Meropenem Treatment and Dosage for Adults with Normal Renal Function
For adults with normal renal function, the recommended dosage of meropenem is 500 mg IV every 8 hours for skin and skin structure infections, and 1 gram IV every 8 hours for intra-abdominal infections and other serious bacterial infections. 1
Standard Dosing Regimens
- For complicated skin and skin structure infections: 500 mg IV every 8 hours 1
- For complicated intra-abdominal infections: 1 gram IV every 8 hours 1
- When treating skin and skin structure infections caused by Pseudomonas aeruginosa, a higher dose of 1 gram every 8 hours is recommended 1
- For carbapenem-resistant Enterobacterales (CRE) bloodstream infections: 1 gram IV every 8 hours by extended infusion (3 hours) 2
Administration Methods
- Standard administration: Intravenous infusion over approximately 15-30 minutes 1
- Bolus injection: Doses of 1 gram may be administered as an intravenous bolus injection (5-20 mL) over approximately 3-5 minutes 1
- Extended infusion: For resistant organisms with higher MICs (≥8 mg/L), extended infusion of meropenem for 3 hours is recommended 2
- Continuous infusion may be used but requires consideration of meropenem's limited stability at room temperature 3
Treatment Duration
- Bloodstream infections: 7-14 days 2
- Complicated urinary tract infections: 5-7 days 2
- Complicated intra-abdominal infections: 5-7 days 2
- Treatment duration should be individualized according to infection site, source control, underlying comorbidities, and initial response to therapy 2
Special Clinical Scenarios
- For hospital-acquired pneumonia or ventilator-associated pneumonia: 1 gram IV every 8 hours 2
- For polymyxin-based combinations in carbapenem-resistant infections: Meropenem 1 gram IV every 8 hours by extended infusion 2
- In critically ill patients with preserved renal function, higher daily doses may be considered due to altered pharmacokinetics 3
Pharmacokinetic Considerations
- Meropenem has a half-life of approximately 1 hour in patients with normal renal function 4
- The volume of distribution is 21L, indicating predominantly extracellular distribution 4
- Up to 70% of the drug is recovered in urine, with the remainder metabolized to a beta-lactam ring-opened form 4
Safety Profile
- Most common meropenem-related adverse events include diarrhea (2.3%), rash (1.4%), nausea/vomiting (1.4%), and injection site inflammation (1.1%) 5
- Meropenem has a relatively low pro-convulsive activity compared to other beta-lactams, but neurological adverse effects may occur when plasma concentrations exceed 64 mg/L 3
- Meropenem is generally well-tolerated in all patients, including children and patients with neutropenia 5
Common Pitfalls and Caveats
- Underdosing is common in ICU patients with normal renal function due to increased clearance and volume of distribution 3
- When using extended infusion, consider drug stability (6-12 hours at room temperature) 3
- For patients with renal impairment, dosage adjustment is necessary based on creatinine clearance 1
- Therapeutic drug monitoring (TDM) may be beneficial in critically ill patients to ensure adequate drug levels and prevent toxicity 6