Meropenem Dosing for Sacral Decubitus Ulcer Abscess Due to E. coli ESBL
For a sacral decubitus ulcer abscess caused by E. coli ESBL, administer meropenem 1 gram IV every 8 hours, combined with surgical debridement of necrotic tissue. 1
Rationale for Dosing
Standard Dosing for Complicated Skin and Soft Tissue Infections
- The FDA-approved dose for complicated skin and soft tissue infections (cSSTI) is 500 mg IV every 8 hours 1
- However, when treating cSSTI caused by Gram-negative organisms like E. coli, particularly ESBL-producing strains, the dose should be increased to 1 gram every 8 hours 1
- Administer as an IV infusion over 15-30 minutes, or as a bolus injection over 3-5 minutes 1
ESBL-Specific Considerations
- Meropenem demonstrates excellent activity against ESBL-producing Enterobacteriaceae, with 98.3% susceptibility rates 2
- Clinical cure rates for ESBL E. coli infections treated with carbapenems reach 98% in clinical trials 2
- Monte Carlo simulations demonstrate that for ESBL E. coli with MIC ≤0.25 μg/mL, standard dosing achieves adequate pharmacodynamic targets 3
- For higher MIC values (>0.25 μg/mL), extended infusion (3 hours) or increased dosing frequency may be necessary 3
Infection-Specific Management
Pressure Ulcer Infections
- Infected decubitus ulcers are typically polymicrobial, involving both aerobes (S. aureus, Enterococcus, Proteus, E. coli, Pseudomonas) and anaerobes (Bacteroides fragilis, Clostridium perfringens) 4
- Surgical debridement is mandatory to remove necrotic tissue 4
- Antibiotic therapy should be reserved for patients with severe infections, spreading cellulitis, or systemic signs of infection 4
Alternative Carbapenem Options
- Ertapenem 1 gram IV every 24 hours is an acceptable alternative for community-acquired ESBL infections 4
- Ertapenem is preferred when single daily dosing is advantageous and reserves broader-spectrum carbapenems for more resistant organisms 4
- Imipenem-cilastatin 500 mg IV every 6 hours is another option 4
Renal Dose Adjustments
Dosing in Renal Impairment
- CrCl 26-50 mL/min: 1 gram every 12 hours 1
- CrCl 10-25 mL/min: 500 mg every 12 hours 1
- CrCl <10 mL/min: 500 mg every 24 hours 1
Critical Pitfalls to Avoid
Common Errors
- Do not use the 500 mg dose for ESBL E. coli infections—this is inadequate for Gram-negative pathogens and may lead to treatment failure 1
- Do not rely on antibiotics alone—failure to perform adequate surgical debridement is associated with poor outcomes in pressure ulcer infections 4
- Do not assume monotherapy is sufficient for polymicrobial infections—consider adding coverage for MRSA (vancomycin 15 mg/kg IV every 12 hours) and anaerobes (metronidazole 500 mg IV every 8 hours) if not already covered 4
Enhanced Dosing Strategies
- In patients with preserved renal function (CrCl >80 mL/min) and high MIC organisms (>1 μg/mL), consider dose fractionation: 1 gram every 6 hours with 3-hour infusion 3
- In vasopressor-dependent critically ill patients, standard dosing is usually adequate due to altered pharmacokinetics 3