Carbapenemi – Wikipedia

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from Wikipedia, L’Encilopedia Libera.

Basic chemical structure of the carbapenemi
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I carbapenemi They are a class of antibiotics, having the wider spectrum of action available, with β-lactic ring structure; More precisely, the chemical structure of the Carbapenemi contains 2.3-Dihydro-1hpirrol.

Carbapenemi are active against many positive gram and gram negative grams, Aerobi and anaerobic bacteria.

They are part of this class of drugs:

Carbapenemi have a broad spectrum activity towards gram-negative bacteria and a slightly lower activity against gram-positive bacteria. In therapy they are combined with a second drug with broad-spectrum gram-positive activities. In recent years, concern has emerged for the increase in carbapenemi resistance rates, since there are few therapeutic options for the treatment of infections caused by bacteria resistant to these drugs (such as Klebsiella pneumoniae and entertainable) [first] [2] [3] [4] .

Gram-negative pathogens [ change | Modifica Wikitesto ]

The spectrum of impenem, DoriPenem and Merophenem activities include most of the Enterabacteriaceae, including Escherichia coli , Klebsiella pneumoniae , Enterobacter cloacae , Citrobacter freundii , Proteus wonderful It is Serratia marcescens . The activity is maintained against most of the strains of E. coli It is K. pneumoniae Beta-lactamase manufacturers with extended cephalosporine resistant spectrums. Impenem, DoriPenem and Merophenem have a good activity against most of the strains of Pseudomonas aeruginosa It is Acinetobacter . The activity observed against these pathogens is important because they are resistant to many other classes of antibiotics. [3]

Gram-positive pathogens [ change | Modifica Wikitesto ]

The spectrum of activities against gram-positive bacteria is large enough, but not as much as gram-negative bacteria. A good activity is observed against Staphylococcus Sensitive to meticillin, even if there are other antibiotics that provide adequate coverage for these infections. A good activity for streptococci is observed, including penicillin resistant strains. Carbapenemi are not very active against Staphylococcus aureus resistant to mestickel and enterococci since they do not bind to the binding protein the penicillin used by these pathogens. [3]

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Other [ change | Modifica Wikitesto ]

Carbapenemi have a good activity against anaerobes like i Bacteroides fragilis . Like other beta-lactemic, they have no activities against atypical bacteria, who have not cell walls and therefore are not influenced by the synthesis of the cell wall synthesis. [3]

They are used exclusively in a hospital environment in serious and sensitive infections to the specific drug, verifying sensitivity via antibiogram in order to avoid the onset of resistance.
Some types of bacteria have become resistant to the Carbapenemi, among these there are some strains of entertainable, Klebsiella pneumoniae , Stenotrophomonas maltophilia , Pseudomonas aeruginosa It is Proteus wonderful .

Intra-abdominal infections [ change | Modifica Wikitesto ]

Ertapenem is one of the first choice drugs recommended for the treatment of intra-abdominal infections acquired in the community of mild to moderate gravity. DoriPenem, Impenem and Merophenem are recommended for abdominal infections acquired in high -risk communities and for abdominal infections acquired in the hospital. [5]

Pneumonia [ change | Modifica Wikitesto ]

Impenem and Merophenem are recommended in the pneumonia therapy acquired in the hospital with a late onset or associated with the fans, especially if caused by Pseudomonas , Acinetobacter O Entertainable Extended spectrum beta-lactamase manufacturers. The therapy provides for the combination in general with an aminoglycoside, and is recommended in infections from Pseudomonas to avoid resistance development during treatment. [6]

Carbapenemi are used less in the treatment of pneumonia acquired in the community, since the most common responsible pathogens ( Streptococcus pneumoniae , Haemophilus influenazae , atypical bacteria and enterobacteria) are more sensitive to fluorochinoloni, amoxicillin or azithromycin. Impenem and meropenem are useful in cases where there is the suspicion of an infection from P. aeruginosa . [7]

Blood infections [ change | Modifica Wikitesto ]

A 2015 study established that the piperacillin-tazobactam combination gives results equivalent to carbapenem treatment in patients with sepsis. [8] For infections from Entertainable , Carbapenemi are superior to alternative treatments. [9]

