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A Brief Review of a New Antibiotic: Meropenem-vaborbactam

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Meropenem-vaborbactam is a newly approved antibiotic for complex urinary tract infections and to treat carbapenem-resistant Enterobacteriaceae infections. Its advantage over meropenem is the betalactamase inhibitor which slows bacterial resistance. This medication has been studied in numerous countries and has relatively few side effects. There were slightly higher incidences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), elevations, infusion site phlebitis, but less anemia, vaginal infections, and discontinuation when compared with pipercacilin-tazobactam.
The combination drug's relevance for the geriatrician is that older adults are at higher risk for urinary tract infections (UTIs). Some drugs that had previously been prescribed are now less useful for treating UTIs. This leaves clinicians with drugs that have more side effects.
This new drug has two significant drug interactions. Meropenem competes with probenecid in the kidney's tubular secretion. This increases the concentration of meropenem. Meropenem lessens valproic acid blood levels, putting patients at risk for seizures. It is not known to impact cytochrome p450 enzymes. It comes as a dry powder and should be diluted in 250 mL of normal saline and given over a three-hour infusion.
Vaborbactam is not known to have drug interactions. Vaborbactam does not affect the cytochrome p450 enzymes. This antibiotic has been studied in patients as old as 92 years. Renal dose adjustment allows the medication to be administered safely at all stages of kidney disease. If a patient is on dialysis, it is to be given after dialysis. No dose adjustment is needed based on the Child-Pugh score (i.e., for hepatic function). Based on local resistance, it may be beneficial to add this medication to one's formulary.
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Document Type: Abstract

Publication date: March 1, 2019

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