IDStewardship

Doripenem (Doribax)

[Doripenem photo]

KEY POINTS

  • As of 2022, doripenem remains discontinued in the United States
  • Doripenem (Doribax) is an injectable carbapenem and beta-lactam antibiotic that interferes with bacterial cell wall synthesis in sensitive organisms
  • Use is commonly reserved for infections due to drug-resistant Gram negative bacteria such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and E. coli
    • Doripenem is believed to have enhanced activity versus Pseudomonas aeruginosa, however promising in vitro data has not translated into better clinical outcomes as compared to other anti-pseudomonal carbpanems (i.e., meropenem and imipenem-cilastatin)
    • DOES NOT cover MRSA or VRE
    • Carbapenems like doripenem are generally considered the drugs of choice for ESBL-producing organisms (aka ESBL-positive organisms)
      • ESBL = extended-spectrum beta-lactmase
    • Reserve this “big gun” antibiotic until you absolutely have to use it
  • Holds FDA-approval for:
    • Complicated intra-abdominal infection
    • Complicated urinary tract infections, including pyelonephritis
  • Typical dose is 500mg every 8 hours in adults
    • Adjust doses when kidney function is below creatinine clearance of 50 mL/min
  • Patients who are allergic to penicillins or cephalosporins may also be allergic to carbapenems
    • Generally speaking cross-reactivity is low, be more concerned in patients with a history of severe allergic reaction
  • Beware seizures and hypersensitivity
  • Beware drug interaction with valproic acid, as doripenem can reduce valproic acid concentrations
  • Hospital commonly carry meropenem or doripenem, but not both

RESOURCES

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