What is the recommended dose of Meropenem (generic name) for pediatric patients?

Pediatric Meropenem Dosing

For pediatric patients 3 months and older, administer meropenem 20 mg/kg IV every 8 hours for complicated intra-abdominal infections and complicated skin/soft tissue infections, or 40 mg/kg IV every 8 hours (maximum 2 grams per dose) for meningitis. 1

Age-Specific Dosing Guidelines

Neonates and Infants Less Than 3 Months

Dosing is based on gestational age (GA) and postnatal age (PNA): 1

• Infants <32 weeks GA and PNA <2 weeks: 20 mg/kg IV every 12 hours 1
• Infants <32 weeks GA and PNA ≥2 weeks: 20 mg/kg IV every 8 hours 1
• Infants ≥32 weeks GA and PNA <2 weeks: 20 mg/kg IV every 8 hours 1
• Infants ≥32 weeks GA and PNA ≥2 weeks: 30 mg/kg IV every 8 hours 1

These recommendations apply specifically to complicated intra-abdominal infections in neonates with normal renal function. 1

Pediatric Patients 3 Months and Older

Indication-based dosing: 1

• Complicated skin and skin structure infections (cSSSI): 10 mg/kg IV every 8 hours (maximum 500 mg per dose) 1
• Complicated intra-abdominal infections (cIAI): 20 mg/kg IV every 8 hours (maximum 1 gram per dose) 1
• Bacterial meningitis: 40 mg/kg IV every 8 hours (maximum 2 grams per dose) 1

For cSSSI caused by Pseudomonas aeruginosa: Increase dose to 20 mg/kg (or 1 gram for patients >50 kg) every 8 hours 1

Patients Weighing Over 50 kg

Use adult dosing: 1

• cSSSI: 500 mg IV every 8 hours 1
• cIAI: 1 gram IV every 8 hours 1
• Meningitis: 2 grams IV every 8 hours 1

Administration Guidelines

Meropenem should be administered as an IV infusion over 15-30 minutes. 1 Alternatively, doses may be given as an IV bolus injection over 3-5 minutes, though there is limited safety data for bolus administration of 40 mg/kg doses (up to 2 grams). 1

For neonates less than 3 months, administer as a 30-minute IV infusion. 1

Dosing in Renal Impairment

There is no established dosing guidance for pediatric patients with renal impairment. 1 However, in pediatric hemodialysis patients, a dose of 25 mg/kg daily or 40 mg/kg every other day has been suggested based on pharmacokinetic modeling. 2

Special Populations and Considerations

Drug-Resistant Tuberculosis Treatment

For multidrug-resistant tuberculosis in children, meropenem is dosed at 20-40 mg/kg per dose three times daily, typically combined with clavulanate (25 mg/kg of the amoxicillin component three times daily). 3 Frequency may be reduced in renal dysfunction. 3

Multidrug-Resistant Gram-Negative Infections

For carbapenem-resistant Enterobacterales or extensively drug-resistant organisms in pediatric patients, dosing follows the standard recommendations above, though combination therapy is often required. 3

Pharmacokinetic Rationale

The recommended 20 mg/kg every 8 hours dosing maintains plasma concentrations above the MIC90 for most susceptible pathogens throughout the dosing interval. 4 Meropenem demonstrates a half-life of approximately 1.1 hours in children, with approximately 55% recovered unchanged in urine. 4 No significant age-dependent pharmacokinetic differences exist among pediatric patients 2 months to 12 years. 4

Common Pitfalls to Avoid

• Do not underdose meningitis: The 40 mg/kg dose is critical for adequate CSF penetration 1
• Do not use adult doses in children <50 kg: Weight-based dosing is essential 1
• Do not forget to increase dose for P. aeruginosa in cSSSI: Standard 10 mg/kg dosing is inadequate 1
• Do not mix with other drugs: Compatibility has not been established 1
• Do not freeze reconstituted solutions: Use freshly prepared solutions when possible 1