II. Indications
- Third-line Antibiotic in otherwise uncomplicated Urinary Tract Infection
- Adult women with limited or no alternative oral antibacterial option (multi-drug resistance, ESBL)
- Escherichia coli, Klebsiella Pneumoniae, or Proteus mirabilis Urinary Tract Infection
III. Contraindications
- Stage 5 CKD (eGFR <15 ml/min) or End Stage Renal Disease
- Patients in this cohort have not been studied
- Probenacid has low efficacy at eGFR <30 ml/min
IV. Mechanism
- Sulopenem Etzadroxil is the first oral Carbapenem (Thiopenem)
- Binds Penicillin binding Proteins, inhibiting Bacterial cell wall synthesis (as with other Carbapenems)
- Sulopenem Etzadroxil is an oral prodrug
- Hydrolyzed by intestinal esterases into sulopenem
- Probenacid
- Added to increase Sulopenem urinary excretion
V. Medications
- Sulopenem Etzadroxil and Probenecid tablet (500 mg/500 mg)
VI. Dosing
- Women: 1 tablet orally twice daily for 5 days
VII. Adverse Effects
- Diarrhea (10%)
- Nausea or Vomiting (2-4%)
- Abdominal Pain (1%)
- Vulvovaginal Candidiasis (2%)
- Headache (2%)
-
Hemolytic Anemia
- Increased risk with Probenecid in G6PD Deficiency
- Gout Exacerbation
VIII. Drug Interactions
-
Organic Anion Transporter (OAT1 and OAT3)
- Inhibited by Probenecid and may increase concentrations of drugs that rely on OAT for excretion
- Affected drugs include NSAIDS and Sulfonylureas
IX. References
- LoVecchio (2025) Crit Dec Emerg Med 39(1): 36
- Dunne (2023) Clin Infect Dis 76(1):78-88 +PMID: 36068705 [PubMed]
- Zhanel (2022) Drugs 82(5):533-57 +PMID: 35294769 [PubMed]
