The carbapenem antibiotics imipenem/cilastatin and meropenem offer therapeutic options for unusual and highly antibiotic-resistant organisms encountered in the neonatal intensive care unit. The agents have a very broad spectrum of antibiotic activity, favorable safety profiles, and good drug penetration into all body sites, making them a reasonable choice for term and preterm infants who have difficult-to-treat infections. Although a moderate amount of pharmacokinetic data support the safe use of carbapenem antibiotics in neonates, the broad-spectrum activity of the agents dictates that their use be limited to the treatment of highly resistant, nosocomially acquired bacteria and mixed aerobic and anaerobic infections.
Carbapenems are beta-lactam antibiotics that have broad-spectrum aerobic and anaerobic activity. Like other beta-lactam antibiotics, they exert an antibacterial effect by binding penicillin-binding proteins, thereby disrupting bacterial cell wall synthesis. Because imipenem is rapidly degraded by renal proximal tubule dipeptidases, it is marketed in combination with the dipeptidase inhibitor cilastatin....
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