Le point sur les carabapénèmes

The carbapenems are a potent class of broad-spectrum antibiotics, and their stability against hydrolysis by most β-lactamases make them major weapons in the treatment of severe nosocomial infections, especially for initial empirical therapy. Three parenteral molecules are currently marketed: imipenem, meropemem and ertapenem. Doripenem will be soon available. Their spectrum of activity covers the majority of Gram-positive and Gram-negative pathogens, including anaerobes but some bacterial species such as methicillin-resistant S. aureus, S. maltophilia and E. faecium are resistant. Ertapenem is not active against P. aeruginosa. Carbapenems exhibit a time-dependent bactericidal effect. The most critical pharmacodynamic parameter is the percentage of time drugs levels remain above the MIC, which should be above 40%. In ICU patients, the main current role for imipenem, meropenem and doripenem remains for use in nosocomial infections. The major threat is the emergence of carbapenemases amongst enterobacteriaceae.