Advances in the use of carbapenem antibiotics in the management of serious bacterial infections in special patient populations. I: Safety and efficacy in children and elderly patients

Objective: To assess the efficacy and cost-effectiveness of carbapenem. Background: Carbapenems are a relatively new class of betalactam antibiotics that have been shown to be effective in treating polymicrobial infections when used alone or with other agents. Their spectrum of activity includes aerobic and anaerobic grampositive and gram-negative organisms, especially Pseudomonas aeruginosa. The problem of bacterial resistance in chemotherapy is of grave concern worldwide; attempts to curtail this problem have led to the adoption of systematic approaches aimed at overcoming bacterial resistance. The strategies used frequently involve highly potent but toxic agents such as aminoglycosides. As a result, efforts have been intensified to develop agents with relatively low toxicity to be used as monotherapy in the treatment of serious infections in special populations. Monotherapy with relatively safe, cost-effective agents devoid of debilitating toxicity has been the goal of anti-infective pharmacotherapy in recent times. In pediatric and geriatric populations with serious infections, carbapenem therapy has shown promising results. For instance, in bacterial meningitis and intra-abdominal and lower respiratory tract infections resulting from acute exacerbation of cystic fibrosis, the carbapenem antibiotics are excellent drugs of choice. Conclusion: Preclinical pharmacologic studies indicate that newer agents such as meropenem and ER-35786 have superior activity against most strains of Pseudomonas, a favorable safety profile, and stability against renal dehydropeptidase enzyme. In addition, treatment regimens using carbapenems have been cost-efficient alternatives to other antibiotic classes, especially when all costs involved in patient care are considered.