Tripenem Uses

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What is Tripenem?

Tripenem injection is used to treat infections caused by bacteria. It works by killing the bacteria or preventing their growth. Tripenem will not work for colds, flu, or other virus infections.

Tripenem is to be given only by or under the direct supervision of your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Tripenem is used in certain patients with the following medical condition:

Tripenem indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tripenem I.V. and other antibacterial drugs, Tripenem I.V. should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Tripenem I.V. is useful as presumptive therapy in the indicated condition (e.g., intra-abdominal infections) prior to the identification of the causative organisms because of its broad spectrum of bactericidal activity.

For information regarding use in pediatric patients [seeIndications and Usage (1.1), (1.2), (1.3), Dosage and Administration (2.3), Adverse Reactions (6.1), andClinical Pharmacology (12.3)].

Skin and Skin Structure Infections (Adult Patients and Pediatric Patients 3 Months of Age and Older Only)

Tripenem I.V. is indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species.

Intra-abdominal Infections (Adult and Pediatric Patients)

Tripenem I.V. is indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species.

Bacterial Meningitis (Pediatric Patients 3 Months of Age and Older Only)

Tripenem I.V. is indicated as a single agent therapy for the treatment of bacterial meningitis caused by Streptococcus pneumoniae‡, Haemophilus influenzae, and Neisseria meningitidis.

‡ The efficacy of Tripenem as monotherapy in the treatment of meningitis caused by penicillin nonsusceptible isolates of Streptococcus pneumoniae has not been established.

Tripenem I.V. has been found to be effective in eliminating concurrent bacteremia in association with bacterial meningitis.

How should I use Tripenem?

Use Tripenem as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Tripenem.

Uses of Tripenem in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Intra-abdominal infections: Treatment of complicated appendicitis and peritonitis in adult and pediatric patients caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, Bacteroides thetaiotaomicron, and Peptostreptococcus species.

Meningitis, bacterial: Treatment of bacterial meningitis in pediatric patients 3 months and older caused by Haemophilus influenzae, Neisseria meningitidis, and penicillin-susceptible isolates of Streptococcus pneumoniae.

Skin and skin structure infection, complicated: Treatment of complicated skin and skin structure infections in adults and pediatric patients 3 months and older caused by Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), P. aeruginosa, E. coli, Proteus mirabilis, B. fragilis, and Peptostreptococcus species.

Off Label Uses

Anthrax

Based on the Centers for Disease Control and Prevention (CDC) expert panel meetings on prevention and treatment of anthrax, Tripenem is an effective and recommended agent for the treatment of anthrax meningitis and an effective and recommended alternative agent for systemic anthrax.

Bite wound infection, treatment, animal or human bite

Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTIs), Tripenem is an effective and recommended alternative agent for treatment of animal or human bite wounds.

Bloodstream infection (gram-negative bacteremia)

Based on the IDSA guidelines for the diagnosis and management of intravascular catheter-related infection, Tripenem is effective and recommended in the management of catheter-related bloodstream infection.

Clinical experience also suggests the utility of Tripenem for the treatment of bloodstream infection caused by gram-negative pathogens, including Pseudomonas aeruginosa.

Tripenem description

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The chemical name of Tripenem trihydrate is -Azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid, 3-[[5-[(dimethylamino)carbonyl]-3-pyrrolidinyl]thio]-6-(1-hydroxyethyl)-4-methyl-7-oxo, trihydrate, [4R-[3(3S*,5S*),4α,5β,6β(R*)]]-.(4R,5S,6S)-3-[[(3S,5S)-5-(Dimethylcarbamoyl)-3-pyrrolidinyl]thio] -6-[(1R)-1-hydroxyethyl]-4-methyl-7-oxo-1-azabicyclo[3.2.0]hept-2-ene-carboxylic acid, trihydrate. The molecular formula of Tripenem trihydrate is C17H25N3O5S·3H2O and its CAS number is 119478-56-7.

DBL Tripenem for Injection is presented as a sterile white to pale yellow crystalline powder containing Tripenem trihydrate equivalent to Tripenem, 500 mg or 1 g, blended with sodium carbonate anhydrous. DBL Tripenem for Injection contains 208 mg sodium carbonate anhydrous and 90.2 mg of sodium for each gram of Tripenem (anhydrous potency). It contains no antimicrobial preservative and is for use in one patient on one occasion only..

Tripenem dosage

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Adults: The recommended dose of Tripenem injection of 500 mg is given every 8 hours for a skin and skin structure infections when treating infections caused by Pseudomonas aeruginosa, dose of 1 gram every 8 hours is recommended, and 1 gram given every 8 hours for intra-abdominal infections. Tripenem injection should be administered by intravenous infusion over approximately 15 to 30 minutes. Doses of 1 gram every 8 hours may also be administered as an intravenous bolus injection (5 to 20 mL) over approximately 3-5 minutes.

