Doripenem

General

• Type: Carbapenem (broad-spectrum beta-lactamase)
• Dosage Forms: IV
• Common Trade Names: Doribax

Adult Dosing

Intra-abdominal infection, complicated

• 500mg IV q8h x5-14 days

UTI, complicated

• 500mg IV q8h x10 days

Anthrax, systemic

• 500mg IV q8h for at least 2 wk as part of multi-drug regimen

Pediatric Dosing

Anthrax, systemic

• Neonates >32 weeks gestation
  • 20-30 mg/kg/day IV divided q8-12h for two weeks as part of multi-drug regimen
• 1+ month old
  • 120 mg/kg/day IV divided q8h for at least two weeks as part of multi-drug regimen
    • Max: 1 g/dose

Special Populations

• Pregnancy Rating: B
• Lactation: May use while breastfeeding
• Renal Dosing
  • Adult
    • CrCl 30-50: 250mg IV q8h
    • CrCl 10-30: 250mg IV q12h
    • CrCl <10: Not defined
    • HD: Not defined
  • Pediatric
    • May be required, but specifics not defined
• Hepatic Dosing
  • Adult
    • No adjustment
  • Pediatric
    • May be required, but specifics not defined

Contraindications

• Allergy to class/drug
• Anaphylactic reaction to beta-lactams
• Inhalational use
• Ventilator-associated pneumonia
• Caution:
  • Hypersensitivity to beta-lactams
  • Hypersensitivity to multiple allergens
  • Renal impairment
  • CNS disorder
  • Seizure history or risk
  • Recent abx-associated colitis

Adverse Reactions

Serious

• Hypersensitivity Reaction
• Anaphylaxis
• Stevens-Johnson Syndrome, Toxic epidermal necrolysis
• Seizures
• C. diff associated diarrhea
• Pneumonia, interstitial

Common

• Headache
• Nausea, Diarrhea
• Anemia
• Phlebitis, rash, pruritus
• ALT, AST Elevation
• Candidiasis, vuvlovaginal

Pharmacology

• Half-life: 1h
• Metabolism: Kidney minimally
• Excretion: Urine 85% (70% unchanged), feces <1%
• Mechanism of Action: Inhibits cell wall synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	S
	Enterococcus faecalis	I
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	S
	C. jeikeium	X1
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	X2
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	I
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	S
	Prevotella melaninogenica	S
	Clostridium difficile	X2
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia