Carbapenems and Vancomycin

Question 1

What type of spectrum are the Carbapenems?

What type of forms are they available in?

Answer 1

All are broad spectrum.

All are injectables, no oral forms.

Question 2

What are the Carbapenems?

Answer 2

Imipenem/Cilastatin
Doripenem
**Meropenem
Ertapenem

Question 3

What are the Carbapenems used for?

Answer 3

Resistant organisms, treatment of mixed aerobic/anaerobic infections

Question 4

What additional information is there about Imipenem and Ertapenem?

Answer 4

Imipenem needs help:
Cilastatin is a renal dehydropeptidase inhibitor
Seizure potential

Ertapenem newer but…
Lower activity against Pseudomonas and Acinetobacter

Question 5

What is Carbapenem resistant Enterobacteriaceae?

Answer 5

Actions of KPC (Klebsiella pneumoniae cabapenemase) and NDM (New Delhi Metallo-beta-lactamase)

• Greater mortality
• Implied resistance to other therapies
• No new alternatives in the pipeline
• Rapid spread possible in health-care settings
• Potential movement from health-care setting to community

Question 6

Prescription for Meropenem (Merrem IV™)?

Answer 6

1 g IVPB
every eight (8) hours

For severe patient, get ID consult!

Question 7

What does vancomycin kill?

Answer 7

Broad spectrum of gram-positive organisms. (Staph, Strep)

- All gram-negative bacilli and mycobacteria are resistant

Question 8

What is the vancomycin injection used for?

Answer 8

Skin/soft tissue (MRSA) , bone/joint infections, respiratory tract, central nervous system infection, endocarditis, vascular catheter infections

Question 9

What is the oral form of vancomycin used for?

Answer 9

Clostridium difficile

Question 10

What are possible vancomycin side effects?

Answer 10

• Emergence of resistance (VRE)
• Renal dosing needed
• IV to PO not possible
• The Three “Ns” of toxicity
  - Neurotoxicity
  - Nephrotoxicity
  - Neutropenia

Question 11

Prescription for Vancomycin?

Answer 11

15 to 20 mg/kg/dose IVPB
every eight (8) to twelve (12) hours

Never > 40 mg

Question 12

What do you do before the 5th dose of Vancomycin?

Answer 12

Draw a serum Vancomycin sample to get the level measured. Need to make sure the level doesn’t go below the MIC ( < 15 mg)

Question 13

Prescription for Vancomycin solution?

Answer 13

250 mg/5 mL
125 mg every six (6) hours orally for 10 days

For sever C. diff

Question 14

What is Telavancin (Vibativ™)?

Answer 14

Works like vancomycin and then some…
Indicated for
- Complicated skin/skin structure infection
- Bacterial pneumonia for hospitalized patients

Note:

• Renally adjusted
• Boxed warning about new or worsening kidney failure