The dose and duration of therapy should be determined depending on the type and severity of the infection and the condition of the patient.
The following daily doses are recommended:
Adults
500 mg intravenously every 8 hours in the treatment of pneumonia, urinary tract infections, gynecological infections such as endometritis, skin infections and skin structures.
1 g intravenously every 8 hours in the treatment of nosocomial pneumonia, peritonitis, suspected bacterial infection in patients with symptoms of neutropenia, and septicemia.
In the treatment of meningitis, the recommended dose is 2 g every 8 hours.
The safety of taking a dose of 2 g in the form of a bolus injection has not been sufficiently studied.
Special categories of patients
Patients with impaired renal function
In patients with creatinine clearance less than 51 mL / min, the dose should be reduced as follows:
Creatinine clearance | Dose | Frequency is entered and si |
26-50 ml / min | 500 mg - 1.0 g - 2.0 g | every 12 hours |
10-25 ml / min | 250 - 500 mg - 1.0 g | every 12 hours |
<10 ml / min | 250 - 500 mg - 1.0 g | every 24 hours |
Meropenem is excreted in hemodialysis and hemofiltration. If prolonged treatment is required, it is recommended to administer a dose (determined according to the type and severity of the infection) at the end of hemodialysis to restore the effective concentration in the blood plasma.
At present, there is no data on the experience of using the drug for administration to patients on peritoneal dialysis.
Patients with impaired hepatic function
Patients with hepatic insufficiency do not need a dose adjustment.
Elderly patients
In elderly patients with normal renal function or creatinine clearance greater than 50 mL / min, dose adjustment is not required.
Children
For children aged 3 months to 12 years, the recommended dose for intravenous administration is 10-20 mg / kg every 8 hours, depending on the type and severity of the infection, the sensitivity of the pathogen and the patient's condition.For children weighing more than 50 kg, dosages should be used for adults. With meningitis, the recommended dose is 40 mg / kg every 8 hours. The safety of administering a dose of 40 mg / kg in the form of a bolus injection has not been adequately studied. Experience with the drug in children with impaired liver and kidney function is absent.
Preparation of solutions and method of administration
Meropenem for intravenous use may be given as an intravenous bolus injection, or as an intravenous infusion.
To prepare a solution for intravenous bolus injections, the drug should be dissolved with sterile water for injection (5 ml per 250 mg), with a solution concentration of 50 mg / ml (injected for at least 5 minutes). The resulting solution remains stable for 3 hours at a temperature of up to 25 ° C and for 16 hours when stored in a refrigerator (2-8 ° C).
To prepare a solution for intravenous infusions, the drug should be dissolved with 0.9% sodium chloride solution or 5% dextrose solution, with the concentration of the solution should be from 1 to 20 mg / ml (injected for 15-30 minutes). The resulting solution remains stable for 3 hours at a temperature of up to 25 ° C and for 24 hours when stored in a refrigerator (2-8 ° C), if 0.9% sodium chloride solution was used for its preparation.A solution prepared using a 5% dextrose solution should be used immediately.
The possibility of using meropenem in the regime of prolonged infusion (up to 3 hours) is based on pharmacokinetic and pharmacodynamic parameters (see the section "Pharmacokinetics"). To date, clinical data and safety data supporting this regimen are limited.
The drug solution should not be frozen.
The prepared solution is recommended to be administered immediately after preparation (from the microbiological point of view), if the conditions for the preparation of the solution do not exclude the possibility of microbiological contamination.