20-Year History of Carbapenems: Current Microbiological and Clinical Aspects

Abstract

The carbapenems are one of the most important classes of antimicrobial agents with an exceptionally broad spectrum of in vitro activity in association with low toxicity and beneficial pharmacokinetic parameters. Spectrum of activity of imipenem, meropenem and doripenem included majority of gram(+), gram(–) aerobic and anaerobic microorganisms, excluding methicillin-resistant Staphylococcus aureus, Stenotrophomonas maltophilia and majority of Enterococcus faecium strains. In comparison with above mentioned carbapenems, ertapenem is not active against non-fermeters and enterococci. However half-life of ertapenem is approximately 4 hours which allows once daily administration of the drug. Efficacy of imipenem and meropenem has been proven in a variety of randomized clinical trials in the treatment of severe infections including sepsis and neutropenic fever and these drugs are used throughout the world for the management of patients with severe and moderate nosocomial and polymicoribial infections. Activity and pharmacokinetic parameters of ertapenem determine its use for the treatment of severe community-acquired infections and, in some cases conduction of outpatient intravenous antimicrobial therapy. Despite of finishing of the III phase of clinical trials of doripenem further investigation of the drug’s clinical efficacy and safety in various infections is required. Panipenem, biapenem and faropenem (an orally administered penem) are registered on the pharmaceutical markets of some asian countries (Japan, China, Korea), and tebepenem is undergoing the II phase of clinical trials in Japan.