Imipenem cilastatin

Extensive carbapenem and penem antibiotic research has been ongoing since thienamycin was discovered in 1978. However, only the imipenem-cilastatin combination has become a commercial product. Launched in 1985 in the United States as a broad-spectmm hospital product under the name Ptimaxin, this product had worldwide sales of some 300 million in 1988. Sales were predicted to rise to 345 million for the year ending 1989 (154). 

Adjust dose of imipenem/cilastatin based on body weight (refer to package insert). 

It is often difficult to narrow the spectrum of activity of the antibiotic choice since the infections are usually polymicrobial. As such, patients may receive long courses of broad-spectrum antibiotics such as imipenem/cilastatin and... 

Imipenem/cilastatin 500 mg every 6 hours 5% incidence of seizure nausea is also a concern... 

Piperacillin-tazobactam 3.375-4.5 g IV every 6 hours Imipenem-cilastatin 500 mg IV every 6 hours Ceftazidime 2 g IV + clindamycin 600 mg IV every 8 hours... 

General Imipenem/cilastatin, meropenem, ertapenem, or extended-spectrum penicillins with 3-lactamase inhibitor 1. Aztreonam with clindamycin or metronidazole 2. Ciprofloxacin with metronidazole 3. Aminoglycoside with clindamycin or metronidazole ... 

Gangrenous or Imipenem/cilastatin, meropenem, ertapenem, 1. Aztreonam with clindamycin or metronidazole... 

Insufficiency SO years) peripheral neuropathy Enterobacteriaceae, P. aeruginosa, Enterococcus spp., anaerobes Vancomycin PLUS (1) piperacillin/tazobactam (2) imipenem/cilastatin or meropenem (3) cefepime or ceftazidime and clindamycin or metronidazole (4) ciprofloxacin or levofloxacin and clindamycin or metronidazole... 

Animal and human studies support the use of antibiotics for the prevention of infectious morbidity and mortality in severe ANP. The most effective antimicrobial agents are the fluoroquinolones, imipenem-cilastatin, and metronidazole, which achieve adequate penetration into pancreatic juice and necrotic tissue and inhibit the growth of enteric bacteria. Although a recent meta-analysis [185] suggested that prophylactic antibiotic administration reduces sepsis and mortality and this approach has been recommended by recent guidelines and consensus state-... 

Imipenem/cilastatin (i.v.) minimal to moderate i minimal to marked i low rates of C. difficile 36,41... 

Only patients with severe AP complicated by necrosis should receive infection prophylaxis with broad-spectrum antibiotics. Agents that cover the range of enteric aerobic gram-negative bacilli and anaerobic organisms should be started within the first 48 hours and continued for 2 to 3 weeks. Imipenem-cilastatin (500 mg every 8 hours) may be most effective a fluoroquinolone (e.g., ciprofloxacin, levofloxacin) with metronidazole should be considered for penicillin-allergic patients. 

See section on treatment of bacterial pneumonia. Macrolide/azalide erythromycin, clarithromycin, azithromycin. cTetracydine tetracycline hydrochloride, doxycydine. Cephalosporin cefuroxime, ceftriaxone, cefotaxime. eCarbapenem imipenem-cilastatin, meropenem. Fluoroquinolone ciprofloxacin, gatifloxacin, or levofloxacin. 

Third-generation cephalosporin ceftriaxone, cefotaxime, cefepime. Note that cephalosporins are not active against Listeria. cCarbapenem imipenem-cilastatin, meropenem. 

Imipenem-Cilastatin IV Dosing Schedule for Adults with Normal Renal... 

Imipenem-cilastatin IV is not recommended in pediatric patients with CNS infections because of the risk of seizures and in pediatric patients less than 30 kg with impaired renal function, as no data are available. 

Hemodialysis - Imipenem-cilastatin is cleared by hemodialysis. The patient should receive imipenem-cilastatin after hemodialysis and at 12-hour intervals timed from the end of that dialysis session. 

Microbiology Imipenem-cilastatin has a high degree of stability in the presence of -lactamases, including penicillinases and cephalosporinases produced by gram-negative and gram-positive bacteria. 

Resistance As with other -lactam antibiotics, some strains of P. aeruginosa may develop resistance fairly rapidly during treatment with imipenem-cilastatin. Pseudomembranous colitis Pseudomembranous colitis has occurred with virtually all antibiotics. 

Renal function impairment Do not give imipenem-cilastatin IV to patients with Ccr less than or equal to 5 mL/min/1.73 m, unless hemodialysis is instituted within 48 hours. For patients on hemodialysis, imipenem-cilastatin IV is recommended only when the benefit outweighs the potential risk of seizures. 

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