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International Journal of Clinical Pharmacy

, Volume 33, Issue 6, pp 958–963 | Cite as

Evaluation of doripenem utilization and susceptibilities at a large urban hospital

  • Brett J. Balderson
  • Mary E. D. Yates
  • Neelu P. Patil
  • Katie J. SudaEmail author
Research Article

Abstract

Background Bacterial resistance presents a constant challenge in the treatment of hospitalized patients, particularly with Gram-negative infections. Carbapenems have an important role in the treatment of resistant nosocomial organisms. Doripenem, a recently approved carbapenem, has shown efficacy in clinical trials, but there is little published data on utilization in a general patient population. Objective The clinical utilization of doripenem in a general adult inpatient population was evaluated during a carbapenem formulary conversion. Setting A 706-bed acute care tertiary hospital serving an urban community. Methods After formulary conversion to doripenem, the first 100 patients to receive doripenem were included in the analysis. Baseline characteristics were recorded for each patient, along with indication for treatment, prescribing physician, dose and frequency of doripenem and duration of treatment. Patients were monitored for adverse reactions to doripenem. Bacterial culture results were recorded. For positive cultures, doripenem susceptibility was determined by Etest. Patients were followed until discontinuation of antibiotic therapy, discharge or death to determine treatment outcomes. Successful treatment was defined as clinical or microbiological cure, while patients with infection-related mortality or requiring subsequent antibiotics for the index infection were considered treatment failure. Main outcome measures Clinical utilization of doripenem, including indications and doses used. Results Doripenem treatment was recorded in 102 patients. The most common indications for treatment were pneumonia and sepsis. The majority of doripenem orders were written by Infectious Disease or Pulmonology Services. Forty-nine patients were treated successfully with doripenem and six patients experienced treatment failure. The remainder of patients were not evaluable by predefined outcomes criteria. Adverse events were reported in eight patients and included acute renal failure, Clostridium difficile-associated diarrhea and seizures. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common organisms in culture results. Doripenem demonstrated in vitro activity against 81% of all organisms and susceptibility results had >90% correlation with meropenem and imipenem susceptibilities. Conclusion In our limited sample size, doripenem was safe and effective against various types of infections in a general inpatient population with similar bacterial susceptibilities to other cabapenems. Doripenem was utilized for appropriate indications, but doses were frequently outside the manufacturers labeling. Adverse events were uncommon, and no serious adverse events were directly associated with doripenem treatment.

Keywords

Carbapenem Doripenem Utilization 

Notes

Funding

None.

Conflicts of interest

None.

