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# Tebenigen (Tebipenem) ## Overview Tebipenem pivoxil is an oral carbapenem antibiotic. Its pivoxil ester enhances oral absorption. ## Primary Indications * Complicated urinary tract infections (cUTI), including pyelonephritis, typically in patients for whom oral therapy is appropriate. * Complicated intra-abdominal infections (cIAI), typically in patients for whom oral therapy is appropriate. ## Adult Dosing **cUTI/Pyelonephritis:** 600 mg orally every 8 hours for 7 days. **cIAI:** 600 mg orally every 8 hours for 7 to 14 days. *Maximum daily dose:* 1800 mg. ## Pediatric Dosing Not established. ## Dose Adjustments * **Renal Impairment:** * CrCl 30-49 mL/min: 600 mg orally every 12 hours. * CrCl <30 mL/min: 600 mg orally every 24 hours. * Dose adjustment in hemodialysis patients should be based on CrCl. ## Contraindications * Known hypersensitivity to tebipenem, other carbapenems, or any component of the formulation. * Concomitant use with valproic acid or divalproex sodium (increased risk of breakthrough seizures). ## Adverse Effects * **Most Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, rash. * **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), seizures. ## Key Drug Interactions * **Valproic Acid/Divalproex Sodium:** Decreases serum concentrations of valproic acid, potentially leading to loss of seizure control. Concurrent use is contraindicated. * **Probenecid:** May increase tebipenem plasma concentrations. Monitor for adverse effects. ## Monitoring * Renal function (especially if CrCl is <50 mL/min). * Signs and symptoms of *C. difficile*-associated diarrhea. * Signs and symptoms of hypersensitivity reactions. ## Clinical Pearls * Tebipenem pivoxil is the first orally administered carbapenem. * Administer with or without food. * The pivoxil ester is hydrolyzed in the gastrointestinal tract and blood to release active tebipenem. * Consider use in patients who require oral step-down therapy from intravenous carbapenems. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete and up-to-date details.*