Carbapenems in clinical practice


  • S.O. Kramarov Bogomolets National Medical University, Kyiv, Ukraine,
  • V.V. Yevtushenko Bogomolets National Medical University, Kyiv, Ukraine,



meropenem, carbapenems, infection, children


Increasing frequency of infections caused by multi-drug resistant organisms is currently observed in the adult and pediatric population. It is the clinician’s responsibility to use wide-spectrum antibiotics when appropriate, where such a potent treatment is required. Carbapenems are the most efficient beta-lactams, especially against Gram-negative bacilli, and the most preserved from resistance so far. This review summarizes microbiological, pharmacokinetic and pharmacodynamic characteristics of currently available carbapenems. Their clinical use in different pediatric settings is then discussed, based on published evidence. Among available carbapenems, meropenem has superior pharmacokinetic and pharmacodynamic properties, higher tolerance and easier use in the pediatric population.


Papp-Wallace KM, Endimiani A, Taracila MA, Bonomo RA. Carbapenems: past, present, and future. Antimicrob Agents Chemother. 2011 Nov;55(11):4943-60. doi: 10.1128/AAC.00296-11.

List of Carbapenems. Available from: Accessed: March 16, 2019.

Bush K, Bradford PA. β-Lactams and β-Lactamase Inhibitors: An Overview. Cold Spring Harb Perspect Med. 2016 Aug 1;6(8). pii: a025247. doi: 10.1101/cshperspect.a025247.

Brook I, Wexler HM, Goldstein EJC. Antianaerobic antimicrobials: spectrum and susceptibility testing. Clin Microbiol Rev. 2013 Jul;26(3):526-46. doi: 10.1128/CMR.00086-12.

Wanger A, Chavez V, Huang RSP, Wahed A, Actor JK, Dasgupta A. Antibiotics, Antimicrobial Resistance, Antibiotic Susceptibility Testing, and Therapeutic Drug Monitoring for Selected Drugs. Microbiol Mol Diagnosis Pathol. 2017:119-153. doi:10.1016/B978-0-12-805351-5.00007-7.

Codjoe FS, Donkor ES. Carbapenem Resistance: A Review. Med Sci (Basel). 2017 Dec 21;6(1). pii: E1. doi: 10.3390/medsci6010001.

Tutu van Furth AM, El Tahir O. Bacterial meningitis. BMJBest Pract. 2018. Available from: Accessed: March 20, 2019.

Le Saux N, Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age. Paediatr Child Health. 2014 Mar;19(3):141-52.

van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. doi: 10.1016/j.cmi.2016.01.007.

Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):701-706. doi:10.1093/cid/cix152.

Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the Epidemiology of Pediatric Severe Sepsis. Pediatr Crit Care Med. 2013;14(7):686-693. doi:10.1097/PCC.0b013e3182917fad.


on RM. Monotherapy for Patients with Severe Sepsis? NEJM J Watch. 2012;2012. doi: 10.1056/ID201205300000003.

Sartelli M, Abu-Zidan FM, Ansaloni L, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015 Aug 12;10:35. doi: 10.1186/s13017-015-0032-7.

Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59. doi: 10.1111/j.1469-0691.2011.03672.x.

Arthur LE, Kizor RS, Selim AG, van Driel ML, Seoane L. Antibiotics for ventilator-associated pneumonia. Cochrane Database Syst Rev. 2016 Oct 20;10:CD004267. doi:10.1002/14651858.CD004267.pub4.

Kalanuria AA, Ziai W, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208. doi:10.1186/cc13775.

Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. doi:10.1093/cid/ciw353.

Kumar RR, Kim JT, Haukoos JS, et al. Factors Affecting the Successful Management of Intra-Abdominal Abscesses With Antibiotics and the Need for Percutaneous Drainage. Dis Colon Rectum. 2006;49(2):183-189. doi:10.1007/s10350-005-0274-7.

Sartelli M, Chichom-Mefire A, Labricciosa FM, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29. doi:10.1186/s13017-017-0141-6.

Shirah GR, O’Neill PJ. Intra-abdominal infections. Surg Clin North Am. 2014;94(6):1319-1333. doi:10.1016/j.suc.2014.08.005.

Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and Management of Complicated Intra‐abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133-164. doi:10.1086/649554.

Karimi F, Ashrafi F, Moghaddas A, Derakhshandeh A. Management of Febrile Neutropenia: A Description of Clinical and Microbiological Findings by Focusing on Risk Factors and Pitfalls. J Res Pharm Pract. 2018;7(3):147-156. doi:10.4103/jrpp.JRPP_18_16.

White L, Ybarra M. Neutropenic Fever. Hematol Oncol Clin North Am. 2017;31(6):981-993. doi:10.1016/j.hoc.2017.08.004.

Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. doi:10.1093/cid/cir073.