Meropenem Dosing in Adults with Normal Renal Function
For adults with normal renal function, administer meropenem 1 gram intravenously every 8 hours for most serious infections, with infusion over 15-30 minutes or as a 3-5 minute bolus injection. 1
Standard Dosing by Indication
The FDA-approved dosing varies by infection type:
- Complicated intra-abdominal infections: 1 gram IV every 8 hours 1
- Complicated skin and skin structure infections: 500 mg IV every 8 hours 1
- Complicated skin infections caused by Pseudomonas aeruginosa: 1 gram IV every 8 hours 1
Administration Methods
Standard infusion over 15-30 minutes is the typical route, though 1 gram doses may alternatively be given as an IV bolus over 3-5 minutes. 1
Extended Infusion for Resistant Organisms
When treating infections with organisms having MIC ≥4-8 mg/L, use extended infusion over 3 hours to optimize pharmacokinetic/pharmacodynamic properties by maximizing time above the MIC. 2 This is particularly important for:
- Carbapenem-resistant Enterobacterales with meropenem MIC ≥8 mg/L 3
- Hospital-acquired or ventilator-associated pneumonia 3
- Bloodstream infections with carbapenem-resistant organisms 3
Critical Care Considerations
ICU patients with preserved renal function require higher daily doses due to altered pharmacokinetics including increased clearance and expanded volume of distribution. 3 The standard 1 gram every 8 hours dosing is appropriate, but extended infusion should be strongly considered. 3
Continuous Infusion Option
Continuous infusion may be used in critically ill patients, but requires preparation of new infusion bags every 6 hours due to meropenem's limited stability at room temperature. 3, 2
Therapeutic Drug Monitoring
TDM is recommended in ICU patients with clinical signs of potential toxicity or when treating highly resistant organisms. 3 Target trough concentrations should remain below 64 mg/L to prevent neurological toxicity, particularly seizures. 3, 4
Neurological deterioration may occur in approximately two-thirds of ICU patients when free trough concentration normalized to the EUCAST clinical breakpoint for Pseudomonas aeruginosa exceeds 8. 3
Treatment Duration
Standard treatment durations based on infection type: 3
- Bloodstream infections: 7-14 days
- Complicated urinary tract infections: 5-7 days
- Complicated intra-abdominal infections: 5-7 days
- Hospital-acquired/ventilator-associated pneumonia: individualized based on clinical response
Common Pitfalls to Avoid
Underdosing is the most common error in ICU patients with normal renal function due to increased clearance and volume of distribution. 3 Do not reduce doses in critically ill patients unless renal function is impaired.
When using continuous infusion, do not prepare infusion bags for longer than 6 hours due to drug instability at room temperature. 3, 2
For Pseudomonas infections, always use 1 gram every 8 hours, not the 500 mg dose approved for other skin infections. 1