Les carbapénèmes

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 in France imipenem, meropemem and ertapenem and doripenem will be very 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.