meropenemvaborbaktam

Meropenemvaborbaktam, also known as meropenem-vaborbaktam, is a fixed-dose intravenous antibiotic combination consisting of meropenem, a broad-spectrum carbapenem, and vaborbactam, a boron-containing beta-lactamase inhibitor. Vaborbaktam inhibits certain beta-lactamases, notably class A enzymes such as KPC, thereby protecting meropenem from enzymatic degradation and restoring its activity against resistant bacteria.

The combination is intended for use against serious infections caused by susceptible Gram-negative bacteria. It is indicated for complicated urinary tract infections, including acute pyelonephritis, and for hospital-acquired and ventilator-associated pneumonia. It does not reliably cover organisms producing metallo-beta-lactamases, and susceptibility testing should guide use.

Administration and pharmacokinetics are via intravenous infusion. A common dosing regimen is 4 g every 8 hours given as a 3-hour infusion, with dose adjustments for renal impairment. Both components are primarily eliminated by the kidneys, requiring renal function-based dosing. The drug has a pharmacokinetic profile similar to other beta-lactams, with a limited ability to penetrate central nervous system barriers in the absence of meningeal inflammation.

In terms of spectrum, meropenem-vaborbaktam is active against many Enterobacterales, including certain carbapenemase-producing strains, but its activity is limited against non-fermenters and organisms producing enzymes not inhibited by vaborbaktam. Resistance can arise through additional beta-lactamases, porin changes, or efflux mechanisms, underscoring the importance of antimicrobial stewardship.

Safety considerations include common adverse events such as headache, diarrhea, nausea, rash, and infusion-site reactions; hypersensitivity and seizure risk exist, particularly with high doses or in predisposed individuals.