12.7 Carbapenems
Carbapenems are a beta-lactam “cousin” to penicillins and cephalosporins. Examples are meropenem and imipenem. They are typically reserved for severe, multi-drug resistant infections.
Indications for Use
Carbapenems are useful for treating life-threatening, multidrug-resistant infections due to their broad spectrum of activity (Papp-Wallace, 2011). These antibiotics are effective in treating gram-positive and gram-negative infections. Because of their broad spectrum of activity, these medications can be especially useful for treating complex hospital-acquired infections or for clients who are immunocompromised. Imipenem is often combined with cilastatin (imipenem/cilastatin) to prevent the renal inactivation of imipenem (Vallerand & Sanoski, 2024).
Mechanism of Action
Carbapenems are typically bactericidal and work by inhibiting the synthesis of the bacterial cell wall.
Nursing Considerations
Intravenous and intramuscular administration only.
Carbapenems are similar to cephalosporins. Cross sensitivity may occur in clients allergic to penicillin or cephalosporins.
Across the Lifespan: Some carbapenems (eg. meropenem) are considered safe for use in pediatrics. Information related to carbapenems in pregnancy is limited.
Dose adjustments are required based on renal dysfunction in older adults.
Monitoring:
- Labs prior to and periodically include renal panel, CBC and liver panel.
- Obtain history of reactions to penicillin drugs prior to initiating therapy.
- Obtain culture and sensitivity before initiating therapy, with first dose may be given prior to results returning.
Side / Adverse Effects:
- Side effects include nausea, vomiting, diarrhea, and rash. They are mostly well-tolerated.
- Adverse effects can include clostridium difficile associated diarhea. Monitor for any change in bowel patterns. Hypersensitivity reactions may occur, monitor for a rash, hives and swelling.
Client Teaching
- Monitor for signs of superinfection and report any occurrence to the provider. If a client experiences fever and bloody diarrhoea, they should contact the provider immediately.
- The client should also be advised that side effects can occur even weeks after the medication is discontinued.
(Vallerand & Sanoski, 2024)
Carbapenems Medication Card
Now let’s take a closer look at the medication card for Carbapenems (Daily Med, 2019: UpToDate, 2021). Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Chapter 12 Antimicrobials Medication Cards
Medication Card: Carbapenems
Prototypes: imipenem and meropenem
Mechanism: Bactericidal. Broad-spectrum for both gram-positive and gram-negative infections.
Indications
- Complex body cavity, connective tissue infections in hospitalized patients.
- Bone, joint, skin, soft tissues infections
- Bacterial endocarditis
- Intra-abdominal infection
- Pneumonia
- Gynecological infection, UTI
- Septicemia
- Meropenem: only drug for bacterial meningitis
Administration
- IV, IM only. Onset: immediate (IV), peak: 5 min, duration: 10-12 mins; ½ life: 1 hr
- Older adult: use cautiously
Side Effects
- Similar to cephalosporins
- CNS: confusion, seizures, Neurotoxicity at high concentrations
- Resp: Apnea
- GI: GI upset (including dysbiosis, C-diff), N/V, diarrhea, dehydration, electrolyte imbalance
- Derm: Rash (Drug reaction w/ Eosinophilia and Systemic Systems
- Superinfection
Contraindications
- Drug Interactions: Valporic Acid, Cyclosporine, ganciclovir, probenecid (not with Meropenem): worsen seizures, confusion
- pt’s who have had anaphylactic rxns to beta-lactams
- Impaired renal function
- Pregnancy (only use if benefits outweigh risk to fetus)
- Hx of renal disease
- Seizure disorder
Nursing Considerations
Monitor for systemic signs of infection: elevated WBC count, fever, culture results. Monitor site of infection for improvement.
Labs prior to and periodically include renal panel, CBC and liver panel.
Clinical Reasoning and Decision-Making Activity
Using the above information, consider the following clinical scenario question:
John Smith was admitted to the hospital with a serious abdominal infection. The nurse notices that this client is allergic to penicillin as he prepares to administer the first dose of imipenem medication. What is the nurse’s next best action?
Note: Answers to the Clinical Reasoning Activities and Critical Thinking questions can be found in the Chapter 12: Antimicrobial Medications answer key – Fundamentals of Nursing Pharmacology – 2nd Canadian Edition section at the end of the book.
References
Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019. ↵
Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., & Bonomo, R. A. (2011). Carbapenems: past, present, and future. Antimicrobial agents and chemotherapy, 55(11), 4943–4960. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195018/ ↵
UpToDate (2021). Meropenem. https://www.uptodate.com/contents/search ↵
Vallerand, A. & Sanoski, C. (2024). Davis’s Canadian drug guide for nurses (19th ed.). F.A. Davis Company: Canada
