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-