Renal Impairment: Dosage should be reduced in patients with creatinine clearance less than 51 mL/min.

When only serum creatinine is available, the following formula (Cockroft and Gault equation) may be used to estimate creatinine clearance.

There is inadequate information regarding the use of Tripenem in patients on hemodialysis. There is no experience with peritoneal dialysis.

Hepatic Impairment: No dosage adjustment is necessary in patients with impaired hepatic function.

Elderly: No dosage adjustment is required for elderly patients with creatinine clearance values above 50 mL/min.

Children: For pediatric patients from 3 months of age and older, the Tripenem injection, dose is 10, 20 or 40 mg/kg every 8 hours (maximum dose is 2 g every 8 hours), depending on the type of infection (complicated skin and skin structure infections, intra-abdominal or meningitis). Pediatric patients weighing over 50 kg should be administered Tripenem injection at a dose of 500 mg every 8 hours for complicated skin and skin structure infections, 1 g every hour for intra-abdominal infections and 2 g every 8 hours for meningitis. Tripenem injection, should be given as intravenous infusion over approximately 15 to 30 minutes or as an intravenous bolus injection (5 to 20 mL) infusion over approximately 3-5 minutes. There is limited safety data available to support the administration of a 40 mg/kg (up to a maximum of 2 g) bolus dose.

Tripenem interactions

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What other drugs will affect Tripenem?

Probenecid competes with Tripenem for active tubular secretion and thus inhibits the renal excretion, with the effect of increasing the elimination half-life and plasma concentration of Tripenem. As the potency and duration of action of Tripenem dosed without probenecid are adequate, the co-administration of probenecid with Tripenem is not recommended.

The potential effect of Tripenem on the protein-binding of other drugs or metabolism has not been studied. The protein binding of Tripenem is low (approximately 2%) and, therefore, no interactions with other compounds based on displacement from plasma proteins would be expected.

Tripenem may reduce serum valproic acid levels. Subtherapeutic levels may be reached in some patients.

Tripenem has been administered concomitantly with other medications without adverse pharmacological interactions. However, no specific data regarding potential drug interactions is available (apart from probenecid as previous;y mentioned).

Decreases in blood levels of valproic acid have been reported when it is co-administered with carbapenem agents resulting in a 60-100% decrease in valproic acid levels in about 2 days. Due to the rapid onset and the extent of the decrease, co-administration of Tripenem in patients stabilised on valproic acid is not considered to be manageable and therefore should be avoided.

Oral Anticoagulants:

Simultaneous administration of antibiotics with warfarin may augment its anticoagulant effects. There have been many reports of increases in the anticoagulant effects of orally administered anticoagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents. The risk may vary with the underlying infection, age and general status of the patient so that the contribution of the antibiotic to the increase in international normalised ratio (INR) is difficult to assess. It is recommended that the INR should be monitored frequently during and shortly after co-administration of antibiotics with an oral anticoagulant agent.

Incompatibilities: Tripenem must not be mixed with other medicinal products except those mentioned in Cautions for Usage.

Tripenem side effects

See also:
What are the possible side effects of Tripenem?

Adult Patients: During reported clinical investigations, 2,904 immunocompetent adult patients were treated for infections outside the CNS with Tripenem (500 or 1,000 mg every 8 hrs). Deaths in 5 patients were assessed as possibly related to Tripenem; 36 patients (1.2%) had Tripenem discontinued because of adverse events. Many patients in these reported trials were severely ill and had multiple background diseases, physiological impairments, and were receiving multiple other drug therapies in the seriously ill patient population, it was not possible to determine the relationship between observed adverse events and therapy with Tripenem.

Local Adverse Reaction: Local adverse reactions that were reported irrespective of the relationship to therapy with Tripenem were as follows: Inflammation at the injection site (2.4%), injection site reaction (0.9%), phlebitis/thrombophlebitis (0.8%), pain at the injection site (0.4%), edema at the injection site (0.2%).

Systemic Adverse Reactions: Systematic adverse clinical reactions that were reported irrespective of the relationship to Tripenem occurring in >1% of the patients were diarrhea (4.8%), nausea/vomiting (3.6%), headache (2.3%), rash (1.9%), sepsis (1.6%), constipation (1.4%), apnea (1.3%), shock (1.2%) and pruritus (1.2%).

