Meropenem is not contraindicated in AKI or CKD. It is commonly used in renal impairment, but because it is primarily cleared by the kidneys, the dose or interval must be adjusted to renal function to prevent accumulation and neurotoxicity, including seizures.

For adults, use estimated creatinine clearance (CrCl, usually Cockcroft-Gault) and base the adjustment on the usual infection-specific dose.

Examples, if the intended standard regimen is 1 g IV every 8 hours:

If the intended standard regimen is 500 mg IV every 8 hours:

In AKI, renal function can change rapidly, so reassess creatinine, urine output, dialysis status, and dosing at least daily. In severe sepsis, clinicians may give an appropriate initial full loading dose, then adjust subsequent doses, but this should be individualized by the treating team or pharmacist.

For intermittent hemodialysis or CRRT, the regimen differs, so do not apply the table without a dialysis-specific dosing plan. The official FDA prescribing information recommends adjustment when CrCl is 50 mL/min or less. Meropenem is stable to renal dehydropeptidase and has a lower seizure incidence than imipenem, but excess exposure in renal dysfunction can still increase neurologic adverse effects. Goodman & Gilman's The Pharmacological Basis of Therapeutics, lines 1009-1015.