Hello ladies and gentlemen and welcome to another video at the Pharmacist Academy. In this video I'll be reviewing the carbapenem class. Now these are agents that we use a lot in clinical practice and in this video I will tell you exactly why. Now I also have other videos reviewing other classes of antibiotics so make sure you check them out. I will include the link down below.
And if you're learning infectious diseases for the first time, I also have an introduction video to infectious diseases. So make sure you check that out. That will help you develop that foundation to help you understand infectious diseases going forward.
So just like all beta-lactams, carbapenems inhibit the formation of bacterial cell wall. And they do this by binding to the penicillin-binding protein, also known as trans... peptidase. Now for those of you who don't know, this protein is responsible for building the bacteria cell wall.
Okay. And when the bacteria has a cell wall, it's good for its structure. It holds everything in place.
So once you inhibit the formation of this, it leads to bacteria death. Okay. So our beta-lactams are bactericidal because they kill the bacteria.
They don't just stop the growth, they actually kill it. Now the reason why we love using carbapenems in clinical practice is because they have a broad spectrum of activity. So many times in the hospital you may get a patient who has some kind of infection, right? We send the cultures out, but sometimes it may take a while to get the results back.
So it's very nice to have these kind of agents that we could give the patient. that will cover a broad range of bacteria. Now one thing that stands out here is that they cover resistant organisms which I will discuss a little bit more in this video.
So due to the broad spectrum carbapenems are usually referred to as the big guns okay. I mean because it's the big guns we don't want to just randomly use it but when we need to use it we don't hesitate we definitely use these agents. And once we find out exactly what organism or what bacteria is causing the infection, that's when we deescalate and, you know, use an agent that's more specific for that bacteria. Now, carbapenems exhibit a time-dependent antibacterial activity, just like all beta-lactams. So this means that when you give a carbapenem, right, The concentration at which it inhibits the growth of the organism, you want this concentration to be maintained in the blood, right?
So the longer this concentration is maintained, the more effective they are. Some important facts about carbapenems. They're normally used for intra-abdominal infections, urinary tract infections, especially when it's due to ESBL-producing organisms.
Diabetic foot infections, pneumonia. Now very similar to other beta-lactams, they have a risk of causing seizures. In fact, the carbapenems do have one of the highest risk of causing seizures compared to the other beta-lactams. Side effects include diarrhea, rash, bone marrow suppression.
In terms of monitoring, this is where the pharmacist role really becomes important. So as a pharmacist, you want to make sure that you're constantly checking to see if the culture has resulted. So as I mentioned earlier, we tend to use these agents as empiric therapy when we give these medications to the patient, even though we don't know which bacteria is causing the infection, simply because they have a broad range of coverage and they are more likely to cover one of the organisms that's most likely causing the infection. So you want to keep looking for the culture results because once the results come back, you want to de-escalate, take the patient off the broad spectrum antibiotic and put them on something that's more targeted against that specific bacteria. And as you know, doing this can actually reduce the risk of resistance.
Keep in mind that if the renal function is not that great and they get the wrong dose, they have a higher chance of developing seizures. In terms of SpectrumF activity, They cover gram positives, okay, so staphylococcus, streptococcus, and some of the gram positive anaerobes. They have activity against enterococcus faecalis, but not facium, and they do not cover MRSA or atypical organisms.
Now, carbapenems also cover gram negative organisms, so they cover enterobacteria shea. This is a large family of gram negative. organisms. So this may include E.
coli, protease, klebsiella, etc. They also cover Neisseria, H. influenzae, Providencia, and other gram-negative anaerobes.
Now they are a good option for patients with ESBL infections. And I'm not going to go into this specific resistant organism or resistance in this video. I already talked about this in previous videos. So like I said, I'm going to include the link down below so that you guys can check it out.
But just know that usually the drug of choice for ESBLs are carbapenems. They have good activity against pseudomonas. Okay, so once again, whenever you learn that an antibiotic cover a specific resistant organism, make sure you know that.
Okay, make sure you memorize that because it's going to come up again. So here are the different carbapenems. And I have this acronym here for you guys, DIME. Now, please keep in mind that dori-penem is not approved to treat any type of pneumonia because when they did the trials, they found that it actually increased death in the patients who received the dori-penem. Imipenem cilastatin also known as premaxin.
Now this is a carbapenem in combination with this agent here which actually inhibits this enzyme called dihydropeptidase which breaks down the imipenem once it gets to the kidneys potentially reducing the amount of imipenem in the body. Now also keep in mind that imipenem has the highest risk of causing seizures compared to other carbapenems. And also imipenem, it was the first carbapenem to actually come out, and then meropenem.
And meropenem is the only carbapenem approved for treatment of meningitis, and that's because it has very good penetration into the CSF. Erdapenem. Now out of all the carbapenems, erdapenem is the only one that doesn't cover pseudomonas.
Now also compared to the other carbapenems, it's more susceptible to carbapenemases. And carbapenemases are simply beta-laxamases that break down carbapenems. And I've actually discussed this in more detail in previous videos.
So please, please check it out, okay? I'm going to include the link in the descriptions. And it's also given once daily.
Now, three things I want you to take away from the carbapenems. One, they are broad spectrum, okay? So they are a very nice option for empiric therapy. Whenever you don't know which bacteria is causing the infection, you can usually go to carbapenems and you will be good. They have this seizure risk.
So you always want to be careful in patients with renal impairment and patients receiving high doses of these agents and they require renal adjustments. So once again pharmacists please make sure you calculate the cran and clearance and adjust it as needed. And that would be the end of this video. I hope this video was pretty straightforward for you guys.
As I mentioned earlier carbapenems are very common in clinical practice. But as I went through this video, as you can see, they're not that complicated, pretty straightforward, broad spectrum agents with a seizure risk and make sure you adjust for any renal impairment. If this video is helpful, please like, comment, subscribe, and share it with anybody that you feel may benefit from this video. Make sure to connect with me on these social media platforms.
Thank you for watching this video. Take care.