Meropenem Dosing for Patients with Creatinine Clearance of 38 mL/min
For a patient with moderate renal impairment (creatinine clearance of 38 mL/min), the recommended dose of meropenem is the standard dose administered every 12 hours instead of every 8 hours. 1
Dosing Recommendations
- For a patient with creatinine clearance between 26-50 mL/min, maintain the recommended dose based on infection type but extend the dosing interval to every 12 hours 1
- For complicated skin and skin structure infections: 500 mg IV every 12 hours 1
- For intra-abdominal infections: 1 gram IV every 12 hours 1
- For infections caused by Pseudomonas aeruginosa: 1 gram IV every 12 hours 1
Administration Method
- Administer meropenem via intravenous infusion over 15 to 30 minutes 1
- Alternatively, administer as an intravenous bolus injection (5-20 mL) over 3-5 minutes 1
- For patients undergoing hemodialysis, administer after dialysis sessions to avoid premature elimination of the drug 2
Pharmacokinetic Considerations
- Meropenem is predominantly excreted unchanged in the urine, making dosage adjustments necessary in patients with renal insufficiency 3
- The half-life of meropenem increases from approximately 1 hour in healthy volunteers to up to 13.7 hours in patients with end-stage renal disease 3
- Total body clearance and renal clearance of meropenem are linearly related to creatinine clearance 4
- In patients with moderate renal impairment, the extended dosing interval helps maintain therapeutic concentrations while reducing the risk of drug accumulation 5
Clinical Considerations
- Maintaining adequate dosing is critical as underdosing may lead to treatment failure and potential development of antimicrobial resistance 3
- The excellent tolerability profile of meropenem allows for appropriate dosing to ensure efficacy while minimizing toxicity concerns 3
- For critically ill patients with infections caused by pathogens with higher minimum inhibitory concentrations (MICs), more aggressive dosing strategies may be considered after consulting with infectious disease specialists 6
Monitoring Recommendations
- Monitor renal function regularly during treatment 1
- Assess clinical response to therapy and adjust dosing if necessary based on microbiological results and patient response 6
- Be vigilant for any signs of adverse effects, although meropenem is generally well-tolerated even in patients with renal impairment 5