Meropenem

IV short-infusion regimens for renal bands >50 / 26-50 / 10-25 / <10 mL/min:

• Standard: 1 g every 8 hours / 1 g every 12 hours / 500 mg every 12 hours / 500 mg daily.
• Meningitis or cystic fibrosis: 2 g every 8 hours / 2 g every 12 hours / 1 g every 12 hours / 1 g daily.

IHD: standard 500 mg initially, then every evening; meningitis/cystic fibrosis 1 g initially, then every evening.

CVVHD: standard 1 g every 8 hours; meningitis/cystic fibrosis 2 g every 12 hours. Discuss flow exceeding 2 L/hour with ID pharmacy.

Selected extended infusion uses a 1 g loading dose over 30 minutes, with maintenance beginning 4 hours later. At renal function >50 / 26-50, standard maintenance is 1 g over 3 hours every 8 / 12 hours; meningitis/cystic fibrosis maintenance is 2 g at those intervals. Below 26, use short infusion. Meningitis extended-infusion evidence is limited.

Standard CVVHD treatment: 1 g IV load then 500 mg every 6 hours at dialysate flow 1-4 L/hour. For meningitis, cystic fibrosis or MIC 4, the guide uses 2 g loading, then 2 g every 12 hours at 1 L/hour or every 8 hours at 2-4 L/hour. Do not use the anephric non-CRRT column while clearance is being provided by CVVHD.