Imipenem dosage

UACH To evaluate impact of renal function monitoring program, focusing on appropriate dosages of imipenem OD None None DCA Potential to save 11,500 annually by adjusting imipenem dosages on basis of renal function Input costs not considered no control group clinical outcomes not considered... 

Erythromycin is considered the optimal drug for treatment of Campylobacter infections. The rate of resistance of Campylobacter to erythromycin remains low. Other advantages of this drug include ease of administration, low cost, lack of major toxicity, and narrow spectrum of activity.14 The recommended dosage for adults is 250 mg orally four times daily or 500 mg orally twice daily for 5 to 7 days. For very ill patients, treatment with gentamicin, imipenem, cefotaxime, or chloramphenicol is indicated, but susceptibility tests should be performed. 

Empirical regimens containing Cefepime, ceftazidime, imipenem, meropenem Vancomycin dosages may be adjusted based on... 

Dosage recommendations represent the quantity of imipenem to be administered. 

The safety profile of the carbapenems is comparable to that of other beta-lactam antibiotics, in particular with regard to laboratory abnormalities, the most common ones being those related to liver function (3,4). In patients with pre-existing nervous system disease or who take dosages above the recommended limits (for example in renal impairment) seizures appear to be more common with imipenem + cilastatin. 

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). 

To describe and evaluate dosing intervention program for imipenem OA Pre/post None ADRs, DCA Decreased number of seizure episodes cost savings due to dosage change Retrospective chart review... 

Drug therapy individualization for the patient receiving CRRT is complicated by the fact that patients with ARF may have a higher residual nonrenal clearance of some drugs than patients with CKD who have a similar CLcr. " " For example, the nonrenal clearance of imipenem in patients with ARF (91 mL/min) is between the values observed in CKD patients (50 mL/min) and those with normal renal function (130 mL/min)." This may occur because of less exposure to or accumulation of uremic by-products thatmay alter hepatic function. A nonrenal clearance value in a patient with ARF that is higher than anticipated based on chronic renal failure data would result in lower than expected, possibly subtherapeutic, serum concentrations. For example, in order to maintain comparable serum concentration, the imipenem dose requirement in patients with ARF would be 2,000 mg/ 24 hours as compared to the recommended dosage for patients with ESKD of 1,000 mg/24 hours." ... 

Imipenem is hydrolyzed by a dipeptidase found in the brush border of the proximal tubule. To prolong drug activity, imipenem is combined with cilastatin, an inhibitor of the dehydropeptidase the combined formulation is available as primaxin. Both imipenem and cilastatin have a t 2 of 1 hour. When administered with cilastatin, 70% of administered imipenem is recovered in the urine as the active drug. Dosage should be reduced for patients with renal insufficiency. 

Contraindications Use with caution witb clients with allergy to imipenem, cUastin or otber beta-lactams. Kidney problems require a reduced dosage. More than 2 g daily increase the risk for seizures... 

Although there is only an isolated report of an interaction between valproate and imipenem, there are now several reports of the interaction between valproate and meropenem or panipenem. Seizures or increased seizure frequeney have been reported. It would therefore seem prudent to monitor the valproate levels in any patient also given carbapenems, being alert for the need to increase the valproate dosage, or to use another antibacterial, or an alternative to valproate. Carbamazepine and phenytoin did not interact in the above reports. The manufacturers of ertapenem have no reports of an interaction on their files, but prudently warn about a possible interaction with valproate because of the interactions seen with other carbapenems. 

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