Additional adverse systemic clinical reactions that were reported irrespective of relationship to therapy with Tripenem and occurring in ≤1% but >0.1% of the patients are listed as follows within each body system in order of decreasing frequency: Bleeding Events were Seen as Follows: Gastrointestinal hemorrhage (0.5%), melena (0.3%), epistaxis (0.2%), hemoperitoneum (0.2%), summing to 1.2%.

Body as a Whole: Pain, abdominal pain, chest pain, fever, back pain, abdominal enlargement chills, pelvic pain.

Cardiovascular: Heart failure, heart arrest, tachycardia, hypertension, myocardial infarction, pulmonary embolus, bradycardia, hypotension, syncope.

Digestive System:

Oral moniliasis, anorexia, cholestatic jaundice/jaundice, ileus, hepatic failure, dyspepsia, intestinal obstruction.

Hemi/Lymphatic: Anemia, hypochromic anemia, hypervolemia.

Metabolic/Nutritional: Peripheral edema, hypoxia.

Nervous System: Insomnia, agitation/delirium, confusion, dizziness, seizure, nervousness, paresthesia, hallucinations, somnolence, anxiety depression, asthenia.

Respiratory: Respiratory disorder, dyspnea, pleural effusion, asthma, increased cough, lung edema.

Skin Appendages: Urticaria, sweating, skin ulcer.

Urogenital System: Dysuria, kidney failure, vaginal moniliasis, urinary incontinence.

Adverse Laboratory Changes: Adverse Laboratory Changes that were Reported Irrespective of Relationship to Tripenem and Occurring in >0.2% of the Patients Were as Follows: Hepatic: Increased serum glutamic-pyruvic transaminase (SGPT), alanine transaminase (ALT), serum glutamic-oxaloacetic transaminase (SGOT), aspartate transaminase (AST), alkaline phosphatase, lactate dehydrogenase (LDH), and bilirubin. Hematologic increased platelets, increased eosinophils, decreased platelets, decreased hemoglobin, decreased hematocrit, decreased whole blood count (WBC), shortened prothrombin time and shortened partial thromboplastin time, leukocytosis, hypokalemia.

Urinalysis: Presence of red blood cells.

Renal: Increased creatinine and increased blood urea nitrogen (BUN).

Note: For patients with varying degrees of renal impairment, the incidence of head failure, kidney failure, seizure and shock reported irrespective of relationship to Tripenem increased in patients with moderately severe renal impairment CrC >10-26 mL/min.

Complicated Skin and Skin Structure Infection: In a reported study of complicated skin and skin structure infection, the type of clinical adverse reactions were similar to those listed as mentioned previously. The patients with the most common adverse events with an incidence of >5% were: Headache (7.8%), nausea (7.8%), constipation (7%), diarrhea (7%), anemia (5.5%) and pain (5.1 %). Adverse events with an incidence of >1%, and not listed as mentioned previously, include: Pharyngitis, accidental injury gastrointestinal disorder; hypoglycemia; peripheral vascular disorder and pneumonia.

Pediatric Patients: Tripenem was studied in 515 pediatric patients (>3 months to <13 years) with serious bacterial infections (excluding meningitis) at dosages of 10-20 mg/kg every 8 hrs. The types of clinical adverse events seen in these patients are similar to the adults, with the most common adverse events reported as possibly, probably or definitely related to Tripenem and their rates of occurrence as follows: Diarrhea (3.5%), rash (1.6%), nausea and vomiting (0.8%).

Meropem was studied in 321 pediatric patients (>3 months to <17 years) with meningitis at a dosage of 40 mg/kg every 8 hrs. The types of clinical adverse events seen in these patients are similar to the adults, with the most common adverse events reported as possibly, probably or definitely related to Tripenem and their rates of occurrence as follows: Diarrhea (4.7%), rash (most diaper area moniliasis) (3.1%), oral moniliasis (1.9%), glossitis (1%).

In the meningitis studies the rates of seizure activity during therapy were comparable between patients with no CNS abnormalities who received Tripenem and those who received comparator agents (either cefotaxime or ceftriaxone). In the Tripenem treated group, 12/15 patients with seizures had late onset seizures (defined as occurring or later) versus 7,120 in the comparator arm.

Adverse Laboratory Changes: Laboratory abnormalities seen in the pediatric-aged patients in both the pediatric and the meningitis studies are similar to those reported in adult patients. There is no experience in pediatric patients with renal impairment.

Post-Marketing Experience: World wide post-marketing adverse events not previously listed in the product label and reported as possibly, probably or definitely drug related are listed within each body system in order of decreasing severity.

Hematology: Agranulocytosis, neutropenia and leukopenia; a positive Coombs' test and hemolytic anemia toxic epidermal necrolysis, Stevens-Johnson syndrome (SJS), angioedema and erythema multiform.

