Carbapenems Indications abdominal infections; acute gynaecologi- cal infections; community-acquired pneumonia; dia- The carbapenems are beta-lactam antibacterials with a
5.1.2.2 Carbapenems Indications abdominal infections; acute gynaecologi- cal infections; community-acquired pneumonia; dia- The carbapenems are beta-lactam antibacterials with a
betic foot infections of the skin and soft-tissue; broad-spectrum of activity which includes many Gram-
prophylaxis for colorectal surgery positive and Gram-negative bacteria, and anaerobes;
Cautions sensitivity to beta-lactam antibacterials imipenem, meropenem, and doripenem have good
(avoid if history of immediate hypersensitivity reac- activity against Pseudomonas aeruginosa. The carbape-
tion, see also p. 290); elderly, renal impairment nems are not active against meticillin-resistant Staphy-
(Appendix 3), CNS disorders—risk of seizures; lococcus aureus and Enterococcus faecium.
pregnancy (Appendix 4); interactions: Appendix 1 (ertapenem)
Imipenem and meropenem are used for the treatment of Contra-indications breast-feeding (Appendix 5) severe hospital-acquired infections and polymicrobial
infections including septicaemia, hospital-acquired Side-effects diarrhoea, nausea, vomiting, headache, pneumonia, intra-abdominal infections, skin and soft-
injection-site reactions, rash, pruritus, raised platelet tissue infections, and complicated urinary-tract infec-
count; less commonly dry mouth, taste disturbances, tions. Doripenem is an alternative for hospital-acquired
dyspepsia, abdominal pain, anorexia, constipation, pneumonia, complicated intra-abdominal infections,
melaena, antibiotic-associated colitis, bradycardia, and complicated urinary-tract infections.
hypotension, chest pain, oedema, pharyngeal dis- comfort, dyspnoea, dizziness, sleep disturbances,
Ertapenem is licensed for treating abdominal and confusion, asthenia, seizures, vaginitis, raised glucose, gynaecological infections and for community-acquired
petechiae; rarely dysphagia, cholecystitis, liver disor- pneumonia, but it is not active against atypical respir-
der (including jaundice), arrhythmia, increase in blood atory pathogens and it has limited activity against peni-
pressure, syncope, nasal congestion, cough, wheez- cillin-resistant pneumococci. It is also licensed for treat-
ing, anxiety, depression, agitation, tremor, pelvic ing foot infections of the skin and soft tissue in patients
peritonitis, renal impairment, muscle cramp, scleral with diabetes. Unlike the other carbapenems, ertape-
disorder, blood disorders (including neutropenia, nem is not active against Pseudomonas or against Acine-
thrombocytopenia, haemorrhage), hypoglycaemia, tobacter spp.
electrolyte disturbances; very rarely hallucinations
BNF 57 Dose
5.1.2 Cephalosporins, carbapenems, and other beta-lactams
injection-site reactions; less commonly eosinophilia, . By intravenous infusion , ADULT and ADOLESCENT over
thrombocytopenia; rarely convulsions; also reported
13 years, 1 g once daily; CHILD
3 months–13 years,
paraesthesia, leucopenia, haemolytic anaemia,
15 mg/kg every 12 hours (max. 1 g daily) reduction in partial thromboplastin time, Stevens- Surgical prophylaxis, colorectal surgery, ADULT over 18
Johnson syndrome, and toxic epidermal necrolysis years, 1 g completed within 1 hour before surgery
Dose
A . By intravenous injection over 5 minutes or by Intravenous infusion , powder for reconstitution,
intravenous infusion , 500 mg every 8 hours, dose ertapenem (as sodium salt), net price 1-g vial = £31.65
Invanz c (MSD)
doubled in hospital-acquired pneumonia, periton-
Electrolytes Na 6 mmol/1-g vial
itis, septicaemia and infections in neutropenic patients; CHILD
3 months–12 years [not licensed for infection in neutropenia] 10–20 mg/kg every 8
hours, over 50 kg body weight adult dose Indications aerobic and anaerobic Gram-positive and
IMIPENEM WITH CILASTATIN
3 months–12 Gram-negative infections; surgical prophylaxis; hos-
Meningitis, 2 g every 8 hours; CHILD
years 40 mg/kg every 8 hours, over 50 kg body weight pital-acquired septicaemia (Table 1, section 5.1); not
adult dose
indicated for CNS infections Exacerbations of chronic lower respiratory-tract Cautions sensitivity to beta-lactam antibacterials
infection in cystic fibrosis, up to 2 g every 8 hours; (avoid if history of immediate hypersensitivity reac-
CHILD 4–18 years 25–40 mg/kg every 8 hours tion, see also p. 290); renal impairment (Appendix 3);
Meronem c (AstraZeneca) A CNS disorders (e.g. epilepsy); pregnancy (Appendix
Injection , powder for reconstitution, meropenem (as 4); breast-feeding (Appendix 5); interactions:
trihydrate), net price 500-mg vial = £8.60; 1-g vial = Appendix 1 (imipenem with cilastatin)
Side-effects nausea, vomiting, diarrhoea (antibiotic-
Electrolytes Na 3.9 mmol/g
associated colitis reported), taste disturbances, tooth
ns or tongue discoloration, hearing loss; blood disorders,
positive Coombs’ test; allergic reactions (with rash, pruritus, urticaria, Stevens-Johnson syndrome, fever, anaphylactic reactions, rarely toxic epidermal necro-
5.1.2.3 Other beta-lactam antibiotics Infectio
lysis, exfoliative dermatitis); myoclonic activity, con-