Review Topic
  • A 65-year-old man is admitted to the medical intensive care unit for management of sepsis. He was started on empiric antibiotic treatment with vancomycin and piperacillin-tazobactam after blood cultures were obtained. His temperature is 102°F (38.9°C), blood pressure is 79/65 mmHg, pulse is 120/min, and respirations are 22/min. Blood culture grow Pseudomonas aeruginosa which is sensitive to meropenem and his antibiotics are narrowed.
  • Mechanism of action
    • binds to penicillin-binding proteins (PBPs) inhibiting transpeptidation
      • impairs peptidoglycan synthesis, a needed component of cell wall biosynthesis
  • Mechanism of resistance
    • carbapenemase production
    • altered PBPs
  • Drugs
    • doripenem
    • imipenem
      • must be administered with cilastatin (a renal dehydropeptidase I inhibitor) to prevent its metabolism in the renal tubules
    • meropenem
    • ertapenem
  • Clinical use
    • gram-positive cocci
    • gram-negative rods
    • anaerobes
    • preferably used in the setting of a life-threatening infection or when other antibiotic therapies have failed
  • Adverse effects
    • seizures
      • meropenem is the carbapenem that has a decreased risk of seizure
    • gastrointestinal distress
    • rash

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