Clinical Microbiology and Antimicrobial Chemotherapy. 2003; 5(2):126-143
This paper presents analysis of microbiological, clinical and pharmacoeconomic studies of carbapenems. Use of carbapenems during the last two decades was not associated with emergence of resistance to these agents among clinically significant human pathogens, except for Pseudomonas aeruginosa. Clinical efficacy of carbapenems in patients with different infections is similar to and often higher than those of other comparative antimicrobials and their combinations. In spite of expensiveness of carbapenems, pharmacoeconomic studies have demonstrated advantages of these drugs over the number of cheaper conventional antibiotics. Taking into consideration that inadequate empirical antimicrobial treatment is associated with significant increase in mortality, particularly in patients with serious infections, carbapenems are no longer considered as second line antimicrobials. The main ways to improve use of carbapenems are de-escalation therapy and optimal dosing of these antimicrobials.