Imipenem/Cilastatin: Difference between revisions

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==General==
==General==
*Type: [[Carbapenems]]
*Type: [[Is DrugClass::Carbapenems]]
*Dosage Forms:
*Dosage Forms:
*Common Trade Names:
*Common Trade Names: Primaxin


==Adult Dosing==
==Adult Dosing==
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*Moderately-susceptible organisms: 1g IV q6-8 hours  
*Moderately-susceptible organisms: 1g IV q6-8 hours  
*Max: Lower of 50mg/kg or 4 g/day
*Max: Lower of 50mg/kg or 4 g/day
===UTI===
*500mg IV q6h
===[[Pneumonia]], hospital acquired===
*500mg IV q6h x7 days
===[[Anthrax]], systemic===
*1g IV q6h for at least 2wk


==Pediatric Dosing==
==Pediatric Dosing==
===General<ref>Red Book, 2012</ref>===
===General<ref>Red Book, 2012</ref>===
*60-100mg/kg/day IV divided q6 hours
*60-100mg/kg/day IV divided q6 hours
*First Dose: 10-16.6 mg/kg IV x 1
*First Dose: 10-16.6mg/kg IV x 1
*Max: 4000mg/day
*Max: 4000mg/day
===[[Anthrax]], systemic===
*Neonates >32 wk gestation
**40-75 mg/kg/day IV divided q8-12h for at least 2wk
*1 month and older
**100 mg/kg/day IV divided q6h for at least 2wk


==Special Populations==
==Special Populations==
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*Renal Dosing
*Renal Dosing
**Adult
**Adult
***If usual dose 500mg q6h
****CrCl 60-89: 400mg q6h
****CrCl 30-59: 300mg q6h
****CrCl 15-29: 200mg q6h
****CrCl <15: Avoid unless HD w/in 48h
****HD: 200mg q6h, give dose after dialysis, no supplement
****PD: No supplement
***If usual dose 1000mg q8h
****CrCl 60-89: 500mg q6h
****CrCl 30-59: 500mg q8h
****CrCl 15-29: 500mg q12h
****CrCl <15: Avoid unless HD w/in 48h
****HD: 500mg q12h, give dose after dialysis, no supplement
****PD: No supplement
***If usual dose 1000mg q6h
****CrCl 60-89: 750mg q8h
****CrCl 30-59: 500mg q6h
****CrCl 15-29: 500mg q12h
****CrCl <15: Avoid unless HD w/in 48h
****HD: 500mg q12h, give dose after dialysis, no supplement
****PD: No supplement
**Pediatric
**Pediatric
***< 30 kg: Avoid use in renal impairment
***> 30 kg:
****CrCl 41-70: Decrease dose 50%
****CrCl 21-40: Decrease dose 63%; give q8h
****CrCl 6-20: Decrease dose 75%, give q12h
****CrCl <5: Avoid unless HD w/in 48h
****HD: Give dose after dialysis, no supplement
****PD: No supplement
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult: Not defined
**Pediatric
**Pediatric: Not defined


==Contraindications==
==Contraindications==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Hypersensitivity reaction
*[[Anaphylaxis]]
*[[Stevens-Johnson syndrome]]/[[Toxic epidermal necrolysis]]
*Erythema multiforme
*Neurotoxicity
*[[Seizure]]
*Superinfection
*C. diff associated [[diarrhea]]
*Hemorrhagic [[colitis]]
*Myelosuppression
*[[Hemolytic anemia]]
*Hepatotoxicity
*[[Acute renal failure]]


===Common===
===Common===
*LFT Increase
*[[Seizure]]
*Platelet abnormality
*[[Diarrhea]]
*[[Thrombophlebitis]]
*[[Oliguria]]/Anuria
*Rash
*[[Nausea]]


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 1h
*Metabolism:  
*Metabolism:  
*Excretion:  
**Imipenem: Kidney
**Cilastatin: Unknown
*Excretion: Urine 70%
*Mechanism of Action:
*Mechanism of Action:
**Bactericidal
**Imipenem inhibits cell wall synthesis
**Cilastatin inhibits renal dihydropeptidase I, preventing imipenem metabolism


