Meropenem

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

500 mg – 1 g every 8 hoursHigher doses used in cystic fibrosis and meningitis (up to 2 g every 8 hours)

PHARMACOKINETICS

Molecular weight :437.5

%Protein binding :2

%Excreted unchanged in urine : 70

Volume of distribution (L/kg) :0.351

half-life – normal/ESRD (hrs) :1/6–13.72

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : 500 mg – 2 g every 12 hours

10 to 20 : 500 mg – 1 g every 12 hours or 500 mg every 8 hours

<10 : 500 mg – 1 g every 24 hours

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. Dose as in GFR

<10 : mL/min

HD :Dialysed. Dose as in GFR

<10 : mL/min or 1–2 g post dialysis2

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min

CAV/VVHD :Dialysed. 0.5–1 g every 8 hours2,3 or 1 g every 12 hours1 CVVhdF1 g every 12 hours3

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsProbenecid: avoid concomitant use

ADMINISTRATION

Reconstition

Add 5 mL water for injection to each 250 mg of meropenem

Route

Rate of Administration

Bolus: 5 minutes IV Infusion: 15–30 minutes

Comments

Further dilute in 50–200 mL sodium chloride 0.9%, glucose 5% or glucose 10% if for infusionStable for 24 hours once reconstituted Minimum volume 1 g in 10 mL. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3 rd Edition, 2006)

OTHER INFORMATION

Metabolite is inactive and renally excreted Each 1 g vial contains 3.9 mmol of sodium Has less potential to induce seizures than imipenemHas been used intraperitoneally for peritoneal dialysis Pseudomonas peritonitis at concentration of 100 mg/L50% is removed by CVVHF, 13–53% by CVVHDF, 50% by intermittent

HD :.2Differences in renal replacement doses are due to the different flow rates used in the studies

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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