Oral Carbapenem Options
Currently, there is only one oral carbapenem available: tebipenem pivoxil hydrobromide (TBP-PI-HBr), which is approved in Japan for pediatric use only and is under development for adult use in other markets. 1
Current Clinical Reality
No Oral Carbapenems in Standard Practice
- All carbapenems routinely used in clinical guidelines are administered parenterally (intravenously) 2, 3
- Group 1 carbapenems include ertapenem (IV only) 2, 3
- Group 2 carbapenems include imipenem, meropenem, and doripenem (all IV only) 2, 3
- Guidelines consistently specify these agents for parenteral administration, with oral antibiotics reserved for step-down therapy after initial IV treatment 2
The Exception: Tebipenem Pivoxil Hydrobromide
- Tebipenem pivoxil hydrobromide is an oral prodrug that converts to tebipenem, the active carbapenem 1, 4
- Currently approved only in Japan for pediatric patients since 2009 1
- Under clinical development for adult use, particularly for complicated urinary tract infections 5
- Demonstrates activity against multidrug-resistant Gram-negative pathogens, including quinolone-resistant and ESBL-producing Enterobacteriaceae 1, 4, 5
Practical Clinical Implications
When Carbapenem Coverage is Needed
- For severe infections requiring carbapenem coverage: Use IV carbapenems (ertapenem, meropenem, imipenem, or doripenem) as recommended by guidelines 2
- For step-down oral therapy: Switch to non-carbapenem oral options when clinically appropriate 2, 6
Recommended Oral Alternatives for Step-Down
When transitioning from IV carbapenem therapy, consider these oral options based on pathogen and clinical scenario:
- Amoxicillin-clavulanate 875/125 mg orally twice daily for skin/soft tissue infections and mixed infections 6
- Levofloxacin 500 mg orally once daily for respiratory infections and gram-negative coverage 6
- Combination therapy with metronidazole for anaerobic coverage when needed 6
Important Caveats
Geographic Availability
- Tebipenem pivoxil is not available in most countries outside Japan 1
- Even in Japan, it is restricted to pediatric use 1
Clinical Development Status
- Adult formulations of tebipenem pivoxil are investigational 4, 5, 7, 8
- Bioequivalence studies show it can be administered without regard to meals 8
- Concomitant antacids or proton pump inhibitors minimally affect exposure 7