Tripenem contraindications

See also:
What is the most important information I should know about Tripenem?

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For Tripenem, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to Tripenem or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Active ingredient matches for Tripenem:

Meropenem in Indonesia.


Unit description / dosage (Manufacturer)Price, USD
Tripenem 0.5 g x 1's$ 24.55
Tripenem 1 g x 1's$ 45.32

List of Tripenem substitutes (brand and generic names):

Tripenem 1 1 g x 1 Bottle
TROYPENEM 1000 MG INJECTION 1 vial / 1 injection each (Troikaa Pharmaceuticals Ltd)$ 8.93
TROYPENEM 500 MG INJECTION 1 vial / 1 injection each (Troikaa Pharmaceuticals Ltd)$ 3.97
Troypenem 1000mg Injection (Troikaa Pharmaceuticals Ltd)$ 8.93
Troypenem 500mg Injection (Troikaa Pharmaceuticals Ltd)$ 3.97
U Life 250 mg Injection (Uniword Marketing (P) Ltd)$ 9.52
U Life 1000 mg Injection (Uniword Marketing (P) Ltd)$ 0.03
U Life 500 mg Injection (Uniword Marketing (P) Ltd)$ 0.02
V-Nem 1g AMP / 1 (Veliko)$ 30.16
V-Penum 500mg POWD / 1 (Intas)$ 10.30
V-PENUM 500MG/500MG INJECTION 1 vial / 1 injection each (Intas)$ 11.34
V-PENUM INJECTION 1 vial / 1 injection each (Intas)$ 7.56
VALUPENEM 1000MG INJECTION 1 vial / 2 ML injection each (Abbott India Ltd)$ 12.68
Valupenem 1gm Injection (Abbott India Ltd)$ 6.34
Varnem 1000mg Injection (Varenyam Healthcare Pvt Ltd)$ 10.00
Varnem 500mg Injection (Varenyam Healthcare Pvt Ltd)$ 5.29
VENCER 1000MG INJECTION 1 vial / 10 ML injection each (Unimark)$ 34.77
VENCER 125MG INJECTION 1 vial / 1 injection each (Unimark)$ 3.57
VENCER 500MG INJECTION 1 vial / 1 injection each (Unimark)$ 14.80
Vencer 125mg Injection (Unimark)$ 3.57
Vencer 500mg Injection (Unimark)$ 14.80
Veropen 1g POWD / 1 (Ventus)
Veropen 125mg POWD / 1 (Ventus)
VERPENEM 1000MG INJECTION 1 vial / 1 injection each (Karnataka Antibiotics & Pharmaceuticals Ltd)$ 26.19
VERPENEM 500MG INJECTION 1 vial / 1 injection each (Karnataka Antibiotics & Pharmaceuticals Ltd)$ 10.15
Verpenem 500mg Injection (Karnataka Antibiotics & Pharmaceuticals Ltd)$ 10.15
Vhpenem-1g 1 g x 1 Bottle
Vivem 500mg VIAL / 1 (Intas)
Vivem 1000mg VIAL / 1 (Intas)
VIVEM 1000MG INJECTION 1 vial / 1 injection each (Intas)$ 36.71
VIVEM 500MG INJECTION 1 vial / 5 ML injection each (Intas)$ 21.59
Vivem 1000mg Injection (Intas)$ 36.71
Vivem 500mg Injection (Intas)$ 4.32
VIVEM PLUS 1000MG INJECTION 1 vial / 1 GM injection each (Intas Pharmaceuticals Ltd)$ 13.59
VIVEM PLUS 1000 MG INJECTION 1 vial / 1 ML injection each (Intas Pharmaceuticals Ltd)$ 14.27
Vopenem 125 mg Injection (Vokin Biotech Pvt. Ltd.)$ 5.56
Vopenem 1000 mg Injection (Vokin Biotech Pvt. Ltd.)$ 0.03

References

  1. DailyMed. "MEROPENEM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "meropenem". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "meropenem". http://www.drugbank.ca/drugs/DB00760 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Tripenem are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Tripenem. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

1 consumer reported useful

Was the Tripenem drug useful in terms of decreasing the symptom or the disease?
According to the reports released by ndrugs.com website users, the below mentioned percentages of users say the drug is useful / not useful to them in decreasing their symptoms/disease. The usefulness of the drug depends on many factors, like severity of the disease, perception of symptom, or disease by the patient, brand name used [matters only to a certain extent], other associated conditions of the patient. If the drug is not effective or useful in your case, you need to meet the doctor to get re-evaluated about your symptoms/disease, and he will prescribe an alternative drug.
Users%
Useful1
100.0%


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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