Which carbapenems are used for ESBL-producing organisms?

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When ESBL enzymes break down many beta-lactams, the antibiotics that remain reliably active are the carbapenems. ESBLs don’t efficiently hydrolyze carbapenems, so these drugs are the go-to option for treating infections caused by ESBL-producing organisms. Among the carbapenems, meropenem and ertapenem are commonly used for these infections. Meropenem offers broad activity, including against Pseudomonas, which is helpful in severe cases or mixed infections. Ertapenem also works well against ESBL-producing Enterobacterales, but it lacks activity against Pseudomonas and Acinetobacter, so the clinical context matters. Imipenem and doripenem are active as well, but imipenem carries a higher risk of seizures and doripenem has less favorable data in some settings, which is why meropenem or ertapenem are typically highlighted as the preferred options for ESBL producers.