Meropenem with vaborbactam

How it works

Meropenem inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, while vaborbactam inhibits class A serine beta-lactamases such as KPC, protecting meropenem from enzymatic hydrolysis.

Prescribing in practice

• It should be reserved, ideally with microbiology and infection-specialist input, for confirmed or strongly suspected resistant Gram-negative infection to preserve activity, noting vaborbactam does not inhibit metallo-beta-lactamases.
• Cross-reactivity with other beta-lactams means caution is needed in patients with penicillin or cephalosporin hypersensitivity.
• The dose requires adjustment in renal impairment, and meropenem can reduce valproate concentrations and lower the seizure threshold.

Monitoring

Monitor renal function for dose adjustment, clinical response and signs of superinfection or Clostridioides difficile, and review valproate levels if co-prescribed.

Counselling the patient

• Report any rash, swelling or breathing difficulty that could indicate an allergic reaction.
• Tell the team about previous penicillin or other antibiotic allergies.
• Report new or worsening diarrhoea during or after treatment.

Evidence & guidelines

Use against resistant Gram-negative infection is supported by the TANGO trials and reflected in the SPC and antimicrobial stewardship guidance.