Dose of meropenam and vancomycin
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meropenem dosing regimens adults renal adjustment
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vancomycin dosing regimens adults renal adjustment
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Meropenem — Dosing
Standard Adult Doses
| Indication | Dose | Interval | Infusion |
|---|---|---|---|
| Mild–moderate infections | 500 mg | q8h | 30 min IV |
| Moderate–severe infections | 1 g | q8h | 30 min IV |
| Severe/life-threatening (e.g., meningitis, febrile neutropenia, nosocomial pneumonia) | 2 g | q8h | 30 min–3h IV |
| Augmented renal clearance (CrCl >130 mL/min) | 1–2 g | q6–8h | Extended/CI |
Renal Dose Adjustment (Adults)
| CrCl (mL/min) | Dose | Interval |
|---|---|---|
| >50 | Standard dose | q8h |
| 26–50 | Standard dose | q12h |
| 10–25 | Half dose | q12h |
| <10 / HD | Half dose | q24h (give after HD) |
Extended infusion (3-hour infusion) is preferred for organisms with higher MICs (e.g., P. aeruginosa, Acinetobacter) to maximize time-dependent killing (fT>MIC).
Vancomycin — Dosing
Standard Adult Doses
| Indication | Dose | Interval |
|---|---|---|
| General serious infections (MRSA, endocarditis, meningitis) | 15–20 mg/kg (actual body weight) | q8–12h IV |
| Loading dose (severe/critically ill) | 25–30 mg/kg (single dose) | Once |
| Max single dose | 3,000 mg | — |
| Max infusion rate | 10–15 mg/min (to avoid Red Man Syndrome) | — |
Typical starting dose in a 70 kg patient: 1,250–1,500 mg q12h
Renal Dose Adjustment
| CrCl (mL/min) | Interval |
|---|---|
| >90 | q8–12h |
| 50–90 | q12h |
| 20–49 | q24h |
| 10–19 | q48–72h |
| <10 / HD | Dose by levels; give after HD |
| CRRT | 1 g q24h (adjust by levels) |
Therapeutic Drug Monitoring (TDM)
The 2020 ASHP/IDSA/SIDP Vancomycin Guidelines recommend AUC-guided dosing over trough-only monitoring:
| Parameter | Target |
|---|---|
| AUC₀₋₂₄ | 400–600 mg·h/L (for serious MRSA infections) |
| Trough (if AUC not available) | 15–20 mg/L |
| Peak (1h post-infusion) | 25–40 mg/L |
Trough-only monitoring is associated with nephrotoxicity; AUC/MIC-guided dosing is now the standard of care.
Key Points
- Meropenem is time-dependent; extended or continuous infusion improves PK/PD outcomes for resistant organisms.
- Vancomycin requires individualized dosing based on weight, renal function, and TDM; always dose per pharmacy protocol.
- Both drugs need renal dose adjustment — meropenem by reducing frequency, vancomycin by extending interval and monitoring levels.
- In hemodialysis: meropenem supplemental dose after each session; vancomycin redosed when trough <10–15 mg/L.
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