References

  1. 1.
    Jones RN, Huynh HK, Biedenbach DJ. Activities of doripenem against drug-resistant clinical pathogens. Antimicrob Agents Chemother. 2004;48(8):3136–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Talbot GH, Bradley J, Edwards JE, Gilbert D, Scheld M, Bartlett JG. Bad bugs need drugs: an update on the development pipeline from the Antimicrobial Availability Task Force of the Infectious Diseases Society of America. Clin Infect Dis. 2006;42(S3):657–68.PubMedCrossRefGoogle Scholar
  3. 3.
    Diekema DJ, BootsMiller BJ, Vaughn TE, Woolson RF, Yankey JW, Ernst EJ. Antimicrobial resistance trends and outbreak frequency. Clin Infect Dis. 2004;38(1):78–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Infectious Diseases Society of America. Bad bugs, no drugs: as antibiotic R&D stagnates, a public health crisis brews. Alexandria,VA; 2004.Google Scholar
  5. 5.
    Cosgrove S. The relationship between resistance and patient outcomes: mortality, length of hospital stay and healthcare costs. Clin Infect Dis. 2006;42(S2):S82–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The Influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146–55.PubMedCrossRefGoogle Scholar
  7. 7.
    Greer ND. Doripenem (Doribax): the newest addition to the carbapenems. Proc (Bayl Univ Med Cent). 2008;21(3):337–41.Google Scholar
  8. 8.
    Amyes SGB, Walsh FM, Bradley JS. Best in class: a good principal for antibiotic usage to limit resistance development? J Antimicrob Chemother. 2007;59(5):825–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Chastre J, Wunderink R, Prokocimer P, Lee M, Kaniga K, Friedland I. Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: a multi-center, randomized study. Crit Care Med. 2008;36(4):1089–96.PubMedCrossRefGoogle Scholar
  10. 10.
    Rea-Nieto A, Niederman M, Lobo SM, Schroeder E, Lee M, Kaniga K. Efficacy and safety of doripenem versus piperacillin/tazobactam in nosocomial pneumonia: a randomized, open-label, multi-center study. Curr Med Res Opin. 2008;24(7):2113–26.CrossRefGoogle Scholar
  11. 11.
    Keam SJ. Doripenem A review of its use in the treatment of bacterial infections. Drugs. 2008;68(14):2021–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Walsh F. Doripenem: a new carbapenem antibiotic. A review of comparative antimicrobial and bactericidal activities. Ther Clin Risk Manag. 2007;3(5):789–94.PubMedGoogle Scholar
  13. 13.
    Jones RN, Sader HS, Fritsche TR. Comparative activity of doripenem and three other carbapenems tested against gram-negative bacilli with various β–lactamase resistance mechanisms. Diagn Microbiol Infect Dis. 2005;52(1):71–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Doribax [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical Inc; 2007.Google Scholar
  15. 15.
    Bhavnani SM, Hammel JP, Cirincione BB, Wikler MA, Ambrose PG. Use of pharmacokinetic-pharmacodynamic target attainment analyses to support phase 2 and 3 dosing strategies for doripenem. Antimicrob Agents Chemother. 2005;49(9):3944–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Ikawa K, Morikawa N, Ikeda K, Ohge H, Sueda T. Pharmacodynamic assessment of doripenem in peritoneal fluid against gram-negative organisms: use of population pharmacokinetic modeling and Monte Carlo simulation. Diagn Microbiol Infect Dis. 2008;62(3):292–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Lucasti C, Jasovich A, Umeh O, Jiang J, Kaniga K, Friedland I. Efficacy and tolerability of IV doripenem versus meropenem in adults with complicated intra-abdominal infection: a phase III, prospective, multicenter, randomized, double-blind, noninferiority study. Clin Ther. 2008;30(5):868–83.PubMedCrossRefGoogle Scholar
  18. 18.
    Gerding DN, Johnson S, Peterson LR, Muligan ME, Silva J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16:459–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Prescott WA Jr, DePestel DD, Ellis JJ, Regal RE. Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy. Clin Infect Dis. 2004;38:1102–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Sodhi M, Axtell SS, Callahan J, Shekar R. Is it safe to use carbapenems in patients with a history of allergy to penicillin? J Antimicrob Chemother. 2004;54:1155–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Prescott WA, Kusmierski KA. Clinical importance of carbapenem hypersensitivity in patients with self-reported and documented penicillin allergy. Pharmacother. 2007;27:137–42.CrossRefGoogle Scholar
  22. 22.
    Frumin J, Gallagher JC. Allergic cross-sensitivity between penicillin, carbapenem, and monobactam antibiotics: what are the chances? Ann Pharmacother. 2009;43:304–15.PubMedGoogle Scholar
  23. 23.
    Jones RN, Sader HS, Fritsche TR, Janechek MJ. Selection of a surrogate β-lactam testing agent for initial susceptibility testing of doripenem, a new carbapenem. Diagn Microbiol Infect Dis. 2007;59(4):467–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Brett J. Balderson
    • 2
  • Mary E. D. Yates
    • 4
  • Neelu P. Patil
    • 3
  • Katie J. Suda
    • 1
    Email author
  1. 1.University of Tennessee Health Sciences Center College of PharmacyMemphisUSA
  2. 2.Baptist Memorial Hospital, MemphisMemphisUSA
  3. 3.University of North Carolina HealthcareChapel HillUSA
  4. 4.Methodist Lebonheur Healthcare-Germantown HospitalGermantownUSA

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