Imipenem/Cilastatin: Difference between revisions

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==General==
==General==
*Type: [[Carbapenems]]
*Type: [[Is DrugClass::Carbapenems]]
*Dosage Forms:
*Dosage Forms:
*Common Trade Names: Primaxin
*Common Trade Names: Primaxin
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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
===Indications by Disease===
{{#ask: [[Has DrugName::Imipenem/Cilastatin]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Pediatric Dosing==
==Pediatric Dosing==
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*First Dose: 10-16.6mg/kg IV x 1
*First Dose: 10-16.6mg/kg IV x 1
*Max: 4000mg/day
*Max: 4000mg/day
===Indications by Disease===
{{#ask: [[Has DrugName::Imipenem/Cilastatin]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==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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[[Category:Pharmacology]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 11:07, 20 March 2026

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


Indications by Disease

DiseaseDoseContext
Acute cystitis500mg IV q8hrInpatient
Anthrax1g IV q6h for at least 2wkAnthrax, systemic
Ascending cholangitis500mg IV q6hrs
Diabetic foot infection500mg IV q6hrsInpatient DFI
Ludwig's angina500mg (20mg/kg) IV q6 hoursImmunocompromised
Neutropenic fever1g IV q8hrsInpatient monotherapy
Osteomyelitis500mg IV q6hElderly/Hematogenous
Osteomyelitis500mg IV q6hDM/Vascular insufficiency
Osteomyelitis500mg IV q6hHuman bite
Osteomyelitis500mg IV q6hAnimal bites
Pneumonia (main)500mg q6hICU, Risk of Pseudomonas
Pneumonia (main)500mg q6hHAP, High Risk
Pneumonia (main)500mg q6hVAP, High Risk
Pyelonephritis500mg IV q8hrAdult Inpatient

Pediatric Dosing

General[1]

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


Indications by Disease

DiseaseDoseContext
AnthraxNeonates >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 2wkAnthrax, systemic

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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