Oral Penems and Antimicrobial Stewardship: Is Faropenem a Friend or Foe? A Comprehensive Review

Faropenem stands out as a unique oral penem antibiotic with activity against both Gram-positive and Gram-negative bacteria, including strains that produce extended-spectrum β-lactamases (ESBLs). Though commonly prescribed across Asian nations—especially Japan and India—its place in contemporary antimicrobial stewardship remains hotly debated. This comprehensive review examines faropenem's pharmacological characteristics, clinical effectiveness, resistance concerns, regulatory status, and appropriate positioning in modern treatment protocols. Available evidence raises significant red flags about carbapenem cross-resistance, gaps in surveillance systems, and limited high-quality research. The World Health Organization's designation of faropenem as a RESERVE antibiotic highlights the critical need for careful prescribing to protect carbapenem effectiveness for life-threatening infections. Keywords: Faropenem, penem antibiotics, antimicrobial stewardship, carbapenem resistance, ESBL, rational prescribing