What is the recommended adult dose of meropenem (Inj meropenem)?

Meropenem Adult Dosing

For most adult infections, administer meropenem 1 gram IV every 8 hours as a 15-30 minute infusion, with dose adjustments based on infection severity, pathogen susceptibility, and renal function. 1

Standard Dosing by Infection Type

Skin and Soft Tissue Infections

• Standard dose: 500 mg IV every 8 hours 1
• Pseudomonas aeruginosa infections: 1 gram IV every 8 hours 1
• Necrotizing infections: 1 gram IV every 8 hours as part of combination therapy 2

Intra-Abdominal Infections

• Standard dose: 1 gram IV every 8 hours 1
• Community-acquired (non-critically ill): 1 gram IV every 8 hours 2
• Healthcare-associated (critically ill): 1 gram IV every 8 hours, with consideration for extended infusion 2
• Treatment duration: 5-7 days, individualized based on source control and clinical response 3

Hospital-Acquired and Ventilator-Associated Pneumonia

• Low risk of multidrug-resistant organisms: 1 gram IV every 8 hours 2
• High risk of multidrug-resistant organisms: 1 gram IV every 8 hours as part of combination therapy 2
• Severe pneumonia: Consider 2 grams IV every 8 hours by extended infusion 3

Administration Methods

Standard Infusion

• 15-30 minute infusion: Appropriate for most infections 1
• Bolus injection: 1 gram doses may be given as IV bolus over 3-5 minutes 1

Extended Infusion (3 hours)

• Carbapenem-resistant Enterobacteriaceae: 1 gram IV every 8 hours by 3-hour infusion 3
• High MIC organisms (≥8 mg/L): Extended infusion recommended to optimize pharmacodynamics 3
• Critically ill patients: Prolonged infusion preferred to achieve target concentrations 3

Renal Dose Adjustments

Dosing must be reduced when creatinine clearance falls below 50 mL/min: 1

• CrCl >50 mL/min: Standard dose every 8 hours 1
• CrCl 26-50 mL/min: Standard dose every 12 hours 1
• CrCl 10-25 mL/min: Half the standard dose every 12 hours 1
• CrCl <10 mL/min: Half the standard dose every 24 hours 1

High-Dose Regimens for Resistant Organisms

Carbapenem-Resistant Infections

• Standard approach: 1 gram IV every 8 hours by 3-hour extended infusion as combination therapy 3
• High MIC KPC-producing organisms (MIC ≥16 mg/L): 2 grams IV every 8 hours by 3-hour extended infusion 3

Critically Ill Patients

• Severe infections or pneumonia: 2 grams IV every 8 hours 3
• Extended infusion strategy: Administer over 3 hours to maximize time above MIC 3

Important Clinical Considerations

No Loading Dose Required

• Meropenem does not require a loading dose for standard administration in patients with normal renal function, unlike colistin, tigecycline, or vancomycin 3

Pharmacodynamic Targets

• Target parameter: Maintain free drug concentrations above MIC for at least 40% of the dosing interval for bacteriostatic effect 4
• Enhanced target: 100% time above MIC for bactericidal effect in critically ill patients, achievable with extended infusion 3
• Clinical response: 80% response rate when meropenem concentrations exceed MIC for >75% of dosing interval 4

Therapeutic Drug Monitoring

• Consider TDM in: Critically ill patients, those with impaired renal function, or when treating resistant organisms with high MIC values 5
• Target trough concentrations: Maintain levels 4-6 times above MIC for optimal outcomes in severe infections 3

Common Pitfalls to Avoid

• Underdosing Pseudomonas infections: Always use 1 gram every 8 hours, not 500 mg 1
• Ignoring renal function: Failure to adjust for creatinine clearance <50 mL/min risks toxicity 1
• Standard infusion for resistant organisms: Use extended 3-hour infusion when MIC ≥8 mg/L 3
• Inadequate duration: Do not stop therapy prematurely; most infections require 5-7 days minimum 3