediatric Patients 3 Months of Age and Older For pediatric patients 3 months of age and older, the meropenem for injection dose is 10 mg/kg, 20 mg/kg or 40 mg/kg every 8 hours (maximum dose is 2 grams every 8 hours), depending on the type of infection (cSSSI, cIAI, intra-abdominal infection or meningitis).
Table 2: RecommendedMeropenem for Injection Dosage Schedule for Pediatric Patients 3 Months of Age and Older with Normal Renal Function Type of Infection Dose (mg/kg) Up to a Maximum Dose Dosing Interval Complicated skin and skin structure infections 10 500 mg Every 8 hours Complicated intra-abdominal infections 20 1 gram Every 8 hours Meningitis 40 2 grams Every 8 hours
The recommended dose of Meropenem for pediatric patients with Urinary Tract Infections (UTIs) is not explicitly stated in the provided drug label. However, based on the available information for other types of infections, the dose for pediatric patients 3 months of age and older is 10 mg/kg, 20 mg/kg, or 40 mg/kg every 8 hours, depending on the type of infection. Since UTIs are not listed, it's unclear which dose would be appropriate.
- The maximum dose is 2 grams every 8 hours.
- For pediatric patients weighing over 50 kg, the dose is 500 mg every 8 hours for cSSSI, 1 gram every 8 hours for cIAI, and 2 grams every 8 hours for meningitis.
- There is no experience in pediatric patients with renal impairment. 2
From the Research
Meropenem Dosage for Pediatric Patients with UTIs
- The recommended dose of Meropenem for pediatric patients with Urinary Tract Infections (UTIs) is 20 mg/kg given every 8 hours, as this dose will maintain plasma meropenem concentrations above the MIC that inhibits 90% of strains tested for virtually all potentially susceptible bacterial pathogens 3.
- A study published in 2024 suggested that for a target of 40% fT > MIC, the most effective dosing regimen is 20 mg/kg every 8 hours with a 3-hour infusion 4.
- Another study published in 2016 found that meropenem given as i.v. bolus doses of 20 mg/kg/dose q8h appeared to be inadequate for PK/PD target attainment for organisms with an MIC of 1 mg/L, and that a 3-hour infusion of a 20 mg/kg/dose improved the PTA 5.
- It is essential to note that the dosage may need to be adjusted based on the patient's renal function and fluid status, as well as the specific characteristics of the infection being treated 4, 5.
- In patients receiving hemodialysis, a dose of 25 mg/kg daily or 40 mg/kg on alternate days may be necessary to achieve an acceptable pharmacodynamic profile 6.