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Meropenem Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Skin and Structure Infection

500 mg IV every 8 hours
-Complicated infections due to Pseudomonas aeruginosa: 1 g IV every 8 hours

Approved indication: As a single agent therapy for treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, S agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), P aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species

Usual Adult Dose for Intraabdominal Infection

1 g IV every 8 hours

Approved indication: As a single agent therapy for treatment of complicated intraabdominal infections (including appendicitis and peritonitis) due to viridans group streptococci, E coli, Klebsiella pneumoniae, P aeruginosa, B fragilis, B thetaiotaomicron, and Peptostreptococcus species

Usual Adult Dose for Meningitis

(Not approved by FDA)

Infectious Diseases Society of America (IDSA) recommendations: 2 g IV every 8 hours for 7 to 21 days

Comments:
-Recommended as an alternative therapy

Usual Adult Dose for Nosocomial Pneumonia

(Not approved by FDA)

American Thoracic Society, IDSA recommendations: 1 g IV every 8 hours
Duration of therapy: If the causative organism is not P aeruginosa, the duration of therapy should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Comments:
-Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Usual Pediatric Dose for Skin and Structure Infection

3 months or older: 10 mg/kg IV every 8 hours
Maximum dose: 500 mg/dose

-Complicated infections due to P aeruginosa: 20 mg/kg IV every 8 hours
Maximum dose: 1 g/dose

Comments:
-Limited safety data available to support use of 40 mg/kg (maximum of 2 g) bolus dose.

Approved indication: As a single agent therapy for treatment of complicated skin and skin structure infections due to S aureus (methicillin-susceptible isolates only), S pyogenes, S agalactiae, viridans group streptococci, E faecalis (vancomycin-susceptible isolates only), P aeruginosa, E coli, P mirabilis, B fragilis, and Peptostreptococcus species

Usual Pediatric Dose for Intraabdominal Infection

3 months or older: 20 mg/kg IV every 8 hours
Maximum dose: 1 g/dose

Comments:
-Limited safety data available to support use of 40 mg/kg (maximum of 2 g) bolus dose.

Approved indication: As a single agent therapy for treatment of complicated intraabdominal infections (including appendicitis and peritonitis) due to viridans group streptococci, E coli, K pneumoniae, P aeruginosa, B fragilis, B thetaiotaomicron, and Peptostreptococcus species

Usual Pediatric Dose for Meningitis

3 months or older: 40 mg/kg IV every 8 hours
Maximum dose: 2 g/dose

Comments:
-Limited safety data available to support use of 40 mg/kg (maximum of 2 g) bolus dose.
-Effective in eliminating concurrent bacteremia associated with bacterial meningitis.
-Efficacy as monotherapy in the treatment of meningitis due to penicillin nonsusceptible isolates of S pneumoniae has not been established.

Approved indication: As a single agent therapy for treatment of bacterial meningitis due to S pneumoniae, Haemophilus influenzae, and Neisseria meningitidis

Renal Dose Adjustments

Adults:
CrCl 26 to 50 mL/min: Recommended dose every 12 hours
CrCl 10 to 25 mL/min: One-half recommended dose every 12 hours
CrCl less than 10 mL/min: One-half recommended dose every 24 hours

Pediatric patients: Data not available

Liver Dose Adjustments

No adjustment recommended.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Hemodialysis, peritoneal dialysis: Data not available

Some experts recommend:
Adults:
Conventional hemodialysis: 500 mg IV every 24 hours; alternatively, a dose of 500 mg to 1 g may be given after each dialysis session

Continuous renal replacement therapy: Clearance may be significantly increased; therefore, dose adjustments may be necessary which should be individualized based on the estimated meropenem clearance. Alternatively, initial doses of 500 mg every 12 hours have been suggested for patients undergoing continuous venovenous hemofiltration, and 750 mg every 8 hours or 1500 mg every 12 hours for patients undergoing continuous venovenous hemodiafiltration.

Other Comments

Administration advice:
-Adults: Give as an IV infusion over about 15 to 30 minutes; alternatively, doses of 1 g may be given as an IV bolus injection over about 3 to 5 minutes.
-Pediatric patients: Give as an IV infusion over about 15 to 30 minutes or as an IV bolus injection over about 3 to 5 minutes.

Storage requirements:
-The manufacturer's product information should be consulted.

IV compatibility:
-Compatibility with other drugs has not been established.
-Meropenem should not be mixed with or physically added to solutions containing other drugs.

General:
-Meropenem is useful as presumptive therapy in the indicated condition before causative organism is identified due to broad spectrum of bactericidal activity.

Monitoring:
-Hematologic: Periodic assessment of organ system functions, including hematopoietic (during prolonged therapy)
-Hepatic: Periodic assessment of organ system functions, including hepatic (during prolonged therapy)
-Renal: Periodic assessment of organ system functions, including renal (during prolonged therapy); renal function in elderly patients

Patient advice:
-Avoid missing doses and complete the entire course of therapy.
-Do not operate machinery or motorized vehicles until it is reasonable well established that meropenem is well tolerated.

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