Carbapenems: Uses, most common brand names, and safety information

Medically reviewed by  Jamie Winn, PharmD

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In 1976, the first beta-lactamase (β-lactamase) inhibitors were found to be naturally produced by the Gram-positive bacterium Streptomyces clavuligerus. This was a major breakthrough in infectious disease therapeutics. Shortly after, 2 β-lactamase inhibitors were isolated, clavulanic acid and thienamycin.

Thienamycin was found to be chemically unstable, so the research continued to find a more stable substitute. The first derivative of thienamycin was imipenem, which was approved by the U.S. Food and Drug Administration (FDA) in November 1985. Like thienamycin, imipenem was unstable and susceptible to deactivation by dehydropeptidase I (DHP-I).

Since imipenem was introduced, more stable carbapenems with a broader spectrum of activity have been discovered.

The list below includes the best carbapenems approved by the U.S. Food and Drug Administration (FDA) and their pricing:

List of Carbapenems

What are Carbapenems?

Carbapenems are in a class of medications called beta-lactam antibiotics (β-lactam antibiotics). Other β-lactam antibiotics include penicillins (amoxicillin), cephalosporins (cephalexin), and monobactams (aztreonam).

Unlike most other β-lactams, carbapenems are resistant to hydrolysis by most β-lactamases. This gives them a broad spectrum of activity against many gram-positive and gram-negative organisms. Carbapenems are typically used as a last resort for known or suspected multidrug-resistant bacterial infections. Bacterial cultures and susceptibility testing should be performed if possible to choose the most effective medication and help reduce antibiotic resistance.

While most other β-lactam treatment options are taken by mouth, carbapenems are administered via intramuscular (IM) or intravenous (IV) injections.

How do Carbapenems work?

Carbapenem antibiotics are similar to the structure and mechanism of action of penicillins. However, carbapenems have a broader antimicrobial spectrum in vitro. This is because carbapenems are resistant to hydrolysis by the β-lactamase enzyme present in some pathogens.

Carbapenems work by binding to penicillin-binding proteins (PBPs) and inhibiting bacterial cell wall synthesis in many gram-positive and gram-negative bacteria. Carbapenems can also be combined with other antimicrobial agents to treat serious infections, including multi-drug-resistant bacterial infections.

What conditions are Carbapenems used to treat?

Carbapenems are antibacterial agents that are used to treat severe infections caused by gram-positive and gram-negative bacteria and anaerobes, such as:

• Urinary tract infections or abdominal infections caused by Pseudomonas aeruginosa (P. aeruginosa)
• Bacterial meningitis
• Community and hospital-acquired pneumonia
• Enterobacteriaceae infections such as Klebsiella pneumoniae (K. pneumoniae), Escherichia coli (E. coli), Serratia marcescens, and Enterobacter species
• Staphylococcus aureus infections (methicillin-susceptible isolates only)
• Acinetobacter baumannii infections
• Respiratory tract infections
• Sepsis (bloodstream infection)
• Acute pelvic infections
• Endocarditis from Enterococcus faecalis or Enterococcus faecium

Antimicrobial resistance is a serious threat to public health, with resistance to carbapenems increasing in recent years. There are two primary resistance mechanisms to carbapenem include extended-spectrum beta-lactamases (ESBLs) and carbapenemases such as the Klebsiella pneumoniae carbapenemase (KPC). This is a serious concern as there are few treatment options for infections caused by carbapenem-resistant bacteria.

Are Carbapenems safe?

When taken as prescribed, Carbapenems are relatively safe and effective. Your healthcare provider should be aware of your medical conditions, including:

• Allergy to carbapenems or other beta-lactam antibiotics
• Seizures
• Kidney impairment

You should also make sure they are aware of all the medications you take, including prescription drugs, over-the-counter medications, and supplements such as Depakene (valproic acid). Carbapenems have been shown to decrease Depakene (valproic acid) concentrations by up to 90%

Can you take Carbapenems while you are pregnant or breastfeeding?

There is limited clinical trial data on carbapenem use during pregnancy. While some animal reproductive studies showed no harmful effects on the fetus, carbapenem use has not been adequately studied in pregnant women.

Some carbapenems have reportedly been found to be excreted in breast milk. While there is not enough data on the effects of carbapenems on the breastfed infant, they may affect the balance of bacteria in the baby’s GI tract.

You should discuss the risks and benefits of any medication you need with your doctor if you are pregnant, plan on becoming pregnant, or are breastfeeding.

What are the common side effects of Carbapenems?

Some common adverse effects of Carbapenems include:

• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Headache
• Fever
• Increased liver enzymes
• Injection site reactions
• Rash
• Vaginitis
• Dizziness

Carbapenems can sometimes cause severe adverse events, including:

• Clostridium difficile-related diarrhea
• Severe allergic reactions
• Anemia
• Low platelet count (thrombocytopenia)
• Kidney impairment
• Liver impairment
• Shortness of breath
• Tachycardia (fast heart rate)

This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.

How much do Carbapenems cost?

Carbapenems are very expensive with an average cost of around $15,000 per year.

You can purchase Carbapenems for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.

Related resources for Carbapenems

• Carbapenem antibiotics for serious infections. BMJ
• Carbapenem antibiotics. Science Direct
• A brief review of carbapenems. Pharmacy Times
• Carbapenems: a broad-spectrum antibiotic. Microbiology Society
• Carbapenems: past, present, and future. National Library of Medicine
• Carbapenem antibiotics for serious infections. BMJ