Carbapenems

Carbapenems belong to a group of β-lactam antibiotics. Comparing with penicillins and cephalosporins, carbapenems are more resistant to hydrolyzing action of β-lactamases, including extended spectrum beta lactamases and possess a wider spectrum of antibacterial activity. Carbapenems were originally developed from thienamycin, a naturally-derived product of Streptomyces cattleya.
Carbapenems are generally used in severe infections of different localizations. In life-threatening infections carbapenems are indicated as preparations of first line treatment.
The following drugs belong to the carbapenem class:

  • Imipenem (often given as part of Imipenem/cilastatin)
  • Meropenem
  • Ertapenem
  • Doripenem
  • Panipenem/betamipron
  • Biapenem
  • PZ-601 (being currently tested)

Faropenem is closely related, but it is a penem, not a carbapenem

Action mechanism
Carbapenems exert bactericidal action associated with interfering with the formation of bacterial cell wall. They suppress certain enzymes responsible for synthesis of murein. Murein (peptidoglycan) forms mesh-like layer outside the plasma membrane of bacteria. Spectrum of activity include gram-positive, gram-negative and anaerobic microorganisms.
Indications
Carbapenems are used to treat severe nosocomial infections caused polyresistant and mixed microflora:

  • Infections of the upper airways
  • Complicated urinary tract infections
  • Intraabdominal infections
  • Infections of the pelvic organs
  • Sepsis
  • Skin and soft tissue infections
  • Bone and joints infections (only imipenem)
  • Endocarditis (only imipenem)
  • Bacterial infections in patients with neutropenia
  • Meningitis (only meropenem)

Administration
Currently the use carbapemens is limited. They are primary administered in the form of intravenous injections in hospital settings in order to avoid developing of bacterial resistance.
Contraindications
Medications are contraindicated for use in known hypersensitivity or allergy to carbapenems. It is not recommended to use carbapenems during pregnancy and breastfeeding (only in case when benefit for mothers overweights the potential risk for fetus).
Side effects
The most common side effects typical for carbapenems include:

  • Allergic reactions: skin rash, urticaria, Quincke's edema, fever, bronchospasm, anaphylactic shock
  • Local reactions: phlebitis, thrombophlebitis
  • Digestive system: nausea, vomiting, colitis
  • CNS: dizziness, tremor, seizures
  • Other: hypotension

Drugs interactions
Solution for injections should not be mixed with other preparations in one infusion system. Carbapenems should not be combined with other β-lactam antibiotic (penicillins, cephalosporins, aztreonam). Concomitant application with cyclosporine and theophylline increases the risk of seizures, especially in elderly patients and patients with significant renal failure.

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