title: Carbapenems.
abstract: OBJECTIVE
  To assess the relative strengths and weaknesses of carbapenems by considering their microbiological, clinical, pharmacokinetics and pharmacokinetic/pharmacodynamic (PK/PD) properties and defining optimal conditions of uses of the new generation of carbapenems.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  Except for ertapenem, the spectrum of activity is similar for all carbapenems, with little differences in activities of individual agents. The absence or reduced expression of two major porins in combination with various beta-lactamases and alteration  of some penicillin binding proteins have been implicated in carbapenem resistance. All carbapenems are not alike, although they have very similar pharmacokinetic properties. The most important PK/PD parameter predicting bacteriological and clinical efficacy is T(>MIC). There  is some circumstantial evidence, such as clinical data in severe critically ill septic patients, impaired renal function patients and neutropenic patients that imipenem has to exceed 66% of T(>MIC) to result in good clinical outcome. Continuous or extend infusion of carbapenems  should result in at least equal efficacy to that of intermittent infusion in the treatment of infections with susceptible bacteria and appear highly appropriate for use in critically ill patients.
  
  
  CONCLUSIONS
  Maximizing clinical outcomes and minimizing antibiotic resistance using  individualized doses may be best achieved with therapeutic drug monitoring of carbapenems.
authors: Laboratory of Clinical Pharmacokinetics and Clinical Pharmacy,INSERM U1034, Haut-Lévêque hospital, CHU Bordeaux, University of Bordeaux, Segalen, Pessac, France. dominique.breilh@chu-bordeaux.fr
authors: Dominique
authors: D
authors: Breilh
authors: Jeannette
authors: J
authors: Texier-Maugein
authors: Bernard
authors: B
authors: Allaouchiche
authors: Marie-Claude
authors: MC
authors: Saux
authors: Emmanuel
authors: E
authors: Boselli
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects; D015780:Carbapenems / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems