Drug reference

Meropenem with vaborbactam

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 571, 572, 573

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Complicated urinary-tract infection [including pyelonephritis] | Complicated intra-abdominal infection ▶BY INTRAVENOUS INFUSION ▶Adult: 2 g every 8 hours for 5–10 days; may be continued for up to 14 days Hospital-acquired pneumonia | Ventilator-associated pneumonia ▶BY INTRAVENOUS INFUSION ▶Adult: 2 g every 8 hours for 7–14 days Bacteraemia [occurring in association with or suspected to be associated with the licensed indications] ▶BY INTRAVENOUS INFUSION ▶Adult: 2 g every 8 hours, duration should be tailored to site of infection Aerobic Gram-negative infections [in patients with limited treatment options] (administered on expert advice) ▶BY INTRAVENOUS INFUSION ▶Adult: 2 g every 8 hours, duration should be tailored to site of infection DOSE EQUIVALENCE AND CONVERSION ▶Dose expressed in terms of meropenem.

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Drug Action

Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.

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Allergy And Cross Sensitivity

Contra-indicated in patients with cephalosporin hypersensitivity. ▶Cross-sensitivity with other beta-lactam antibacterials About 0.5–6.5% of penicillin-sensitive patients will also be allergic to the cephalosporins. Patients with a history of immediate hypersensitivity to penicillin and other beta- lactams should not receive a cephalosporin. Cephalosporins should be used with caution in patients with sensitivity to penicillin and other beta-lactams. l EFFECT ON LABORATORY TESTS False positive urinary glucose (if tested for reducing substances). False positive Coombs’ test. ANTIBACTERIALS › CEPHALOSPORINS, FIRST-GENERATION eiiii F 550

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Safety

Interactions

→Appendix 1: carbapenems. vaborbactam

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Side Effects

▶Common or very common Diarrhoea. electrolyte imbalance . headache. hypoglycaemia. hypotension. nausea. thrombocytosis. vomiting ▶Uncommon Appetite decreased. bronchospasm. chest discomfort. Clostridioides difﬁcile colitis. dizziness. eosinophilia. gastrointestinal discomfort. hallucination. hyperglycaemia. increased risk of infection. infusion related reaction. insomnia. lethargy. leucopenia. neutropenia. pain. paraesthesia. renal impairment. skin reactions. thrombocytopenia. tremor. urinary incontinence. vascular pain ▶Rare or very rare Seizure ▶Frequency not known Agranulocytosis. angioedema. haemolytic anaemia. severe cutaneous adverse reactions (SCARs) ▶Common or very common Abdominal pain. diarrhoea. dizziness. eosinophilia. headache. leucopenia. nausea. neutropenia. skin reactions. thrombocytopenia. vomiting . vulvovaginal candidiasis ▶Uncommon Anaphylactic reaction. pseudomembranous enterocolitis ▶Rare or very rare Agranulocytosis. angioedema. nephritis tubulointerstitial (reversible). severe cutaneous adverse reactions (SCARs) ▶Frequency not known Haemolytic anaemia

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Pregnancy

Manufacturer advises avoid—no or limited information available.

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Breast Feeding

Manufacturer advises discontinue breast-feeding.

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Renal Impairment

Dose adjustments Manufacturer advises reduce dose to 1 g every 8 hours if creatinine clearance 20–39 mL/minute. Manufacturer advises reduce dose to 1 g every 12 hours if creatinine clearance 10–19 mL/minute. Manufacturer advises reduce dose to 0.5 g every 12 hours if creatinine clearance less than 10 mL/minute.

