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Carbapenems

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Topic updated on 09/16/17 10:32pm

Introduction
  • Classification
    • antibiotic
      • penicillin-family (β-lactam)
        • carbapenems
  • Drugs
    • imipenem (+ cilastatin)
    • meropenem
    • doripenem
    • ertapenem
Mechanism
  • Action
    • see Penicillin 
    • β-lactamase resistant
    • normal kidneys break down imipenem with a dihydropeptidase
      • cilastatin, a selective dihydropeptidase inhibitor, is always given with imipenem
        • inhibits renal dihydropeptidase I, thereby decreasing inactivation of drug in renal tubules
      • cilastatin not needed for meropenem
  • Resistance
    • some bacteria can hydrolyze carbapenems
    • some bacteria have decreased the size of their porins, preventing entry of the drug
Uses
  • Imipenem has the broadest activity of any known antibiotic
    • effective against
      • Gram-positives
      • Gram-negatives
        • including most Pseudomonas
        • used for Enterobacter
      • anaerobes
    • NOT effective against
      • MRSA
      • bacteria without peptidoglycan cell walls
        • e.g. Mycoplasma
      • some Pseudomonas spp.
  • Other carbapenems provide similar broad spectrum coverage
    • however, ertapenem does not cover Pseudomonas
Adverse effects
  • Significant adverse effects limit use of these drugs
    • seizures
      • meropenem has reduced risk of seizures
    • nausea, vomiting, GI upset
    • skin rash
  • Allergy
    • 5-10% of patients with penicillin allergy are also allergic to carbapenems
Pharmacology
  • Given IV or IM
  • Renal excretion


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