Doripenem

General
  • Type: Carbapenem (broad-spectrum beta-lactamase)
  • Dosage Forms: IV
  • Common Trade Names: Doribax

Adult Dosing

Intra-abdominal infection, complicated
  • 500mg IV q8h x5-14 days

UTI, complicated
  • 500mg IV q8h x10 days

Anthrax, systemic
  • 500mg IV q8h for at least 2 wk as part of multi-drug regimen

Pediatric Dosing

Anthrax, systemic
  • Neonates >32 weeks gestation
    • 20-30 mg/kg/day IV divided q8-12h for two weeks as part of multi-drug regimen
  • 1+ month old
    • 120 mg/kg/day IV divided q8h for at least two weeks as part of multi-drug regimen
      • Max: 1 g/dose

Special Populations
  • Pregnancy Rating: B
  • Lactation: May use while breastfeeding
  • Renal Dosing
    • Adult
      • CrCl 30-50: 250mg IV q8h
      • CrCl 10-30: 250mg IV q12h
      • CrCl <10: Not defined
      • HD: Not defined
    • Pediatric
      • May be required, but specifics not defined
  • Hepatic Dosing
    • Adult
      • No adjustment
    • Pediatric
      • May be required, but specifics not defined

Contraindications
  • Allergy to class/drug
  • Anaphylactic reaction to beta-lactams
  • Inhalational use
  • Ventilator-associated pneumonia
  • Caution:
    • Hypersensitivity to beta-lactams
    • Hypersensitivity to multiple allergens
    • Renal impairment
    • CNS disorder
    • Seizure history or risk
    • Recent abx-associated colitis

Adverse Reactions

Serious

Common

Pharmacology
  • Half-life: 1h
  • Metabolism: Kidney minimally
  • Excretion: Urine 85% (70% unchanged), feces <1%
  • Mechanism of Action: Inhibits cell wall synthesis

Antibiotic Sensitivities[1]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpS
Enterococcus faecalisI
Enterococcus faeciumR
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisS
C. jeikeiumX1
L. monocytogenesS
Gram NegativesN. gonorrhoeaeX2
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+S
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.I
Pseudomonas aeruginosaS
Burkholderia cepaciaI
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisS
Prevotella melaninogenicaS
Clostridium difficileX2
Clostridium (not difficile)S
Fusobacterium necrophorumS
Peptostreptococcus sp.S

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. Sanford Guide to Antimicrobial Therapy 2014
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