Carbapenems in Pediatrics

Abstract

Antimicrobial resistance is increasing among bacterial pathogens. In particular, organisms producing extended spectrum beta-lactamase enzymes (ESBLs) and AmpC chromosomal beta-lactamase enzymes are resistant to third generation cephalosporins and pose a formidable challenge in the management of seriously ill patients. Carbapenems are a class of broad-spectrum antibiotics with stability against ESBL and AmpC chromosomal beta-lactamases. They are well tolerated by patients. This review will examine the pharmacokinetic and pharmacodynamic properties of two carbapenems imipenem and meropenem and discuss their clinical use in children. References are limited to the English language and extend back to 1980. Sources include computerized databases such as MEDLINE searched using PubMed, and bibliographies of recent articles and books. Approximately 50% of the articles initially reviewed are included in the bibliography. Carbapenems are efficacious in the treatment of a variety of bacterial infections including meningitis, pneumonia, intraabdominal infections, bone, joint and urinary tract infections. The broad spectrum activity and comparatively low toxicity of carbapenems make them valuable therapeutic agents in the treatment of seriously ill patients with bacterial infections. These agents should be used judiciously in order to minimize the risk for development of carbapenem-resistant pathogens.

Antimicrobial activity of antibiotics in combination with natural flavonoids against clinical extended‐spectrum β‐lactamase (ESBL)‐producing Klebsiella pneumoniae

“…In clinical therapy, ESBL-producing K. pneumoniae provides resistance to third-generation cephalosporins, aminoglycosides and monobactams. These strains remain generally susceptible to cephamycins (Komatsu et al, 2003), carbapenems (Ayalew et al, 2003) and β-lactamase inhibitor-β-lactam combinations (Tolun et al, 2004). In this study, ESBL-producing K. pneumoniae isolates were shown to be resistant to a wide range of β-lactams, although they were still susceptible to imipenem (a carbapenem) and cefmetazole (a cephamycin).…”

Validation and Application of a Dried Blood Spot Ceftriaxone Assay

“…In contrast, there are few comparable PK/PD data that relate to older drugs that are often used as first-line treatments for severe infections (7). This has particular relevance for neonatal and pediatric patients because studies performed in adults may not be applicable due to differences in drug disposition (8,9), the spectrum of clinical disease, and bacterial pathogens (10). Additionally, the need for "rich" blood sampling in young children and neonates may be unethical because multiple, large-volume venesections could result in adverse hemodynamic effects (11).…”

Open-Label Study To Evaluate the Single-Dose Pharmacokinetics, Safety, and Tolerability of Doripenem in Infants Less than 12 Weeks in Chronological Age

“…arbapenems have been used safely in newborns, children, and adolescents for empirical and directed treatment of a variety of infections (1)(2)(3)(4)(5).…”