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;
Rep: Women of reproductive potential;
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

MS: RHABDOMYOLYSIS

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.

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: carbapenems beta lactamase inhibitors

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 ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and rash or other symptoms of allergy.
Caution patient to notify health care provider if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care provider. May occur up to several weeks after discontinuation of medication.
Advise patient to notify health care provider promptly if signs and symptoms of rhabdomyolysis (muscle pain or weakness, dark urine) occur.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: Advise women of reproductive potential to use nonhormonal contraceptive and notify health care provider if pregnancy is planned or suspected or if breastfeeding. Monitor breastfed infant for thrush and diarrhea.

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Indications ⬇

Contraind./Precautions ⬆ ⬇