How should Vabomer (meropenem and vaborbactam) be administered?

From the Guidelines

Vabomer (meropenem and vaborbactam) should be administered as an intravenous infusion over 3 hours, with a standard adult dose of 4 grams (2g meropenem/2g vaborbactam) every 8 hours for patients with normal renal function. Dose adjustments are necessary for patients with impaired kidney function:

• for creatinine clearance 30-50 mL/min, reduce to 2 grams every 8 hours;
• for 15-29 mL/min, 2 grams every 12 hours;
• and for <15 mL/min, 1 gram every 12 hours. The medication should be reconstituted with 0.9% sodium chloride or 5% dextrose solution and administered through a dedicated IV line or Y-site. Treatment duration typically ranges from 7-14 days depending on the infection site and severity. Vabomer combines meropenem, a carbapenem antibiotic that disrupts bacterial cell wall synthesis, with vaborbactam, a beta-lactamase inhibitor that protects meropenem from enzymatic degradation by certain resistant bacteria. This combination is particularly effective against carbapenem-resistant Enterobacteriaceae and complex urinary tract infections. Monitor renal function during treatment, as dose adjustments may be needed if kidney function changes, as suggested by the guidelines for the treatment of infections caused by multidrug-resistant gram-negative bacilli 1. It is essential to follow the recommended administration guidelines to ensure the effectiveness of the treatment and minimize potential side effects. The use of Vabomer is supported by recent guidelines, which recommend meropenem-vaborbactam as a treatment option for severe infections due to carbapenem-resistant Enterobacterales (CRE) if active in vitro 1. In addition, the medication's properties, such as its half-life and stability, should be considered when administering it, as outlined in the guidelines for outpatient parenteral antimicrobial therapy 1. However, the most recent and relevant guidelines should always be consulted for the most up-to-date recommendations on the use of Vabomer 1.

From the FDA Drug Label

Administer VABOMERE 4 grams (meropenem 2 grams and vaborbactam 2 grams) every 8 hours by intravenous infusion over 3 hours for up to 14 days, in patients 18 years of age and older with an estimated glomerular filtration rate (eGFR) ≥50 mL/min/1.73m2.

eGFR* (mL/min/ 1. 73m2)Recommended Dosage Regimen for VABOMERE(meropenem and vaborbactam) †, ‡, §Dosing Interval

• As calculated using the Modification of Diet in Renal Disease (MDRD) formula; † All doses of VABOMERE are administered intravenously over 3 hours; ‡ Doses adjusted for renal impairment should be administered after a hemodialysis session; § The total duration of treatment is for up to 14 days 30 to 49VABOMERE 2 grams (meropenem 1 gram and vaborbactam 1 gram)Every 8 hours 15 to 29VABOMERE 2 grams (meropenem 1 gram and vaborbactam 1 gram)Every 12 hours Less than 15VABOMERE 1 gram (meropenem 0.5 grams and vaborbactam 0.5 grams)Every 12 hours

Administration of Vabomer (meropenem and vaborbactam) should be as follows:

• Intravenous Infusion: Administer VABOMERE every 8 hours by intravenous infusion over 3 hours.
• Dosage: The recommended dosage is 4 grams (meropenem 2 grams and vaborbactam 2 grams) for patients with an estimated glomerular filtration rate (eGFR) ≥50 mL/min/1.73m2.
• Renal Impairment: Dosage adjustment is recommended in patients with renal impairment who have an eGFR less than 50 mL/min/1.73m2.
• Preparation and Administration: VABOMERE is supplied as a dry powder in a single-dose vial that must be constituted and further diluted prior to intravenous infusion.
• Storage and Infusion: The intravenous infusion of the diluted solution must be completed within 4 hours if stored at room temperature or 22 hours if stored refrigerated at 2°C to 8°C (36°F to 46°F) 2, 2.

From the Research

Administration of Vabomer

Vabomer, a combination of meropenem and vaborbactam, is administered intravenously. The following are key points to consider for its administration:

• Dose and Frequency: The typical dose is 2 grams (1 gram meropenem and 1 gram vaborbactam) administered every 8 hours as a 3-hour infusion 3.
• Renal Impairment: For patients with renal impairment, dose adjustment is necessary. The clearance of both meropenem and vaborbactam is reduced in patients with renal impairment, requiring dose adjustments to maintain therapeutic levels 4.
• Hemodialysis: In patients undergoing hemodialysis, the administration of meropenem/vaborbactam should be timed to avoid significant loss of the drug during dialysis. It is recommended to complete the infusion at least 2 hours prior to the start of hemodialysis or administer immediately after the end of hemodialysis to minimize drug loss 5.
• Compatibility with Other Drugs: Meropenem/vaborbactam is physically compatible with many intravenous drugs, allowing for co-administration via Y-site. However, compatibility should be checked before co-administering with other medications 6.
• Pharmacokinetics: The pharmacokinetics of meropenem and vaborbactam are similar when administered alone or in combination, with no significant drug-drug interactions observed 7.

Key Considerations

• Monitoring: Patients should be monitored for signs of adverse effects and therapeutic response.
• Dose Adjustment: Dose adjustments may be necessary based on renal function and other individual patient factors.
• Administration Technique: The drug should be administered as a 3-hour infusion to minimize the risk of adverse effects and ensure optimal therapeutic levels.