Carbapenem + β-lactamase inhibitor Pregnancy: eMC §4.6: there are no or limited data (fewer than 300 pregnancy outcomes) from the use of meropenem/vaborbactam in pregnant women; animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precautionary measure it is preferable to avoid the use of Vaborem during pregnancy. Meropenem has been reported to be excreted in human milk and it is unknown whether vaborbactam is excreted in milk; because a risk to the newborn/infant cannot be excluded, breast-feeding must be discontinued prior to initiating therapy. Effects on human fertility have not been studied; animal studies do not indicate harmful effects on fertility.

Meropenem with vaborbactam

Brand names: Vaborem

Meropenem with vaborbactam is an intravenous combination of a carbapenem antibacterial and a beta-lactamase inhibitor, used for serious Gram-negative infections including those caused by certain carbapenem-resistant Enterobacterales.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2 g/2 g (meropenem 2 g with vaborbactam 2 g) every 8 hours by intravenous infusion over 3 hours, in patients with a creatinine clearance of 40 mL/min or above

Route: Intravenous use - administered by intravenous infusion over 3 hours

Frequency: Every 8 hours

eMC §4.2 (Vaborem 1 g/1 g powder for concentrate for solution for infusion). Vaborem should be used to treat infections due to aerobic Gram-negative organisms in adult patients with limited treatment options only after consultation with a physician with appropriate experience in the management of infectious diseases. The 2 g/2 g every 8 hours 3-hour infusion applies to ALL the licensed indications; only the DURATION differs - complicated UTI including pyelonephritis: 5 to 10 days (treatment may continue up to 14 days); complicated intra-abdominal infection: 5 to 10 days (may continue up to 14 days); hospital-acquired pneumonia including ventilator-associated pneumonia: 7 to 14 days; bacteraemia associated with or suspected to be associated with any of the above: duration in accordance with the site of infection; infections due to aerobic Gram-negative organisms in patients with limited treatment options: duration in accordance with the site of infection. Creatinine clearance is calculated using the Cockcroft-Gault formula. ELDERLY: no dose adjustment based on age is required. HEPATIC IMPAIRMENT: no dose adjustment is required. PAEDIATRIC: the safety and efficacy of meropenem/vaborbactam in children and adolescents younger than 18 years of age have not yet been established and no data are available - verify any under-18 use against a children's formulary. For reconstitution and dilution instructions see SPC §6.6. IMPORTANT SOURCE CAVEAT: the US label captured in this bundle is Meropenem for Injection USP - meropenem ALONE, not the fixed combination. Its adult regimens (500 mg every 8 hours for complicated skin and skin structure infections, 1 g every 8 hours for intra-abdominal infections, infused over 15-30 minutes or given as a 3-5 minute bolus) and its paediatric mg/kg tables relate to single-agent meropenem and must NOT be applied to this meropenem/vaborbactam page.

Dose adjustments

Renal

eMC §4.2 Table 2, for patients with a creatinine clearance of 39 mL/min or below (Cockcroft-Gault): CrCl 20 to 39 mL/min - 1 g/1 g every 8 hours, infused over 3 hours; CrCl 10 to 19 mL/min - 1 g/1 g every 12 hours, infused over 3 hours; CrCl less than 10 mL/min - 0.5 g/0.5 g every 12 hours, infused over 3 hours. Treatment duration is as per Table 1 for the relevant indication. Meropenem and vaborbactam are removed by haemodialysis, and doses adjusted for renal impairment should be administered AFTER a dialysis session.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients (eMC §4.3)
Hypersensitivity to any carbapenem antibacterial agent (eMC §4.3)
Severe hypersensitivity (e.g. anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent, e.g. penicillins, cephalosporins or monobactams (eMC §4.3)

Side effects

Headache (8.1% in the pooled Phase 3 studies - the most common adverse reaction) (eMC §4.8)
Diarrhoea (4.7%), nausea (2.2%), vomiting, abdominal pain and abdominal distension
Infusion site phlebitis (2.2%), phlebitis, vascular pain and hypotension
Raised alanine aminotransferase, aspartate aminotransferase and blood alkaline phosphatase; drug-induced liver injury
Common blood and metabolic changes: thrombocythaemia, leucopenia, neutropenia, eosinophilia, thrombocytopenia, hypokalaemia, hypoglycaemia. Uncommon/rare but serious: Clostridioides difficile colitis, anaphylactic reaction, hypersensitivity, angioedema, convulsions, agranulocytosis, haemolytic anaemia, rhabdomyolysis, and severe cutaneous adverse reactions (TEN, Stevens-Johnson syndrome, erythema multiforme, DRESS, AGEP)

Interactions

The eMC §4.5 interactions section was not captured in this bundle - clinician to review it in the SPC. The two interactions below are taken from the US labelling for meropenem alone and relate to the meropenem component
Valproic acid / divalproex sodium - carbapenems including meropenem reduce valproic acid concentrations, potentially below the therapeutic range, increasing the risk of breakthrough seizures; concomitant use is generally not recommended and non-carbapenem antibacterials should be considered in patients whose seizures are controlled on valproate (US meropenem label §5.4, §7.2)
Probenecid - competes with meropenem for active tubular secretion, increasing meropenem plasma concentrations; co-administration is not recommended (US meropenem label §7.1)

Clinical monograph

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.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Imipenem with cilastatin and relebactam · Carbapenem + β-lactamase inhibitor

Pathways