Comparison Of The Major Carbapenems

Comparison of the major Carbapenems Imipenem/cilastatin versus Meropenem

Is Meropenem superior to Imipenem/cilastatin? ,[object Object],Clinical experience indicates that Meropenem is therapeutically equivalent to Imipenem/cilastatin Gauau J et al, Clin Microbiol Infect Dis 1997; 16: 789-96, Chang DC et al, Ann J Surg 1997; 174: 284-90 Colardyn F et al, J Antimicrob Chemother 1996; 38: 523-37 Current text-book teaching also indicates that Meropenem is therapeutically equivalent to Imipenem/cilastatin Ref: Principles and Practice of Infectious Diseases, 6 th Edition, Philadelphia, Elsevier; 2005: 311-8

[object Object],[object Object],[object Object],Edwards SJ et al, Curr Med Res Opin 2005; 21(5):785-794

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Multiple mechanisms of resistance in MDR P. aeruginosa ,[object Object],[object Object],[object Object],Quale J et al, Antimicrob Agents Chemother 2006 May; 50(5): 1633-1641.

Multiple mechanisms of resistance in MDR P. aeruginosa ,[object Object],[object Object],[object Object],[object Object],[object Object],Quale J et al, Antimicrob Agents Chemother 2006 May; 50(5): 1633-1641.

Potency of Carbapenems for prevention of Carbapenem-resistant P. aeruginosa ,[object Object],Sakyo S et al, J Antibiot (Tokyo). 2006 Apr;59(4):220-8 10 -9 per cell per generation Imipenem / cilastatin 10 -7 per cell per generation Meropenem Frequency of selection of Carbapenem-resistant P. aeruginosa Carbapenem

In vivo efficacy against P. aeruginosa expressing efflux pump ,[object Object],[object Object],[object Object],* %T>MIC is an established pharmacodynamic measure of antimicrobial efficacy. It is The total duration of time for which the concentration of the antibiotic remains above MIC Ong CT et al, Diagn Microbiol Infect Dis 2006 (Epub ahead of print)

[object Object],[object Object],[object Object],In vivo efficacy against P. aeruginosa expressing efflux pump Ong CT et al, Diagn Microbiol Infect Dis 2006 (Epub ahead of print)

Infection in Burns patients ,[object Object],[object Object],[object Object],[object Object],Japoni A et al, Burns 2006; 32: 343-347 30.0% Meropenem 28.6% Imipenem / cilastatin Resistance rate against Ps. aeruginosa in burns infection Carbapenem

Activity against Acinetobacter spp. ,[object Object],[object Object],[object Object],Canduela MJ et al, J Antimocrob Chemother 2006; 57: 1220-1222 80% Meropenem 70% Imipenem / cilastatin Resistance rate against Acinetobacter baumanii Carbapenem

Does Acinetobacter spp. exhibit similar susceptibilities to both Carbapenems? ,[object Object],Discordant Carbapenem susceptibilities are a reality! A strain that is susceptible to Imipenem/cilastatin is not always susceptible to Meropenem. Treatment failures with Meropenem and switchover to Imipenem/cilastatin have been documented Lesho E et al, Clin Infect Dis 2005; 41: 758-9

Activity against Acinetobacter spp. ,[object Object],[object Object],[object Object],[object Object],Siroy A et al, Antimicrob Agents Chemother 2005 Dec; 49(12): 4876-4883

Indian data on Carbapenem resistance ,[object Object],Gupta E et al, Indian J Med Res 2006 July; 124: 95-98 17.32% Imipenem/cilastatin 22.16% Meropenem Overall Incidence of Resistance Carbapenem

Indian data on Carbapenem resistance ,[object Object],Gupta E et al, Indian J Med Res 2006 July; 124: 95-98 4.3% 6.9% Klebsiella spp. 2.1% 3.5% E. coli 27.2% 34.7% Acinetobacter spp. 30.0% 37.6% Pseudomonas spp. IMI resistance MEM resistance Organism

PD profiling against ESBL producers ,[object Object],[object Object],Kiffer CRV et al, Int J Antimicrob Agents 2006 (Epub ahead of print) * Clinically significant 99.90% Meropenem 99.96% Imipenem / cilastatin Bactericidal activity Carbapenem 99.88% Meropenem 99.96% Imipenem / cilastatin Probability 40% T>MIC Carbapenem

Activity against CTX-M type ESBLs (capable of hospital outbreaks) ,[object Object],[object Object],Mena A et al, J Clin Microbiol 2006 Aug; 44(8): 2831-2837

Acute Necrotizing Pancreatitis (ANP)* ,[object Object],[object Object],[object Object],Pezzilli R, JOP. J Pancreas (online) 2006; 7(4): 435-437 www.astrazenecaindia.com/Products/ Meronem %20Abridged.pdf * Kindly note that Acute Necrotizing Pancreatitis is not a labelled indication for Zienam® and data presented above is completely based on published clinical evidence

Imipenem/cilastatin in ANP* ,[object Object],[object Object],[object Object],Nordback I et al, J Gastrointest Surg 2001; 5: 113-118 Heinrich S et al, Ann Surg 2006; 243: 154-168 * Kindly note that Acute Necrotizing Pancreatitis is not a labelled indication for Zienam® and data presented above is completely based on published clinical evidence

Imipenem/cilastatin in ANP* ,[object Object],[object Object],Nordback I et al, J Gastrointest Surg 2001; 5: 113-118 ; Manes G et al, Pancreas 2003; 27: 379-383 Heinrich S et al, Ann Surg 2006; 243: 154-168 * Kindly note that Acute Necrotizing Pancreatitis is not a labelled indication for Zienam® and data presented above is completely based on published clinical evidence

Meropenem in Acute Pancreatitis*: Questions that remain unanswered? ,[object Object],[object Object],[object Object],Pezzilli R, JOP. J Pancreas (online) 2006; 7(4): 435-437 * Kindly note that Acute Necrotizing Pancreatitis is not a labelled indication for Zienam® and data presented above is completely based on published clinical evidence

Carbapenems in Febrile Neutropenia ,[object Object],[object Object],[object Object],[object Object],[object Object],Paul M et al, J Antimicrob Chemother 2006; 57: 176-189

Carbapenems in Intra-abdominal Infections ,[object Object],[object Object],[object Object],[object Object],Tellado JM et al, Surgical Infections 2005; 6(3): 329-43 Mosdell GM et al, Ann Surg 1991; 214: 543-549 Montravers P et al, Clin Infect Dis 1996; 23: 486-494

Carbapenems in Intra-abdominal Infections ,[object Object],[object Object],[object Object],Tellado JM et al, Surgical Infections 2005; 6(3): 329-43 Lowe MN et al, Drugs 2000; 60: 619-646

Early empiric Carbapenem therapy in Intra-abdominal Infections ,[object Object],Tellado JM et al, Surgical Infections 2005; 6(3): 329-43 Empiric treatment of suspected or confirmed IAI of any origin or degree of severity in immunosupressed or transplant recepient patients Empiric treatment of IAI of any origin associated with sepsis Intra-abdominal superinfection in tertiary peritonitis Empiric treatment for persistent infection after failure of non-carbapenem therapy Empiric therapy for nosocomial IAI originated >48hr of hospital admission, either in surgical ward or surgical ICU Clinical conditions where Carbapenem therapy may be appropriate

Carbapenems: Myths and Reality ,[object Object],[object Object],[object Object],[object Object],[object Object],Bereznyakov IG, Kharkov Medical Academy of Post Graduate Education, Kharkov, Ukraine

Comparison Of The Major Carbapenems

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Comparison Of The Major Carbapenems