Carbapenems

Carbapenems are antibacterial agents (broad-spectrum antibiotics, reserve antibiotics), which are characterized by a broad anti-catabolic spectrum of activity in the Gram-positive and Gram-negative range. They belong to the reserve antibiotics and are approved for the treatment of severe infections in hospital patients. Carbapenems are not absorbed orally and must be administered parenterally. Imipenem is only administered in a fixed 1:1 combination with cilastatin (e.g. imipenem/cilastatin, meropenem). Cilastatin is an inhibitor of dihydropeptidase in the proximal renal tubules, otherwise imipenem in the kidneys is inactivated very effectively. Ertapenem is also cultivated by this enzyme so that ineffective metabolites appear in the urine. All representatives are resistant to most ß-lactamases.

The following representatives belong to this group:

• imipenem/cilastatin
• Meropenem
• Ertapenem

Achromobacter spp, Acinetobacter spp, Actinomyces spp, Aeromonas hydrophilia, Bacteroides spp, Brucella melitensis, Campylobacter spp, Citrobacter spp, Clostridium spp, Enterobacter spp, Enterococcus faecalis, Erysopelothrix rhusiopathiae, E. coli, Eubacterium spp, Fusobacterium spp, Gardnerella vaginalis, Haemophilus influenzae, Hafnia spp, Klebsiella spp, Listeria monocytogenes, Moraxella catarrhalis, Morganella marganii, Neisseria spp, Nocardia spp, Pasteurella multocida, Peptococcus spp, Peptostreptococcus spp, Propionibacterium acnes, Proteus spp., Providentia spp., Pseudomonas spp., Salmonella spp., Serratia spp., Shigella spp., Staphylococcus spp., Streptococcus spp., Veillonella spp., Yersinia spp.

Rare overall:

Haematological ADRs:

• Blood formation disorders

Gastrointestinal UAW:

• Symptoms of diarrhoea
• Nausea and vomiting

Hepatological ADRs:

• Transaminase and AP increase

Nephrological UAW

• High doses are nephrotoxic: for kidney dysfunction: dose adjustment
• Reddish discoloration of the urine

Neurological UAW:

• Confusion disorders
• Increased risk of cramping with imipenem

Immunological ADRs:

• Carbapenem allergies: incidence of carbapenem allergies is 0.3% to 3.7%. The risk of cross sensitivity between penicillins and carbapenems is < 1% in patients with a positive penicillin skin test (Lee Y et al. 2019)

Increased neurotoxicity with simultaneous use of Ciclosporin A. Also with gangciclovir, valganciclovir and theophylline.

1. Graefe KH et al. Antibacterial agents. In: Graefe KH et al (Eds) Pharmacology and Toxicology. Georg Thieme Publisher Stuttgart S.579-580

2. Lee Y et al (2019) Overview and Insights into Carbapenem Allergy. Pharmacy (Basel) 7: 110.

3. Nesher L et al (2015) Ertapenem usage in cancer patients with and without neutropenia: a report on 97 cases from a comprehensive cancer center. Infection 43:545-550.

4. Urbánek K et al. (2013) Pharmacological characteristics of ertapenem. Clin Microbiol Infecc Lek. 19:8-10