MeropenemVaborbactam

Meropenem/vaborbactam is a fixed‑dose antibiotic combination consisting of the carbapenem meropenem and the novel beta‑lactamase inhibitor vaborbactam. It is used for adults with complicated urinary tract infections, including pyelonephritis, and for complicated intra‑abdominal infections, particularly when bacteria may produce carbapenemase enzymes such as KPC.

Mechanism of action and rationale: Meropenem interferes with bacterial cell wall synthesis by inhibiting penicillin‑binding proteins. Vaborbactam inhibits certain serine beta‑lactamases, notably KPC enzymes, protecting meropenem from hydrolysis and restoring its activity against resistant Enterobacterales. The combination therefore expands meropenem’s activity to organisms that produce KPC, while not broadly addressing metallo‑beta‑lactamases.

Antimicrobial spectrum: The regimen is active primarily against Gram‑negative Enterobacterales, especially KPC‑producing strains. Its activity against non‑KPC producers is largely attributable to meropenem alone, and it has limited to no activity against many nonfermenters or organisms producing metallo‑beta‑lactamases. It is not a general replacement for all carbapenems in every infection, but is particularly used where KPC‑mediated resistance is a concern.

Administration and dosing: Meropenem/vaborbactam is given intravenously, typically as a total daily dose of 4 g (2 g meropenem/2 g vaborbactam) administered every 8 hours, with adjustments for renal function. Infusion duration and duration of therapy depend on the infection being treated and clinical response.

Safety and monitoring: Common adverse events include diarrhea, nausea, headache, and injection‑site reactions. Risks include Clostridioides difficile infection and, in susceptible patients, seizures. Renal function should be monitored and dose adjustments made for renal impairment.

Regulatory status and clinical use: It has been approved in multiple jurisdictions for complicated urinary tract infections and complicated intra‑abdominal infections. Trials, including those in carbapenemase‑producing infections, support its use when KPC producers are suspected or confirmed.