Meropenem Dosing for E. coli Infections
For adults with normal renal function and E. coli infections, administer meropenem 1 gram IV every 8 hours as a 15-30 minute infusion, or 500 mg every 8 hours for uncomplicated skin/soft tissue infections. 1
Standard Dosing by Infection Type
Complicated Intra-abdominal Infections
- 1 gram IV every 8 hours for infections caused by E. coli 1
- Administer as 15-30 minute infusion or 3-5 minute bolus 1
- Duration: 5-7 days for most cases 2
Complicated Skin and Skin Structure Infections
- 500 mg IV every 8 hours for standard cases 1
- 1 gram IV every 8 hours if Pseudomonas aeruginosa is suspected (though this applies to P. aeruginosa, not E. coli specifically) 1
Bloodstream Infections (E. coli)
Urinary Tract Infections
- 1 gram IV every 8 hours for complicated UTI caused by carbapenem-resistant Enterobacterales 2
- Duration: 5-7 days 2
Dosing Adjustments for Renal Impairment
Critical adjustment required when creatinine clearance ≤50 mL/min: 1
| Creatinine Clearance | Dose | Interval |
|---|---|---|
| >50 mL/min | Standard dose (500 mg or 1 g) | Every 8 hours |
| 26-50 mL/min | Standard dose | Every 12 hours |
| 10-25 mL/min | Half standard dose | Every 12 hours |
| <10 mL/min | Half standard dose | Every 24 hours |
Extended Infusion Strategy
For critically ill patients or high MIC organisms (MIC >1 μg/mL), extended infusion is superior to standard infusion: 3, 4
- 1 gram every 6 hours as 3-hour infusion achieves >90% target attainment for MIC up to 2 μg/mL in patients with normal renal function 3
- Extended 3-hour infusions provide target attainment for MIC values up to two-fold higher than 0.5-hour infusions 4
- For patients with creatinine clearance >80 mL/min and MIC 2 μg/mL, maximum dose of 2 grams every 8 hours as 3-hour infusion may be required 3
Special Populations
Pediatric Patients (≥3 months)
- 20 mg/kg every 8 hours (maximum 1 gram per dose) for complicated intra-abdominal infections 1
- 10 mg/kg every 8 hours (maximum 500 mg per dose) for skin/soft tissue infections 1
- Administer as 15-30 minute infusion 1
Critically Ill Patients on Vasopressors
- Standard dosing regimens are generally adequate due to altered pharmacokinetics 3
- Lower total daily doses may achieve therapeutic targets compared to patients not on vasopressors 3
Important Clinical Considerations
ESBL-Producing E. coli
- Meropenem remains highly effective against ESBL-producing E. coli 3, 4, 5
- Standard dosing (1 gram every 8 hours) achieves 100% cumulative fraction of response for most E. coli isolates 4
- Extended infusion not mandatory for ESBL E. coli but may optimize outcomes 4
Carbapenem-Resistant E. coli
- For carbapenem-resistant Enterobacterales (CRE), meropenem-vaborbactam 4 grams IV every 8 hours is preferred over standard meropenem 2
- Standard meropenem monotherapy is not recommended for confirmed CRE 2
Common Pitfalls
- Do not use meropenem 500 mg every 8 hours for serious infections - this dose is only for uncomplicated skin/soft tissue infections 1
- Avoid underdosing in augmented renal clearance - critically ill patients with creatinine clearance >80 mL/min may require higher doses or extended infusions 3
- Do not mix with other drugs - compatibility with other medications has not been established 1
- Adjust for renal function early - failure to dose-adjust can lead to toxicity or treatment failure 1