KEY POINTS
- Meropenem-vaboractam (Vabomere, formerly Carbavance) is the combination of carbapenem (meropenem) plus beta-lactamase inhibitor (vaborbactam)
- Meropenem interferes with bacterial cell wall synthesis in susceptible pathogens through interference with penicillin binding proteins
- Vaborbactam alone has no antimicrobial activity and is a novel cyclic boronic acid inhibitor of numerous class A and class C enzymes
- Designed as a potent inhibitor of serine carbapenemases
- A fixed-dose combination product studied for complicated urinary tract infection and other drug-resistant infections
- Meropenem-vaborbactam was FDA-Approved on August 29th 2017
- Approved for complicated urinary tract infection including pyelonephritis
- The first carbapenem-betalactamase inhibitor combination approved in the United States
- The only antibiotic product in the United States including beta-lactamase inhibitor vaborbactam
- Meropenem has broad-spectrum Gram negative coverage, including multi-drug resistant organisms
- The addition of vaborbactam mainly extends the spectrum of meropenem to include some carbapenem-resistant organisms
- Highly active against many carbapenem-resistant Enterobacteriaceae (CRE)
- Not found to expand coverage to carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, or Stenotrophomonas maltophilia
- The TANGO-2 trial comparing meropenem-vaborbactam to best available therapy was stopped early due to a risk-benefit ratio in favor of meropenem-vaborbactam
- Most likely a drug that will be reserved for CRE
- Dose is 4 grams IV every 8 hours as a 3-hour infusion in adults
- Available intravenous only
- Adjust doses for renal function
- Dose adjustment for hepatic function not recommended in package insert
- Common side effects in trials were headache, infusion site reactions, and diarrhea
- Has the potential to cause serious side effects such as seizure or anaphylaxis
- Beware drug interaction with valproic acid
- Beware short stability once mixed for administration
- Infusion should be completed within 4 hours if stored at room temperature
- Infusion should be completed within 22 hours if stored under refrigeration
- Anticipated that this drug will be very expensive
- Reserve use to preserve it for when it is truly needed (e.g., CRE)
RESOURCES
- Meropenem-vaborbactam Package Insert
- FDA-Approval Announcement for Meropenem-Vaborbactam
- PRESS RELEASE: The Medicines Company announces TANGO-2 trial of meropenem-vaborbactam (formerly, Carbavance) stopped early for superior benefit-risk compared to best available therapy for CRE [July 2017]
- Meropenem-Vaborbactam (M-V) Compared with Piperacillin-Tazobactam (P-T) in the Treatment of Adults with Complicated Urinary Tract Infections (cUTI), including Acute Pyelonephritis (AP) in a Phase 3 Randomized, Double-blind, Double-dummy Trial (TANGO 1) [IDSA 2016]
- Role of newer and re-emerging older agents in the treatment of infections caused by carbapenem-resistant Enterobacteriaceae (Virulence 2017)
- Effect of the β-Lactamase Inhibitor Vaborbactam Combined with Meropenem against Serine Carbapenemase-Producing Enterobacteriaceae (Antimicrobial Agents and Chemotherapy 2016)
- Meropenem–Vaborbactam Tested against Contemporary Gram-Negative Isolates Collected Worldwide During 2014, Including Carbapenem-Resistant, KPC-Producing, Multidrug-Resistant, and Extensively Drug-Resistant Enterobacteriaceae.(Antimicrobial Agents and Chemotherapy 2017)
Photo credit: www.vabomere.com
