karbapenémm

Carbapenems are a class of broad-spectrum beta-lactam antibiotics that include imipenem, meropenem, ertapenem, and doripenem. They are among the most potent agents against multidrug-resistant Gram-negative bacteria. The molecules feature a beta-lactam ring fused to a unique bicyclic system, which provides stability against many beta-lactamases. Carbapenems inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to cell lysis. They are typically administered intravenously and are generally reserved for severe infections or cases where resistant organisms are suspected or confirmed.

Their spectrum covers a wide range of pathogens. They are active against many Enterobacterales and other Gram-negative rods, including some resistant strains, as well as many Gram-positive cocci and anaerobes. Ertapenem has a narrower spectrum, with limited activity against Pseudomonas aeruginosa and Acinetobacter species. Imipenem is often given with cilastatin to prevent renal degradation, while meropenem and doripenem do not require this. Common clinical indications include complicated intra-abdominal infections, complicated urinary tract infections, hospital- or ventilator-associated pneumonia, febrile neutropenia, and gynecological infections where resistant organisms are suspected.

Resistance to carbapenems is an increasing concern. It arises mainly through carbapenemase enzymes (such as KPC, NDM, VIM, IMP, and OXA-48), along with porin loss and efflux mechanisms. This has led to antimicrobial stewardship efforts and the development of newer agents, including combinations of carbapenems with beta-lactamase inhibitors. Adverse effects are generally mild to moderate, but seizures can occur at high doses or with renal impairment, and gastrointestinal symptoms or hypersensitivity reactions may occur.