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
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| ||[[Klebsiella]] sp||'''S'''
| ||[[Klebsiella]] sp||'''S'''
|-
|-
| ||E. coli/Klebsiella ESBL+||'''S'''
| ||E. coli/Klebsiella ESBL+||'''[[Has ESBL::S]]'''
|-
|-
| ||E coli/Klebsiella KPC+||R
| ||E coli/Klebsiella KPC+||R
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| ||[[Acinetobacter sp.]]||I
| ||[[Acinetobacter sp.]]||I
|-
|-
| ||[[Pseudomonas aeruginosa]]||'''S'''
| ||[[Pseudomonas aeruginosa]]||'''[[Has Antipseudomonal::S]]'''
|-
|-
| ||[[Burkholderia cepacia]]||R
| ||[[Burkholderia cepacia]]||R
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*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 19:22, 19 July 2025

General

  • Type: Carbapenems
  • Dosage Forms:
  • Common Trade Names: Primaxin

Adult Dosing

General

  • Fully-susceptible organisms: 500mg IV q6 hours
  • Moderately-susceptible organisms: 1g IV q6-8 hours
  • Max: Lower of 50mg/kg or 4 g/day

UTI

  • 500mg IV q6h

Pneumonia, hospital acquired

  • 500mg IV q6h x7 days

Anthrax, systemic

  • 1g IV q6h for at least 2wk

Pediatric Dosing

General[1]

  • 60-100mg/kg/day IV divided q6 hours
  • First Dose: 10-16.6mg/kg IV x 1
  • Max: 4000mg/day

Anthrax, systemic

  • Neonates >32 wk gestation
    • 40-75 mg/kg/day IV divided q8-12h for at least 2wk
  • 1 month and older
    • 100 mg/kg/day IV divided q6h for at least 2wk

Special Populations

  • Pregnancy: C
  • Lactation: Use caution
  • Renal Dosing
    • Adult
      • If usual dose 500mg q6h
        • CrCl 60-89: 400mg q6h
        • CrCl 30-59: 300mg q6h
        • CrCl 15-29: 200mg q6h
        • CrCl <15: Avoid unless HD w/in 48h
        • HD: 200mg q6h, give dose after dialysis, no supplement
        • PD: No supplement
      • If usual dose 1000mg q8h
        • CrCl 60-89: 500mg q6h
        • CrCl 30-59: 500mg q8h
        • CrCl 15-29: 500mg q12h
        • CrCl <15: Avoid unless HD w/in 48h
        • HD: 500mg q12h, give dose after dialysis, no supplement
        • PD: No supplement
      • If usual dose 1000mg q6h
        • CrCl 60-89: 750mg q8h
        • CrCl 30-59: 500mg q6h
        • CrCl 15-29: 500mg q12h
        • CrCl <15: Avoid unless HD w/in 48h
        • HD: 500mg q12h, give dose after dialysis, no supplement
        • PD: No supplement
    • Pediatric
      • < 30 kg: Avoid use in renal impairment
      • > 30 kg:
        • CrCl 41-70: Decrease dose 50%
        • CrCl 21-40: Decrease dose 63%; give q8h
        • CrCl 6-20: Decrease dose 75%, give q12h
        • CrCl <5: Avoid unless HD w/in 48h
        • HD: Give dose after dialysis, no supplement
        • PD: No supplement
  • Hepatic Dosing
    • Adult: Not defined
    • Pediatric: Not defined

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 1h
  • Metabolism:
    • Imipenem: Kidney
    • Cilastatin: Unknown
  • Excretion: Urine 70%
  • Mechanism of Action:
    • Bactericidal
    • Imipenem inhibits cell wall synthesis
    • Cilastatin inhibits renal dihydropeptidase I, preventing imipenem metabolism

Antibiotic Sensitivities[2]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp S
Enterococcus faecalis S
Enterococcus faecium I
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis S
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae X2
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces S
Bacteroides fragilis S
Prevotella melaninogenica S
Clostridium difficile X2
Clostridium (not difficile) S
Fusobacterium necrophorum S
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Red Book, 2012
  2. ↑ Sanford Guide to Antimicrobial Therapy 2014
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