DORIPENEM

DORIPENEM (dor-i-pen'em) Doribax Classifications: beta-lactam antibiotic; carbapenem antibiotic; Therapeutic: antibiotic Prototype: Imipenem-cilastatin Pregnancy Category: B

Availability

500 mg single-use vials

Action

Inhibits essential penicillin-binding proteins resulting in inhibition of bacterial cell wall synthesis, resulting in bacterial cell death.

Therapeutic Effect

Bacteriocidal against aerobic and anaerobic gram-negative and -positive bacteria, and effectively resolves infection.

Uses

Single agent treatment of complicated intra-abdominal infections and urinary tract infections, including pyelonephritis caused by susceptible Escherichia, Klebsiella, Pseudomonas, Bacteroides, Streptococcus, Peptostreptococcus, Proteus, and Acinetobacter organisms.

Contraindications

Hypersensitivity to doripenem, or beta-lactam antibiotics; multiple allergies; inhalation route.

Cautious Use

Hypersensitivity to cephalosporins, penicillins; moderate to severe renal impairment; older adults; pregnancy (category B); lactation.

Route & Dosage

Complicated Intra-abdominal Infection Adult: IV 500 mg q8h x 5–14 d Complicated UTI, Including Pyelonephritis Adult: IV 500 mg q8h x 10 d Renal Impairment Clcr ≥30 mL/min but ≤50 mL/min: 250 mg q8h; >10 mL/min but <30 mL/min: 250 mg q12h

Administration

Intravenous PREPARE: Intermittent: Add 10 mL of sterile water for injection or NS to the vial, gently shake to form suspension; yields 50 mg/mL. Preparation of 500 mg dose: Withdraw contents of vial with a 21 gauge needle and add to infusion bag of 100 mL of NS or D5W, gently shake until clear. Final concentration is 4.5 mg/mL. Preparation of 250 mg dose: Prepare as for the 500 mg dose then remove 55 mL of solution from IV bag and discard. Infuse the remaining solution, which contains 250 mg (4.5 mg/mL).   ADMINISTER: Intermittent: Infuse over 15–30 min.   INCOMPATIBILITIES Solution/additive: Do not combine with any other drug. Y-site: Do not add to Y-site.

Adverse Effects (≥1%)

Body as a Whole: Anaphylaxis, hypersensitivity reactions. CNS: Headache. CV: Phlebitis. GI: Diarrhea, nausea, oral candidiasis. Hematologic: Anemia. Metabolic: Elevated hepatic enzymes. Skin: Rash. Urogenital: Vulvomycotic infection

Interactions

Drug: Doripenem decreases plasma levels of valproic acid. Probenecid increases doripenem plasma levels.

Pharmacokinetics

Distribution: Minimal protein binding. Metabolism: In liver (18%) to inactive metabolite. Elimination: Urine (primarily unchanged). Half-Life: 1 h.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Perform C&S tests prior to therapy. Monitor periodically LFTs, Hct & Hgb.
• Determine history of hypersensitivity reactions to other beta-lactams, cephalosporins, penicillins, or other drugs.
• Discontinue drug and immediately report S&S of hypersensitivity (see Appendix F).
• Report S&S of superinfection or pseudomembranous colitis (see Appendix F).

Patient & Family Education

• Learn S&S of hypersensitivity, superinfection, and pseudomembranous colitis; report any of these to physician promptly.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug