Carbapenems: the pinnacle of the beta-lactam antibiotics or room for improvement?

Abstract

This article provides a perspective on carbapenems, two examples of which, imipenem/cilastatin and meropenem, are currently available for clinical use. Another analogue, panipenem, which is co-administered with betamipron to act as a nephro-protectant, is registered for use in Japan.¹ This compound has activity and pharmacokinetics similar to imipenem/cilastatin. Several other examples have failed to reach the market whilst at least one is currently in clinical trials. The structure of these is presented in the Figure , which displays an explanation of substituent positioning. However, the focus of this review will be to contrast the two widely available agents, to define differences and then to comment on what advances might be introduced into new analogues.