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Sulopenem Etzadroxil

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Sulopenem Etzadroxil, Sulopenem Etzadroxil and Probenecid, Orlynvah

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