Meropenem Adult Dosing in Normal Renal Function
For adults with normal renal function, administer meropenem 500 mg IV every 8 hours for complicated skin and skin structure infections, or 1 gram IV every 8 hours for intra-abdominal infections and infections caused by Pseudomonas aeruginosa. 1
Standard Dosing Regimens
By Infection Type
- Complicated skin and skin structure infections (cSSSI): 500 mg IV every 8 hours 1
- Pseudomonas aeruginosa infections: 1 gram IV every 8 hours 1
- Intra-abdominal infections: 1 gram IV every 8 hours 1
- Hospital-acquired or ventilator-associated pneumonia: 1 gram IV every 8 hours 2
- Bloodstream infections with carbapenem-resistant organisms: 1 gram IV every 8 hours by extended infusion 2
Administration Methods
- Standard infusion: Administer over 15-30 minutes 1
- Bolus injection: May give 5-20 mL over 3-5 minutes 1
- Extended infusion: Administer over 3 hours when treating resistant organisms with MIC ≥8 mg/L to optimize pharmacokinetic/pharmacodynamic properties 2
Special Considerations for Critically Ill Patients
Higher daily doses should be used at the onset of treatment in ICU patients with preserved renal function due to altered pharmacokinetics. 2
ICU-Specific Factors
- Critically ill patients often have increased clearance of meropenem despite normal renal function 2
- Tissue hypoperfusion from shock and vasoconstrictors alters drug distribution 2
- Underdosing is common in ICU patients with normal renal function due to increased volume of distribution 2
Continuous Infusion Option
- Continuous infusion may be used but requires preparation of new infusion bags every 6 hours due to limited stability at room temperature 2, 3
- This method provides more consistent drug exposure but has practical limitations 3
Treatment Duration by Infection Type
- Bloodstream infections: 7-14 days 2
- Complicated urinary tract infections: 5-7 days 2
- Complicated intra-abdominal infections: 5-7 days 2
Therapeutic Drug Monitoring
TDM is recommended in ICU patients with clinical signs of potential toxicity or expected pharmacokinetic variability. 2, 3
Target Concentrations
- Maintain free drug concentrations above the pathogen's MIC for optimal efficacy 3
- Keep trough concentrations below 64 mg/L to prevent neurological toxicity 2, 4
Toxicity Warning
- 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 2
- Meropenem has relatively low pro-convulsive activity compared to other beta-lactams, but seizures can occur with excessive plasma concentrations 2
Common Pitfalls to Avoid
- Do not underdose in critically ill patients: Standard dosing may be insufficient due to increased clearance 2
- Consider extended infusion for resistant organisms: When MIC is ≥4-8 mg/L, use 3-hour infusion to maximize time above MIC 2
- Monitor for stability issues with continuous infusion: Prepare fresh bags every 6 hours 2
- Do not ignore pharmacokinetic variability in ICU patients: Consider TDM early in treatment 2