Meropenem Vaborbactam (Vabomere) is a combination of carbapenem and beta-lactamase inhibitors used to treat susceptible gram-negative infections.

Meropenem Vaborbactam (Vabomere) Uses:

• Complicated Urinary tract infections:

  • Patients who are 18 years old and older with severe UTIs, which include pyelonephritis, caused due to the following micro-organisms that are susceptible to it are advised to use it:
    • Enterobacter cloacae species complex
    • Klebsiella pneumoniae
    • Escherichia coli,

Meropenem Vaborbactam (Vabomere) Dose in Adults:

Meropenem Vaborbactam (Vabomere) Dosing:

Note:

The dosage is defined as a combination of meropenem/vaborbactam in grams

Treatment of severe urinary tract infections, including pyelonephritis, using Meropenem Vaborbactam (Vabomere) dosage:

• 4 g intravenously thrice daily for not more than 14 days.

Meropenem Vaborbactam (Vabomere) Use in kids:

It is not suggested for usage in individuals less than the age of 18.

Pregnancy Risk Category: Not assigned

• In animal reproduction studies, this combination has not yet been investigated.
• Vaborbactam in pregnancy has been linked to adverse fetal outcomes.

Use of vaborbactam and Meropenem during lactation

• It is unknown if vaborbactam can pass via breast milk. Breast milk contains meropenem.
• Manufacturers recommend weighing the risks to the infant from drug exposure and the benefits for the mother.

Meropenem Vaborbactam (Vabomere) Dose in people suffering from Kidney Disease:

Note:

The combo medications' dosage is stated in grams. The MDRD formula must be used to change the dose in individuals with kidney disease.

• 30 to 49 mL/min/1.73 m2 eGFR:

  • 2 gms 8 hourly

• eGFR less than 15 mL/min/1.73 m2:

  • 1 gm 12 hourly

• 15 to 29 mL per minute per 1.73 m2:

  • 2 gms 12 hourly

• eGFR less than 50 mL/min/1.73 m2:

  • Adjustment in the dose is not necessary

• Hemodialysis patients:

  • Dialyzable (meropenem: 38%; vaborbactam: 53% )
  • On days when you have dialysis, give the dose after hemodialysis.

Dose in Liver disease:

Meropenem and vaborbactam do not undergo hepatic elimination, hence patients with liver illness do not require dose adjustment.

Side effects of Meropenem Vaborbactam (Vabomere):

• Cardiovascular:

  • Phlebitis

• Hepatic:

  • Increased serum ALT
  • Increased serum AST

• Local:

  • Infusion site reaction

• Endocrine & metabolic:

  • Hypokalemia
  •  

• Central nervous system:

  • Headache

• Miscellaneous:

  • Fever

• Hypersensitivity:

  • Hypersensitivity

• Gastrointestinal:

  • Clostridioides (formerly Clostridium) defficile-associated diarrhea
  • Diarrhea
  • Nausea

Contraindication to Meropenem and vaborbactam Include:

• Allergic responses to any ingredient in the formulation, including meropenem, vaborbactam, other carbapenems, beta-lactamase inhibitors, and others
• Individuals who have used beta-lactam medications and experienced anaphylactic responses

Warnings and precautions

• Hypersensitivity reactions

  • Beta-lactam antibacterial medications have been linked to severe allergic reactions such as angioedema and anaphylaxis.
  • Patients who have had allergic reactions to penicillins, cephalosporins or other beta-lactam antibiotics in the past may be at greater risk for allergic reactions.
  • Patients should inquire about any previous hypersensitivity reactions and discontinue treatment immediately if they are able to.

• CNS effects

  • It is possible to experience neurological adverse effects, including seizures, due to its use.
  • Individuals with a record of seizures, CNS infections, brain lesions, tumors, or any other neurological disease are at greater risk for serious neurological adverse events.
  • Patients with renal dysfunction are more likely to experience CNS manifestations. It is important to adjust the dose for renal disease.
  • If a neurological cause is discovered in focal tremors, myoclonus, or seizures, patients may need to stop taking the medication or reduce their dose.
  • It is important to instruct patients not to do tasks that require mental alertness, as this can lead to impairment of motor functions and alertness.

• Superinfection

  • Long-term antibiotic use has been linked to fungal and bacterial superinfections.
  • Even after two months of post-antibiotic treatment, there is a risk of C. difficile infection (CDAD) or pseudomembranous colitis.

• Renal impairment

  • Patients with kidney dysfunction should use it with caution.
  • Patients who have a CrCl lower than 50 ml/minute will need to be adjusted their dose.
  • Patients with decreased renal function are more likely to experience thrombocytopenia and seizures.

Monitoring parameters:

• Keep an eye out for symptoms of allergic reactions, including urticaria, angioedema, anaphylaxis, and severe skin responses.

• Periodically check on kidney functioning. Patients with abnormal or unstable renal functions should have their serum creatinine and eGFR checked every day.

How to administer Meropenem and Vaborbactam?

It is given by an intravenous infusion over three hours.

Mechanism of action of Meropenem and Vaborbactam (Vabomere):

Meropenem:

The penicillin-binding proteins (PBP) binds to prevent the production of the bacterial cell wall.

As a result, the production of peptidoglycan at its ultimate stage within bacterial cell walls is inhibited.

The bacterial cell walls eventually become acted upon by autolytic enzymes (autolysins or murein hydrolases), resulting in bacterial death.

Vaborbactam

A beta-lactamase inhibitor called vaborbactam stops serine beta-lactamases from destroying meropenem. (For instance, K. pneumonitis carbapenemase; [KPC]). It is not antibacterial in nature.

Metabolism:

• Meropenem: The beta-lactam link is hydrolyzed to an open lactam form.
• Not metabolised: vaborbactam

Excretion:

• Meropenem:
  • Urine (40% to 60% [unchanged]; 22% inactive hydrolysis product);
  • feces (~2%);
• Vaborbactam: Urine (75% to 95% [unchanged])

Protein binding:

• Meropenem: ~2%;
• Vaborbactam: ~33%

Half-life elimination:

• Meropenem: 1.22 hours;
• Vaborbactam: 1.68 hours

Meropenem and vaborbactam brands sold abroad:

• Vabomere

Meropenem and vaborbactam Price in the US:

• Each 2 gm vial costs: $198.00

Meropenem Vaborbactam Brands Names in Pakistan:

No Brands Available in Pakistan.