meropenem/vaborbactam

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
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: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS .

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.

Availability ⬆ ⬇

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

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification:

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

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.
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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Indications ⬇

Contraind./Precautions ⬆ ⬇