Carbapenems

• imipenem/cilastatin: imipenem is one of the broadest spectrum antibiotics avail­able. it is combined with cilastatin to prevent its degradation by renal tubular dehydropeptidase. its spectrum covers the Enterobacteriaceae, pseudomonas, Bacteroides fragilis and most Gram-positive cocci. However, it lacks activity against methicillin-resistant staphylococci, Enterococcus faecium, Corynebacte­rium jeikeium, Listeria, Clostridium difficile and Stenotrophomonas maltophilia. Sei­zures have been reported, especially with higher doses and in patients with impaired renal function. The use of this agent should be restricted to the treat­ment of life-threatening infections caused by highly resistant bacteria.
• Meropenem: Meropenem is o similar drug to imipenem but does not require com­bination with o dehydropeptidase inhibitor. it gives up o little activity against Gram-positive pathogens compared to imipenem. This drug has been suggested as an alternative for cefotaxime or ceftriaxone for management of meningitis, caused by penicillin-resistant Streptococcus pneumoniae.