3.7 Carbapenems
Carbapenems are a beta-lactam “cousin” to penicillins and cephalosporins.
Mechanism of Action: Carbapenems are typically bactericidal and work by inhibiting the synthesis of the bacterial cell wall.
Indications: Carbapenems are useful for treating life-threatening, multidrug-resistant infections due to their broad spectrum of activity.[1] These antibiotics are effective in treating gram-positive and gram-negative infections. Because of their broad spectrum of activity, these medications can be especially useful for treating complex hospital-acquired infections or for clients who are immunocompromised.
Nursing Considerations: Considerations for carbapenems are similar to those for cephalosporins. Cross-sensitivity may occur in clients allergic to penicillin or cephalosporins.
Side Effects/Adverse Effects: Common side effects of carbapenems include gastrointestinal upset, including nausea, vomiting, and diarrhea. Additional adverse effects include injection site reactions, skin rash, and pruritis.
Health Teaching & Health Promotion: Clients should monitor for signs of superinfection (such as vaginal itching or discharge indicating a yeast infection or loose or foul-smelling stool indicating C-diff) and report any occurrence to the provider. If a client experiences fever and bloody diarrhea, they should contact the provider immediately. The client should also be advised that side effects can occur even weeks after the medication is discontinued.[2]
Now let’s take a closer look at the medication grid for imipenem in Table 3.7.[3]
Table 3.7 Carbapenem Medication Grid
Class/Subclass |
Prototype/Generic |
Nursing Considerations |
Therapeutic Effects |
Side/Adverse Effects |
|---|---|---|---|---|
| Carbapenems | imipenem | Route: IV
Check for allergies, including penicillin and cephalosporins Dosage adjustment if renal impairment Use with caution with seizure disorder or renal dysfunction |
Monitor for systemic signs of infection:
-Increased WBCs -Fever Monitor actual site of infection Monitor culture results, if obtained |
Similar to cephalosporins |
Critical Thinking Activity 3.7
A client was admitted to the hospital with a serious abdominal infection. The nurse notices that this client has a history of a previous severe allergic reaction to penicillin while preparing to administer the first dose of imipenem medication. What is the nurse’s next best action?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
- Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., & Bonomo, R. A. (2011). Carbapenems: Past, present, and future. Antimicrobial Agents and Chemotherapy, 55(11), 4943–4960. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195018/ ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