What intravenous (IV) antibiotic, similar to Vabomere (meropenem and vaborbactam), can be used as an alternative?

IV Antibiotic Alternatives to Vabomere

Ceftazidime-avibactam is the most comparable IV antibiotic to Vabomere (meropenem-vaborbactam), with similar clinical efficacy, mortality reduction, and safety profile for carbapenem-resistant Enterobacteriaceae infections. 1

Primary Alternative: Ceftazidime-Avibactam

For KPC-producing CRE infections, ceftazidime-avibactam and meropenem-vaborbactam are considered therapeutically equivalent with moderate-quality evidence supporting either agent. 1 Both demonstrate:

• Similar clinical success rates in retrospective comparisons (no significant difference between agents) 1
• Significantly lower 28-day mortality compared to older regimens (18.3% vs 40.8% for ceftazidime-avibactam; 17.9% vs 33.3% for meropenem-vaborbactam) 1, 2
• Reduced nephrotoxicity compared to colistin-based therapy 1
• Higher clinical cure rates than best available therapy consisting of polymyxins, aminoglycosides, or tigecycline 1, 2

Dosing

• Standard regimen: 2.5 g IV every 8 hours over 2-hour infusion 3, 4
• Duration: 5-14 days depending on infection type 4
• Renal adjustment required 4

Site-Specific Considerations

When Vabomere May Be Preferred

For pneumonia or pulmonary infections, meropenem-vaborbactam achieves superior lung penetration with 63-65% intrapulmonary penetration ratios, maintaining concentrations several-fold higher than MIC90 for KPC-producing organisms 1

When Ceftazidime-Avibactam May Be Preferred

• Emerging ceftazidime-avibactam resistance: If KPC variants (D179Y mutations) conferring ceftazidime-avibactam resistance are present, meropenem-vaborbactam becomes the therapeutic option 1
• OXA-48-producing CRE: Ceftazidime-avibactam is the first-line agent (conditional recommendation, very low evidence) 1

Additional Alternatives by Resistance Mechanism

For KPC-Producing CRE

Second-line options include:

• Imipenem-relebactam: Potential alternative but limited clinical data in KPC infections (low evidence quality) 1
• Cefiderocol: Potential alternative but limited clinical data in KPC infections (low evidence quality) 1

For MBL-Producing CRE

Ceftazidime-avibactam PLUS aztreonam is strongly recommended (19.2% vs 44% mortality compared to other regimens, P=0.007) 1

Cefiderocol monotherapy is a conditional alternative (75% clinical cure in CREDIBLE-CR trial) 1

Critical caveat: Neither meropenem-vaborbactam nor ceftazidime-avibactam alone has activity against metallo-β-lactamase producers 1, 3

For Carbapenem-Resistant Acinetobacter baumannii

Neither agent should be used as monotherapy. 5 If polymyxin-based combination therapy is needed, ceftazidime-avibactam has higher synergistic rates with polymyxin B than imipenem-relebactam or meropenem-vaborbactam 5

Y-Site Compatibility Advantage

Meropenem-vaborbactam is compatible with 83% of tested IV medications including aminoglycosides, colistin, linezolid, tigecycline, and vancomycin, but incompatible with amiodarone, calcium chloride, ceftaroline, ciprofloxacin, and ondansetron 6

Key Clinical Decision Algorithm

1. Identify resistance mechanism (KPC vs OXA-48 vs MBL) through susceptibility testing
2. For KPC-producing CRE: Choose ceftazidime-avibactam OR meropenem-vaborbactam based on:
   • Pneumonia → favor meropenem-vaborbactam 1
   • Local ceftazidime-avibactam resistance patterns → favor meropenem-vaborbactam 1
   • Otherwise → either agent acceptable 1
3. For OXA-48-producing CRE: Use ceftazidime-avibactam 1
4. For MBL-producing CRE: Use ceftazidime-avibactam PLUS aztreonam 1

Common pitfall: Avoid using these novel agents for carbapenem-resistant Acinetobacter baumannii as monotherapy—they lack adequate activity and cannot prevent bacterial regrowth at clinically achievable concentrations 5