Meropenem (Meromac) Dosing for Adults with Normal Renal Function
For adults with normal renal function, administer meropenem 1 gram intravenously every 8 hours, with extended infusion over 3 hours recommended for critically ill patients or when treating resistant organisms. 1
Standard Dosing Regimens
Infection-Specific Dosing
- Complicated intra-abdominal infections: 1 gram IV every 8 hours 1
- Complicated skin and skin structure infections: 500 mg IV every 8 hours for non-Pseudomonal infections 1
- Pseudomonas aeruginosa infections: 1 gram IV every 8 hours regardless of infection type 2, 1
- Carbapenem-resistant Enterobacterales (CRE) bloodstream infections: 1 gram IV every 8 hours by extended infusion 3, 4
Administration Methods
- Standard infusion: 15-30 minutes for routine administration 1
- Extended infusion: 3 hours for critically ill patients, resistant organisms with MIC ≥8 mg/L, or when optimizing pharmacodynamic properties 3, 2, 4
- Bolus injection: 3-5 minutes over 5-20 mL volume is an alternative for stable patients 1
Critical Care Considerations
ICU Patients with Preserved Renal Function
- Higher doses are often necessary due to increased drug clearance and altered volume of distribution in critically ill patients 4
- Extended infusion is strongly recommended to maximize time above MIC, particularly for resistant pathogens 2, 4
- Underdosing is a common pitfall in ICU patients with normal renal function due to augmented renal clearance 4
Therapeutic Drug Monitoring
- TDM is recommended for ICU patients with expected pharmacokinetic variability or clinical signs of toxicity 4
- Target trough concentrations below 64 mg/L to prevent neurological toxicity, particularly seizures 5, 4
- Meropenem has lower pro-convulsive activity compared to imipenem, making it safer in high-risk patients 5, 4
Treatment Duration
- Bloodstream infections: 7-14 days 3
- Complicated urinary tract infections: 5-7 days 3
- Complicated intra-abdominal infections: 5-7 days once source control is achieved 3, 2
- Duration should be individualized based on clinical response, source control adequacy, and inflammatory marker trends 3
Critical Pitfalls to Avoid
- Never reduce individual doses below 1 gram for serious infections, even in renal impairment—extend the dosing interval instead 5, 2
- Do not use meropenem monotherapy for polymicrobial infections or carbapenem-resistant organisms—combination therapy is mandatory 3, 2
- Avoid delaying antibiotic administration for culture results—start empiric therapy immediately 2
- Do not administer before dialysis sessions in patients requiring renal replacement therapy, as this leads to premature drug removal 5