Carbapenem

Carbapenems are antibiotics used for the treatment of infections known or suspected to be caused by multidrug-resistant (MDR) bacteria. Their use is primarily in people who are hospitalized.

Like the penicillins and cephalosporins, they are members of the beta lactam class of antibiotics, which kill bacteria by binding to penicillin-binding proteins and inhibiting cell wall synthesis. They exhibit a broader spectrum of activity compared to cephalosporins and penicillins. Their effectiveness is less affected by many common mechanisms of antibiotic resistance than other beta lactams.

Carbapenem antibiotics were originally developed at Merck & Co. from the carbapenem thienamycin, a naturally derived product of Streptomyces cattleya. Concern has arisen in recent years over increasing rates of resistance to carbapenems, as there are few therapeutic options for treating infections caused by carbapenem-resistant bacteria (such as the carbapenem-resistant Enterobacteriaceae and Klebsiella pneumoniae).

The carbapenem ertapenem is one of several first-line agents recommended by the Infectious Disease Society of America for the empiric treatment of community-acquired intra-abdominal infections of mild-to-moderate severity. Agents with anti-pseudomonal activity, including doripenem, imipenem, and meropenem are not recommended in this population. Doripenem, imipenem, and meropenem are recommended for high-risk community-acquired abdominal infections and for abdominal infections that are hospital-acquired.

A 2015 systematic review found little evidence that would support the identification of a best antimicrobial regimen for complicated urinary tract infections, but identified three high-quality trials supporting high cure rates with doripenem, including in patients with levofloxacin-resistant E. coli infections.

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