Doripenem

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 15.09.2022

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Definition
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Synthetic antibiotic (methyl carbapenem) from the carbapenem class.

Pharmacodynamics (Effect)
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Bactericidal effect by inhibition of the cell wall synthesis of bacteria. Doripenem inactivates several essential penicillin-binding proteins (PBP), which leads to inhibition of cell wall synthesis with subsequent cell death. Doripenem is stable against hydrolysis by most beta-lactamases, including penicillinases and cephalosporinases produced by Gram-positive and Gram-negative bacteria, with the exception of carbapenem-hydrolyzing beta-lactamases.

Spectrum of action
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  • Doripenem is comparably effective against Gram-negative pathogens as meropenem and comparably effective against Gram-positive bacteria as imipenem. Activity against Pseudomonas aeruginosa is better, and the risk of resistance developing is lower than with other carbapenems. Mostly effective against Acinetobacter baumannii and against pathogens producing extended-spectrum beta-lactamases ( ESBL).
  • Generally Sensitive Pathogens:
    • Gram-positive aerobes, esp. Enterococcus faecalis, Staph aureus [methicillin-sensitive strains only], Staphylococcus spp.[methicillin-sensitive strains only], Streptococcus pneumoniae, Streptococcus spp.
    • Gram-negative aerobes, esp. Citrobacter spp, Enterobacter aerogenes, Enterobacter cloacae, Haemophilus influenzae, E. coli, Klebsiella pneumoniae, Klebsiella oxytoca, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia spp, Salmonella spp, Serratia marcescens, Shigella.
    • Anaerobes, esp. Bacteroides spp, Peptostreptococci spp, Porphyromonas spp, Prevotella spp, Sutterella wadsworthensis.
  • Basically resistant pathogens are Gram-positive aerobes (Enterococcus faecium) and Gram-negative aerobes (Stenotrophomonas maltophilia, Legionella spp.).

Indication
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Approved for the treatment of nosocomial pneumonia (including respiratory pneumonia), complicated intra-abdominal infections and complicated urinary tract infections.

Pregnancy/nursing period
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Do not use during pregnancy or lactation (insufficient data available). Doripenem passes into breast milk in animal experiments.

Dosage and method of use
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3 times/day 500 mg slowly IV (infusion duration: 1-4 hours). Therapy duration: 5-14 days.

Undesirable effects
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Frequent headaches, gastrointestinal side effects (nausea, diarrhea, oral candidiasis, candidiasis, vulvovaginal, elevated liver enzymes, pruritus, drug exanthema, phlebitis.

Interactions
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Do not use together with valproic acid/sodium valproate (serum valproic acid levels are lowered).

Contraindication
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Patients < 18. LJ. Hypersensitivity reactions to other carbapenems; severe hypersensitivity (e.g. anaphylactic reactions, severe skin reactions) to β lactam antibiotics (e.g. penicilins or cephalosporins).

Preparations
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Doribax

Note(s)
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Synthetic antibiotic (methyl carbapenem) from the carbapenem class.

Authors

Last updated on: 15.09.2022