Bacterial meningitis imipenem

Mercaptopurine [6-MP] (Purinethol) [Antineoplastic/ Antimeta lite] Uses Acute leukemias, 2nd-line Rx of CML NHL, maint ALL in children, immunosuppressant w/ autoimmune Dzs (Crohn Dz) Action Antimetabolite, mimics hypoxanthine Dose Adults. 80-100 mg/mVd or 2.5-5 mg/kg/d maint 1.5-2.5 mg/kg/d Peds. Per protocol X w/ renal/hepatic insuff on empty stomach Caution [D, ] Contra Severe hepatic Dz, BM suppression, PRG Disp Tabs SE Mild hematotox, mucositis, stomatitis, D rash, fever, eosinophilia, jaundice. Hep Interactions T Effects W/ allopurinol T risk of BM suppression W/ trimethoprim-sulfamethoxazole X effects OF warfarin EMS May falsely T glucose OD May cause NA and liver necrosis symptomatic and supportive Meropenem (Merrem) [Antibiotic/Carbapenem] Uses lntra-abd Infxns, bacterial meningitis Action Carbapenem X cell wall synth, a [3-lactam Dose Adults. 1 to 2 g IV q8h Peds. >3 mo, <50 kg 10-40 mg/kg IV q 8h in renal insuff Caution [B, ] Contra [3-Lactam sensitivity Disp Inj 500 mg, 1 g SE Less Sz potential than imipenem D, thrombocytopenia Interactions T Effects W/ probenecid EMS Monitor for signs of electrolyte disturbances and... 

Imipenem is a more common cause of seizures than other beta-lactam antibiotics, particularly when high doses are given (13-15). In one study, seven of 21 children developed seizure activity while receiving imipenem + cilastatin for bacterial meningitis, a recognized risk factor (13). However, computer-assisted monitoring of imipenem + cilastatin dosages in relation to renal function resulted in a reduced incidence of seizures (16). 

In animals, meropenem (17) and other carbapenems (18,19) were less epileptogenic than imipenem. In 403 children there was no meropenem-associated neurotoxicity (20) and meropenem was well tolerated in children with bacterial meningitis (21). In summary, a larger dose range of meropenem than imipenem appears to be tolerated, but when strictly observing known risk factors for seizure propensity the difference between the two compounds is very small (22,23). 

Wong VK, Wright HT Jr, Ross LA, Mason WH, InderUed CB, Kim KS. Imipenem/cilastatin treatment of bacterial meningitis in children. Pediatr Infect Dis J 1991 10(2) 122-5. 

Most common side effects include diarrhea, nausea, vomiting, headache, rash, and infusion-related reactions. Frequency and potential risk of seizures with imipenem appear to be greater in comparison with the other carbapenems and beta-lactam antibiotics. Seizures have occurred most commonly in patients with CNS disorders or bacterial meningitis and/or compromised renal function. May be prevented by dose adjusting for renal insufficency. Pseudomembranous colitis. 

Meropenem (Merrem, Zeneca Pharmaceuticals Wilmington, DE) (53) is a new carbopenem antibiotic approved in 1996 for use as a broad-spectrum injectable antibiotic for treatment of intraabdominal infections and for pediatric bacterial meningitis. The only other carbopenem available on the market today is imipenem. 

---