From the FDA Drug Label
Dosage should be reduced in patients with creatinine clearance of 50 mL/min or less.
Table 1: RecommendedMeropenem for Injection Dosage Schedule for Adult Patients with Renal Impairment Creatinine Clearance (mL/min) Dose (dependent on type of infection) Dosing Interval Greater than 50 Recommended dose (500 mg cSSSI and 1 gram Intra-abdominal) Every 8 hours 26 to 50 Recommended dose Every 12 hours 10 to 25 One-half recommended dose Every 12 hours Less than 10 One-half recommended dose Every 24 hours
The recommended dosing schedule for meropenem in adult patients with renal impairment is as follows:
- Creatinine clearance greater than 50 mL/min: standard dose (500 mg for cSSSI, 1 gram for intra-abdominal infections) every 8 hours
- Creatinine clearance 26-50 mL/min: standard dose every 12 hours
- Creatinine clearance 10-25 mL/min: half of the standard dose every 12 hours
- Creatinine clearance less than 10 mL/min: half of the standard dose every 24 hours 1
From the Research
Meropenem dosing should be adjusted in patients with renal failure based on creatinine clearance (CrCl), with the most recent and highest quality study 2 not directly applicable to meropenem but highlighting the importance of adjusting antibiotic dosing in renal failure.
Key Considerations
- For patients with CrCl 26-50 mL/min, administer 1 gram every 12 hours;
- for CrCl 10-25 mL/min, give 500 mg every 12 hours;
- and for CrCl less than 10 mL/min, administer 500 mg every 24 hours.
Hemodialysis and CRRT Considerations
- For patients on hemodialysis, give 500 mg every 24 hours with an additional dose after dialysis sessions.
- For continuous renal replacement therapy (CRRT), dosing typically ranges from 500 mg every 8-12 hours to 1 gram every 8-12 hours depending on the specific CRRT modality and flow rates, as supported by studies such as 3 and 4.
Rationale
These adjustments are necessary because meropenem is primarily eliminated by the kidneys, and reduced renal function leads to drug accumulation and potential toxicity, as discussed in 5 and 6. The goal of dose adjustment is to maintain effective antimicrobial concentrations while minimizing adverse effects such as seizures, which can occur with excessive levels.
Monitoring and Adjustment
Monitor renal function regularly during therapy and adjust dosing as needed if renal function changes during treatment.