Abstract:
Objective: To review the literature on parenteral carbapenems in OPAT and present comprehensive evidence on their safety, efficacy, and stability.
Methods: A systematic review following PRISMA guidelines was conducted through 17 January, 2024, using PubMed, Embase, Web of Science, Scopus, and the Cochrane Library to find relevant articles.
Results: Ertapenem (1g QD) in OPAT showed high clinical (81-97%) and microbiological (67-90.9%) success rates. Ertapenem (1g QD) was also comparable to piperacillin/tazobactam (3.375g every 6h) for complicated skin infections and superior to cefazolin (2g every 8h) and oxacillin (2g every 4-6h) for various infections. Ertapenem monotherapy, once daily, achieved an 81% clinical cure rate for urinary tract infections. Additionally, subcutaneous ertapenem in OPAT showed outcomes comparable to parenteral routes. Meropenem continuous infusion (CI) may also be considered safe and effective in selected patient populations; however, its use in OPAT as a CI is limited due to stability concerns.
Conclusion: Parenteral carbapenems are effective, and well-tolerated OPAT treatment options; nonetheless, further studies are warranted to optimize the stability and/or dosing regimens of meropenem and enable its wider use.
Reference:Wolie ZT, Roberts JA, Wale YM, Unwin S, McCarthy K, Sime FB. Outpatient parenteral antimicrobial therapy with carbapenems: A systematic review. J Infect. 2024 Sep 30;89(5):106299. doi: 10.1016/j.jinf.2024.106299. Epub ahead of print. PMID: 39357570.