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Adjustment of Dose & Administration

Indication-Specific Adjustment

Therapy is determined based on indication and creatinine clearance

Indication/Population/Pathogen                                                              CrCl (infusion time)
>50 mL/min 25-49 mL/min 10-24 mL/min <10 mL/min OR IHD CRRT

Intra-abdominal infections including necrotizing pancreatitis

Pneumonia

Neutropenic fever

ESBL infections

Pathogen susceptible to meropenem AND patient with allergies to alternative treatments

MDR pathogen (other than Pseudomonas or Acinetobacter) susceptible to meropenem

500 mg q6h (0.5 hr) 500 mg q8h (0.5 hr) 500 mg q12h (0.5 hr) 500 mg q24h (0.5 hr) 500 mg q6h (0.5 hr)

Cystic fibrosis, (susceptible organisms; all indications except CNS as described below)

MDR Pseudomonas/Acinetobacter, susceptible to meropenem

1g q8h (3 hr) 1g q12h (3 hr) 500mg q12h (3 hr) 500mg q24h (3 hr) 1g q12h (3 hr)

CNS infections

Necrotizing fasciitis

Bone/Joint (may give each dose over 30 min prior to discharge or in outpatient setting)

2g q8h (3 hr) 2g q12h (3hr) 1g q12h (3 hr) 1g q24h (give dose after HD) (3 hr) 2g q12h (3hr)

 

Drug-Specific Information

Loading doses: an initial loading dose may be given over 0.5 hours. This approach may be particularly useful to achieve faster target attainment in immunocompromised patients or in patients with previously documented Pseudomonas organisms with higher MIC distribution. Of note, administering loading doses has not been shown to decrease mortality or time to clinical improvement compared to initiating therapy with an extended infusion.

Y-site compatibility with vancomycin: There is not sufficient data to recommend Y-site compatibility with meropenem and vancomycin.  Meropenem 1mg/mL in NS was physically compatible with vancomycin 5 mg/mL in sterile water for injection, however these concentrations and diluents are not used clinically. Therefore, it is not recommended to Y-site vancomycin and meropenem

Dose Adjustments by Pharmacists: Orders for traditional doses/administration of meropenem for adults will be interchanged with alternate dosing. Pharmacists may automatically interchange traditional dosing meropenem orders and adjust the dose of meropenem as indicated in the guideline for renal adjustment. Orders will be adjusted “per protocol, no cosign required.”  The prescriber must be notified if orders need to be adjusted based on indication (i.e. from alternate dosing indication to extended-infusion indication). If there is any question about the indication for meropenem, the prescriber should be contacted for clarification. 

 

Please find optimal dosing recommendations here.

Restricted Use

ID approval required (page 970-GERM) except as noted (see Restriction page)

General Notes

  1. Up-to-date cost information, click here 
  2. IV antimicrobials outpatient (OPAT) dosing, click here
  3. Obesity dosing weight recommendations here
  4. Helpful drug-drug interaction check website here 
  5. When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.