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Dose and formulations

Directions For Administration

For continuous Infection intravenous infusion, manufacturer advises reconstitute each 1 g (as meropenem) vial to produce a 0.05 g (as meropenem)/mL solution with 20 mL Sodium Chloride 0.9%. Dilute reconstituted solution to a ﬁnal volume of 250 mL with Sodium Chloride 0.9%; give over 3 hours.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion ELECTROLYTES: May contain Sodium A ▶Vaborem (A. Menarini Farmaceutica Internazionale SRL) Meropenem (as Meropenem trihydrate) 1 gram,Vaborbactam 1 gram Vaborem 1g/1g powder for concentrate for solution for infusion vials | 6 vial P £334.00 (Hospital only) ANTIBACTERIALS › CEPHALOSPORINS Cephalosporins Overview The cephalosporins are broad-spectrum antibiotics which are used for the treatment of septicaemia, pneumonia, meningitis, biliary-tract infections, peritonitis, and urinary- tract infections. The pharmacology of the cephalosporins is similar to that of the penicillins, excretion being principally renal. Cephalosporins penetrate the cerebrospinal ﬂuid poorly unless the meninges are inﬂamed; cefotaxime p. 555 and ceftriaxone p. 556 are suitable cephalosporins for infections of the CNS (e.g meningitis). The principal side-effect of the cephalosporins is hypersensitivity and about 0.5–6.5% of penicillin-sensitive patients will also be allergic to the cephalosporins. If a cephalosporin is essential in patients with a history of immediate hypersensitivity to penicillin, because a suitable alternative antibacterial is not available, then ceﬁxime p. 555, cefotaxime, ceftazidime p. 555, ceftriaxone, or cefuroxime p. 553 can be used with caution; cefaclor p. 552, cefadroxil p. 551, cefalexin p. 551, cefradine p. 552, and ceftaroline fosamil p. 559 should be avoided. The orally active ‘ﬁrst generation’ cephalosporins, cefalexin, cefradine, and cefadroxil and the ‘second generation’ cephalosporin, cefaclor, have a similar antimicrobial spectrum. They are useful for urinary-tract infections, respiratory-tract infections, otitis media, and skin and soft-tissue infections. Cefaclor has good activity against H. inﬂuenzae. Cefadroxil has a long duration of action and can be given twice daily; it has poor activity against H. inﬂuenzae. Cefuroxime axetil, an ester of the ‘second generation’ cephalosporin cefuroxime, has the same antibacterial spectrum as the parent compound; it is poorly absorbed and needs to be given with food to maximise absorption. Ceﬁxime is an orally active ‘third generation’ cephalosporin. It has a longer duration of action than the other cephalosporins that are active by mouth. It is only licensed for acute infections. Cefuroxime is a ‘second generation’ cephalosporin that is less susceptible than the earlier cephalosporins to inactivation by beta-lactamases. It is, therefore, active against certain bacteria which are resistant to the other drugs and has greater activity against Haemophilus inﬂuenzae. Cefotaxime, ceftazidime and ceftriaxone are ‘third generation’ cephalosporins with greater activity than the ‘second generation’ cephalosporins against certain Gram- negative bacteria. However, they are less active than cefuroxime against Gram-positive bacteria, most notably Staphylococcus aureus. Their broad antibacterial spectrum may encourage superinfection with resistant bacteria or fungi. Ceftazidime has good activity against pseudomonas. It is also active against other Gram-negative bacteria. Ceftriaxone has a longer half-life and therefore needs to be given only once daily. Indications include serious infections such as septicaemia, pneumonia, and meningitis. The calcium salt of ceftriaxone forms a precipitate in the gall bladder which may rarely cause symptoms but these usually resolve when the antibiotic is stopped. Ceftaroline fosamil is a ‘ﬁfth generation’ cephalosporin with bactericidal activity similar to cefotaxime; however, ceftaroline fosamil has an extended spectrum of activity against Gram-positive bacteria that includes meticillin- resistant Staphylococcus aureus and multi-drug resistant Streptococcus pneumoniae. Ceftaroline fosamil is licensed for the treatment of community-acquired pneumonia and complicated skin and soft-tissue infections, but there is no experience of its use in pneumonia caused by meticillin- resistant S. aureus. Cephalosporins f

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Clinical care

Patient And Carer Advice

Driving and skilled tasks Manufacturer advises patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness, lethargy, and paraesthesia.

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Dose text by age group

Adult

2 g every 8 hours for 5–10 days; may be

First-line fragment. Read the complete Indications and Dose section above.

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Adult

2 g every 8 hours for 7–14 days

First-line fragment. Read the complete Indications and Dose section above.

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Adult

2 g every 8 hours, duration should be tailored to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 571

Adult

2 g every 8 hours, duration should be tailored to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 571

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Meropenem with vaborbactam

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 571, 572, 573

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 571

Drug Action

Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.

PDF page 572

Allergy And Cross Sensitivity

PDF pages 572, 573

Safety

Interactions

→Appendix 1: carbapenems. vaborbactam

PDF page 571

Side Effects

PDF pages 571, 572

Pregnancy

Manufacturer advises avoid—no or limited information available.

PDF page 571

Breast Feeding

Manufacturer advises discontinue breast-feeding.

PDF page 571

Renal Impairment

PDF page 572

Dose and formulations

Directions For Administration

PDF page 572

Medicinal Forms

PDF page 572

Clinical care

Patient And Carer Advice

PDF page 572

Dose text by age group

Adult

2 g every 8 hours for 5–10 days; may be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 571

Adult

2 g every 8 hours for 7–14 days

First-line fragment. Read the complete Indications and Dose section above.

PDF page 571

Adult

2 g every 8 hours, duration should be tailored to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 571

Adult

2 g every 8 hours, duration should be tailored to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 571

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.