Carbapenems

Carbapenems is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Imipenem (500 mg–1 g IV/IM q6–8h), meropenem (1–2 g IV q8h or 500 mg IV q6h), doripenem (500 mg IV q8h), and ertapenem (1 g IV q24h) are the currently available carbapenems.
  • Meropenem-vaborbactam (2 g meropenem/2 g vaborbactam q8h) is a combination product consisting of meropenem plus the β-lactamase inhibitor vaborbactam. This agent is FDA approved for treatment of complicated urinary tract infections, including acute pyelonephritis. Meropenem-vaborbactam possesses unique activity against KPC-producing Enterobacteriaceae (but not against metallo-β-lactamases). However, vaborbactam does not appreciably enhance the activity of meropenem against Pseudomonas or Acinetobacter. Because of the meropenem component, this agent is reliably active against MSSA and anaerobes.
  • Carbapenems exert their bactericidal effect by interfering with cell wall synthesis, similar to PCNs and cephalosporins, and are active against most gram-positive and gram-negative bacteria, including anaerobes. They are among the antibiotics of choice for infections caused by organisms producing AmpC or ESBLs.

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