Meropenem Dosing for Sepsis Due to UTI
For sepsis secondary to urinary tract infection, administer meropenem 1 gram intravenously every 8 hours as the standard regimen, with treatment duration of 5-7 days for complicated UTIs. 1, 2
Standard Dosing Protocol
- Meropenem 1 gram IV every 8 hours is the recommended dose for critically ill patients with sepsis from UTI, based on European Urology guidelines 1, 2
- Treatment duration should be 5-7 days for complicated UTIs, though this may be extended based on source control effectiveness and clinical response 2
- For normal renal function, this dosing provides adequate coverage for multidrug-resistant organisms causing urinary sepsis 1
Extended Infusion Considerations
- Consider extended infusion over 3 hours if the pathogen's meropenem MIC is ≥8 mg/L to optimize pharmacokinetic/pharmacodynamic properties 2
- Standard bolus infusion over 30 minutes is appropriate for organisms with MIC <2 mg/L 3
- Extended infusion may allow treatment of infections with higher MIC values while maintaining therapeutic drug levels 4
High-Dose Regimen for Severe Sepsis
- Meropenem 2 grams IV every 8 hours can be used in critically ill patients with severe sepsis, as this dose is associated with improved outcomes in life-threatening infections 4
- The maximum safe daily dose of meropenem is 6 grams, providing flexibility for dose escalation in severe cases 5
- Caution: High doses are associated with increased seizure risk, particularly in patients with renal dysfunction or CNS pathology 4
Carbapenem-Resistant Organisms
If carbapenem-resistant Enterobacterales (CRE) are suspected or confirmed:
- Meropenem-vaborbactam 4 grams IV every 8 hours is the preferred alternative 2
- Ceftazidime-avibactam 2.5 grams IV every 8 hours plus metronidazole is another option 4, 2
- Imipenem-cilastatin-relebactam 1.25 grams IV every 6 hours can be considered 2
Critical Pitfalls to Avoid
- Do not use meropenem empirically for uncomplicated pyelonephritis; reserve it for confirmed multidrug-resistant organisms based on culture results 1
- Address underlying urological abnormalities (obstruction, stones, structural issues) as antimicrobial therapy alone will fail without source control 1
- Adjust dosing for renal dysfunction: patients with creatinine clearance <50 mL/min require dose reduction to 1 gram every 12 hours 6
- Monitor for residual diuresis in critically ill patients, as preserved urine output may increase meropenem clearance and require dose adjustment 3
Renal Replacement Therapy Considerations
For patients on continuous renal replacement therapy (CRRT):
- Oligoanuric patients: 500 mg every 8 hours as 30-minute bolus for susceptible organisms (MIC <2 mg/L) 3
- Patients with preserved diuresis: 500 mg every 8 hours as 3-hour infusion for the same MIC range 3
- For resistant organisms (MIC 2-4 mg/L): increase to 500 mg every 6 hours, with infusion time adjusted based on residual diuresis 3
- CRRT intensity does not significantly modify clearance; residual diuresis is the key determinant 3