Names and pronunciation
(mer-oh-pen′em/va-bor-bak′tam) Vabomere
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Drug reference
(mer-oh-pen′em/va-bor-bak′tam) Vabomere
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Func. class.: Antiinfective—miscel- laneous
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Chem. class.: Carbapenem
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ACTION: Bactericidal; interferes with cell-wall replication of susceptible organisms
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USES: For the treatment of compli- cated urinary tract infections caused by Citrobacter freundii, Citrobacter koseri, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Morganella morganii, Proteus mirabilis, Providencia sp., Pseudomonas aeruginosa, Serratia marcescens
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CONTRAINDICATIONS: Hyper- sensitivity to this product, carbapenems Precautions: Pregnancy, breastfeeding, geriatric patients, renal disease, seizure disorder, gram-negative infection, pneu- monia; hypersensitivity to cephalospo- rins, penicillins
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SIDE EFFECTS GI: Diarrhea, nausea, vomiting, CDAD, hepatitis, glossitis, jaundice RESP: Dyspnea, hyperventilation, cough, sputum SYST: Anaphylaxis, Stevens-Johnson syndrome, angioedema INTEG: Rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site CNS: Seizures, dizziness, weakness, headache, insomnia, agitation, confu- sion, drowsiness CV: Hypotension, tachycardia ENDO: Hypoglycemia
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INTERACTIONS Increase: effect of—valproic acid Drug/Lab Tests Increase: AST, ALT, LDH, BUN, alk phos, bilirubin, creatinine Decrease: prothrombin time False positive: direct Coombs test
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DOSAGE AND ROUTES Complicated urinary tract infection (UTI), including pyelonephritis • Adult: IV 4 g (2 g meropenem and 2 g vaborbactam) q8hr for up to 14 days Renal dose • Adult: IV eGFR ≥50 mL/min/1.73 m2: no change; eGFR 30-49 mL/min/1.73 m2: 2 g (1 g meropenem and 1 g vaborbactam) q8hr; eGFR 15-29 mL/min/1.73 m2: 2 g (1 g me- ropenem and 1 g vaborbactam) q12hr; eGFR <15 mL/min/1.73 m2: 1 g (0.5 g me- ropenem and 0.5 g vaborbactam) q12hr Intermittent hemodialysis • Meropenem and vaborbactam are re- moved by hemodialysis; give drug after hemodialysis
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Available forms: Powder for inj 2 g
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Administer: IV route • Visually inspect for particulate matter and discoloration before use • Reconstitution: Constitute the appropri- ate number of vials as needed for the dose • 2 vials are used for 4-g dose (2 g me- ropenem and 2 g vaborbactam) • 1 vial is used for 2-g (1 g meropenem and 1 g vaborbactam) or 1-g (0.5 g me- ropenem and 0.5 g vaborbactam) doses • Withdraw 20 mL of 0.9% sodium chlo- ride injection from an infusion bag, and constitute each vial • For 4-g (2 g meropenem and 2 g vaborbactam) dose/250 to 1000 mL • For 2-g (1 g meropenem and 1 g vaborbactam) dose/125 to 500 mL • For 1-g (0.5 g meropenem and 0.5 g vaborbactam) dose/70 to 250 mL • Mix gently to dissolve • The constituted solution is concentra- tions of 0.05 g/mL meropenem /0.05 g/mL vaborbactam; the final volume is 21.3 mL • Further dilute before use; do not use by direct injection • Dilution: withdraw the full or partial constituted vial contents from each vial and add back into the 0.9% sodium chloride injection infusion bag • The final concentration of meropenem and vaborbactam will be between 2 and 8 mg/mL • Storage: complete infusion within 4 hr if stored at room temperature or 22 hr if refrigerated at 2°C-8°C (36°F-46°F) Intermittent IV Infusion: • Give over 3 hr
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Assess: • Obtain culture and sensitivity before first dose; product can be given while waiting for results • Infusion site reactions: assess for red- ness, inflammation, pain, and phlebitis at infusion site • Sensitivity to carbapenem antibiotics, penicillins, cephalosporins • Renal disease: lower dose may be re- quired; monitor serum creatinine/BUN, sodium, before, during therapy • CDAD: bowel pattern daily; if severe diarrhea, abdominal pain, fatigue occurs, product should be discontinued M • Infection: temperature, sputum, char- acteristics of wound before, during, and after treatment • Allergic reactions, anaphylaxis: rash, laryngeal edema, wheezing, urticaria, pru- ritus; may occur immediately or several days after therapy begins; identify whether there has been hypersensitivity to penicil- lins, cephalosporins, beta-lactams; cross- sensitivity may occur • Seizures: may occur in those with brain lesions, seizure disorder, bacterial meningitis, or renal disease; stop product, notify prescriber if seizures occur • Overgrowth of infection: perineal itch- ing, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
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Evaluate: • Therapeutic response: negative C&S; absence of symptoms and signs of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • CDAD: to report severe diarrhea • To report sore throat, bruising, bleed- ing, joint pain; may indicate blood dys- crasias (rare) • To report overgrowth of infection: black furry tongue, vaginal itching, foul- smelling stools
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PHARMACOKINETICS Protein binding 2% for meropenem, 33% for vaborbactam; excreted by kidneys; half- life 1.22 hr meropenem, 1.68 hr vaborbac- tam; meropenem is a substrate of OAT1 and OAT3 transporters; use after hemodialysis
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• Adult: IV 4 g (2 g meropenem and 2 g vaborbactam) q8hr for up to 14 days Renal dose
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• Adult: IV eGFR ≥50 mL/min/1.73 m2: no change; eGFR 30-49 mL/min/1.73 m2: 2 g (1 g meropenem and 1 g vaborbactam) q8hr; eGFR 15-29 mL/min/1.73 m2: 2 g (1 g me- ropenem and 1 g vaborbactam) q12hr; eGFR <15 mL/min/1.73 m2: 1 g (0.5 g me- ropenem and 0.5 g vaborbactam) q12hr Intermittent hemodialysis
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• Meropenem and vaborbactam are re- moved by hemodialysis; give drug after hemodialysis
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