meropenem/vaborbactam

Binds to bacterial cell wall, resulting in cell death. Addition of vaborbactam protects meropenem from being degraded by certain serine beta-lactamases such as Klebsiella pneumoniae carbapenemase.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Active against the following gram-negative pathogens:
- Escherichia coli,
- Enterobacter cloacae,
- Klebsiella pneumoniae.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Meropenem undergoes hydrolysis; vaborbactam is not metabolized. Both meropenem and vaborbactam are primarily excreted by the kidneys (40–60% of meropenem and 75–95% of vaborbactam excreted unchanged in the urine).

Half-Life: Meropenem: 1.22 hr; Vaborbactam: 1.68 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	8 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to any of the carbapenems (ertapenem, imipenem, meropenem);
Anaphylactic reactions to other beta-lactams (cross-sensitivity may occur);
OB: Pregnancy.

Use Cautiously in:

Renal impairment (↑ risk of thrombocytopenia and seizures; ↓ dose if eGFR <50 mL/min/1.73 m²);
History of seizures, brain lesions, or meningitis;
Rep: Women of reproductive potential taking hormonal contraceptives;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may be at risk for adverse reactions due to age-related in renal function.

Adv. Reactions/Side Effects ⬆ ⬇

GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), diarrhea

Local: infusion site reactions, phlebitis

Neuro: delirium, headache, paresthesias, SEIZURES

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Probenecid↓ renal excretion of meropenem and ↑ its levels; concurrent use not recommended.
May ↓ valproate levels and ↑ risk of seizures; concurrent use not recommended.
May ↓ levels and effectiveness of hormonal contraceptives.

Route/Dosage ⬆ ⬇

IV (Adults ): 4 g (meropenem 2 g/vaborbactam 2 g) every 8 hr for up to 14 days.

Renal Impairment

IV (Adults ): eGFR 30–49 mL/min/1.73 m²: 2 g (meropenem 1 g/vaborbactam 1 g) every 8 hr for up to 14 days; eGFR 15–29 mL/min/1.73 m²: 2 g (meropenem 1 g/vaborbactam 1 g) every 12 hr for up to 14 days; eGFR <15 mL/min/1.73 m²: 1 g (meropenem 0.5 g/vaborbactam 0.5 g) every 12 hr for up to 14 days.

Availability ⬆ ⬇

Powder for injection: 2 g/vial (1 g meropenem/1 g vaborbactam)

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Obtain a history before initiating therapy to determine previous use of and reactions to penicillins.
Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.
Observe for anaphylaxis (rash, pruritus, laryngeal edema, wheezing). If symptoms occur,immediately discontinue therapy and provide appropriate medical care. Have epinephrine, an antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction.
Assess for history of CNS disorders, including seizures. If focal tremors, myoclonus, or seizures occur, place patient on anticonvulsant therapy as needed and assess need to ↓ meropenem/vaborbactam dose or discontinue.

Lab Test Considerations:

May cause hyperkalemia, hyperglycemia, and hypoglycemia.
Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.

Implementation ⬆ ⬇

amikacin
ampicillin/sulbactam
azithromycin
aztreonam
bumetanide
calcium gluconate
cefazolin
cefepime
ceftazidime
ceftazidime/avibactam
ceftolozane/tazobactam
ceftriaxone
cefuroxime
cisatracurium
dexamethasone
dexmedetomidine
digoxin
diltiazem
dopamine
doxycycline
epinephrine
eptifibatide
ertapenem
esmolol
esomeprazole
famotidine
fentanyl
fosphenytoin
furosemide
gentamicin
heparin
hydrocortisone
hydromorphone
imipenem/cilastatin
insulin, regular
labetalol
levofloxacin
lidocaine
linezolid
lorazepam
magnesium sulfate
mannitol
meperidine
mesna
methylprednisolone
metoclopramide
metronidazole
micafungin
milrinone
morphine
naloxone
nitroglycerin
norepinephrine
octreotide
pantoprazole
penicillin G potassium
phenylephrine
piperacillin/tazobactam
plazomicin
potassium chloride
potassium phosphates
rocuronium
sodium bicarbonate
sodium phosphates
sulbactam/durlobactam
tedizolid
tigecycline
tobramycin
vancomycin
vasopressin
vecuronium

Y-Site Incompatibility:

Intermittent Infusion: Reconstitution: Reconstitute each vial with 20 mL 0.9% NaCl withdrawn from infusion bag. Mix gently to dissolve.Diluent: Dilute further in 250 mL to 1000 mL infusion bag of 0.9% NaCl.Concentration: 2 mg/mL to 16 mg/mL. Solution is clear to light yellow; do not infuse solutions that are discolored or contain particulates. Infusion must be completed within 4 hr if stored at room temperature or 22 hr if refrigerated.
Rate: Infuse over 3 hr.

Patient/Family Teaching ⬆ ⬇

Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy.
Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several wk after discontinuation of medication.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise females of reproductive potential to use nonhormonal contraceptive and notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