Carbapenemi are contraindicated in patients with previous allergic reactions to beta-lactam antibiotics. Since the intramuscular formulations of Ertapenem and Impenem provide for the addition of lidocaine, these types of drugs are contraindicated in patients with previous lidocaine adverse reactions. In addition, Carbapenemi are contraindicated in patients taking valproic acid for convulsions, as it reduces the concentration of valproic acid up to 90%. [ten]

Severe and occasionally fatal allergic reactions may occur in patients treated with Carbapenemi. [11] The convulsions are rare and linked to both in Impenem and Merophenem. [twelfth] Cases of diarrhea related to the It’s hard . Subjects with a penicillin allergy can develop crusade sensitivity to the Carbapenemi.

  1. ^ ( IN ) Brazil: Klebsiella pneumoniae carbapenemase prompts closing of hospital ICU . are Outbreak News Today , 26 July 2015. URL consulted on January 20, 2020 .
  2. ^ ( IN ) Papla-Walace Km, anti-intien a, and the maomo, the Moomo, the Keomo, the Keomo, the Keomo, the Keomo. Carbapenems: Past, Present, and Future . are Antimicrobial agents and chemotherapy , 2011-11. URL consulted on January 20, 2020 .
  3. ^ a b c d ( IN ) Bledh d, texier-butcher j, allaouououch b, Sacux MC, Boselli e, Carbapenems . are Journal of chemotherapy (Florence, Italy) , 2013-02. URL consulted on January 20, 2020 .
  4. ^ ( IN ) Livermore Dm, Woodford N, Carbapenemases: A Problem in Waiting? . are Current opinion in microbiology , 2000-10. URL consulted on January 20, 2020 .
  5. ^ ( IN ) Solomkin JS, Mazuski is, Bradley JS, Rodvold Ka, Goldstein Ej, Baron Ej, Diagnosis and Management of Complicated Intra-Abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America . are Clinical infectious diseases : an official publication of the Infectious Diseases Society of America , January 15, 2010. URL consulted on January 20, 2020 .
  6. ^ ( IN ) Guidelines for the Management of Adults With Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia . are American journal of respiratory and critical care medicine , February 15, 2005. URL consulted on January 20, 2020 .
  7. ^ ( IN ) Woodhead m, blasi f, ewig s, garau j, huchon g, iEven m, Guidelines for the Management of Adult Lower Respiratory Tract Infections–Full Version . are Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases , 2011-11. URL consulted on January 20, 2020 .
  8. ^ National Collaborating Centre for Cancer, Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients , in National Institute for Health and Care Excellence: Guidance , National Institute for Health and Clinical Excellence (UK), 2012. URL consulted on January 20, 2020 .
  9. ^ ( IN ) Vardakas Kz, Tansarli GS, Rafailidis Pi, Falagas Me, Carbapenems Versus Alternative Antibiotics for the Treatment of Bacteraemia Due to Enterobacteriaceae Producing Extended-Spectrum β-Lactamases: A Systematic Review and Meta-Analysis . are The Journal of antimicrobial chemotherapy , 2012-12. URL consulted on January 20, 2020 .
  10. ^ ( IN ) Miranda Herrero MC, Alcaraz Romero Aj, Escudero Vilaplana V, Fernández Lafever Sn, Fernández-Llamazares CM, Barredo Valderrama E, Pharmacological Interaction Between Valproic Acid and Carbapenem: What About Levels in Pediatrics? . are European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society , 2015-03. URL consulted on January 20, 2020 .
  11. ^ ( IN ) Torres MJ, White M, The Complex Clinical Picture of Beta-Lactam Hypersensitivity: Penicillins, Cephalosporins, Monobactams, Carbapenems, and Clavams . are The Medical clinics of North America , 2010-07. URL consulted on January 20, 2020 .
  12. ^ ( IN ) Straw tg, Clinical Review: Balancing the Therapeutic, Safety, and Economic Issues Underlying Effective Antipseudomonal Carbapenem Use . are Critical care (London, England) , 2008. URL consulted on January 20, 2020 .

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