Doripenem is the latest
carbapenem on the market to date. Although not an
antibiotic in a new class, it offers a glimmer of hope in combating serious
infections secondary to multidrug-resistant Gram-negative bacteria when we have not seen a new class of antibacterial, particularly for Gram-negative bacteria, for more than 10 years. In vitro,
doripenem exhibits a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including extended-spectrum β-lactamase (ESBL) and
Amp-C β-lactamase producing Enterobacteriaceae and anaerobes.
Doripenem also exhibits better in vitro activity against Pseudomonas aeruginosa compared to other anti-pseudomonal
carbapenems. It combines the desirable activities of both
imipenem and
meropenem. It has similar activity to
imipenem against Gram-positive pathogens and has the antimicrobial spectrum of
meropenem against Gram-negative organisms. Several randomized clinical trials have demonstrated that
doripenem is non-inferior to
meropenem,
imipenem,
piperacillin/tazobactam, or
levofloxacin in its efficacy and safety profile in treating a wide range of serious
bacterial infections including
intra-abdominal infection, complicated
urinary tract infection, and
nosocomial pneumonia. Due to its wide spectrum of activity and good safety profile it is susceptible to misuse leading to increasing rates of resistance. Judicious use should be considered when using
doripenem as a first-line agent or
drug of choice for serious
infections.
Doripenem is a well-tolerated
drug with common adverse effects including
headache,
nausea and
diarrhea. Caution should be used in patients with
hypersensitivity to
carbapenems and adverse reactions to β-
lactam agents. Dosage adjustment is needed for patients with renal impairment.
Doripenem has demonstrated economic and clinical benefits. It has been shown to reduce hospital
length of stay and duration of
mechanical ventilation for intensive care unit (ICU) patients. Therefore,
doripenem is a welcome addition to our limited armamentarium of
antibiotics available to treat serious
bacterial infections in hospitalized patients.