Extended Infusion Meropenem

These materials are intended for general clinical education and guidance. They are not a substitute for a clinician’s knowledge, skill or judgment in treating patients.

Background

Meropenem is a beta-lactam antibiotic, traditionally dosed at intermittent 30-minute infusions. However, its bactericidal activity correlates with the amount of time its serum concentration remains above the minimum inhibitory concentration of the pathogen (fT>MIC), providing a rationale for longer infusion times. Additionally, the rising incidence of resistant bacteria requires higher antibiotic doses and longer infusions to improve microbiological and clinical success. Recent data from a randomized, controlled trial and a meta-analysis demonstrate reduced mortality and improved clinical cure with prolonged meropenem infusions in patients with sepsis or septic shock.

New policy

Starting summer 2025, Sinai Health has a new infusion policy for meropenem, defaulting to an initial dose infused over 30 minutes, followed 4 hours later by subsequent doses, each infused over 3 hours, administered every 8 hours, for patients with normal renal function.

Dosing and intervals should continue to be adjusted to renal function (see dosing table below).

The updated order set for meropenem now reflects this move to an extended infusion regimen.

Extended meropenem infusions should ideally be administered through a dedicated IV line and require the use of a smart infusion pump.

Note: If the Emergency Department initiated meropenem for the patients, please check the timing of administered doses to determine subsequent dose intervals.

Eligibility

This new infusion regimen applies to all hospitalized adult inpatients, including those admitted to the Emergency Department, Intensive Care Unit, General Internal Medicine, Women’s and Infants' Health, Surgery, and Cardiology.

Exceptions

The following are indications to use intermittent infusions:

• One-time or first doses
• Central nervous system infections
• Medication scheduling and/or drug compatibility conflicts that cannot be resolved with available IV lines;
• Medical interventions that cannot be performed during infusion only if administration times cannot be modified
• Consultation by the Antimicrobial Stewardship Program (ASP), Infectious Disease (ID) or Pharmacy recommending an intermittent infusion protocol

Changes to infusion duration

Following the initial phase of extended infusions, patients who require continued meropenem may potentially be changed to intermittent infusion, if their clinical condition has stabilized and newly acquired microbiological data supports bacterial antibiotics susceptibility (with Pharmacy, ASP or ID consult).

Inquiries

For inquiries regarding extended vs intermittent infusions, drug compatibility and interactions, IV line and smart pumps, and potential de-escalation, please contact the floor pharmacist or ASP team during business hours and the on-call pharmacist after hours.

Dosing and interval table

Dosing and intervals for normal and impaired renal function for extended meropenem infusions