Imipenem + Cilastatin

Imipenem + Cilastatin is an antibiotic combination used for serious bacterial infections. Imipenem is a penem antibacterial that works by inhibiting bacterial cell wall synthesis. Cilastatin is a renal dehydropeptidase inhibitor that limits the renal metabolism of imipenem and protects against nephrotoxic effects. It demonstrates high stability in the presence of beta-lactamases.

• Lower respiratory tract infections
• Urinary tract infections
• Intra-abdominal infections
• Gynecologic infections
• Bacterial septicemia
• Bone and joint infections
• Skin and skin structure infections
• Endocarditis

Adult Dose (IV):

• General (CrCl ≥90 mL/min): 500 mg every 6 hours OR 1000 mg every 8 hours OR 1000 mg every 6 hours
• Mild to moderate infections: 500-750 mg IV every 12 hours
• Intra-abdominal: 250-500 mg IV every 6 hours (severe: 500 mg q6h or 1 g q8h)
• Urinary tract: Uncomplicated: 250 mg q6h; Complicated: 500 mg q6h
• Max daily dose: 50 mg/kg/day or 4 g/day (whichever is lower)

Child Dose (IV):

• ≥3 months: 15-25 mg/kg every 6 hours
• ≤3 months (≥1500 g): 4 wks-3 mo: 25 mg/kg q6h; 1-4 wks: 25 mg/kg q8h; <1 wk: 25 mg/kg q12h

Renal Dose: CrCl 31-70: 500 mg q6-8h; 21-30: 500 mg q8-12h; 6-20: 250 mg q12h; <5: Only if hemodialysis started within 48 hr

Common Side Effects:

• Phlebitis
• Nausea
• Diarrhea
• Vomiting
• Rash
• Pruritus
• Urticaria
• Pain at injection site, erythema
• Fever
• Hypotension
• Seizures
• Dizziness
• Somnolence

Precautions:

• Imipenem + Cilastatin may affect your ability to drive (seizures, dizziness, somnolence)
• Serious and occasionally fatal anaphylactic reactions reported; discontinue if allergy occurs
• Seizures and other CNS adverse reactions reported; if focal tremors, myoclonus or seizures occur, evaluate neurologically
• Caution or avoid in penicillin allergy
• Monitor liver and kidney function

Contraindications:

• Hypersensitivity

Drug Interactions:

• Concurrent administration with probenecid may increase half-life of cilastatin
• Increased risk of generalized seizures when used concurrently with ganciclovir

Food Interactions: It is not known whether it is safe to consume alcohol with Imipenem + Cilastatin; consult your doctor.

Use in Pregnancy: Category C; no adequate and well-controlled studies in pregnant women; use only if potential benefit justifies potential risk to mother and fetus.

Use in Lactation: It is not known whether Imipenem-Cilastatin sodium is excreted in human milk; caution should be exercised.

Pediatric Use: ≥3 months: 15-25 mg/kg every 6 hours; ≤3 months: dose based on age and weight; max 4 g/day.

Renal Impairment: Dose reduction required for CrCl <90 mL/min; patients with CrCl <15 mL/min should not receive unless hemodialysis instituted within 48 hours.

Hepatic Impairment: Limited information available; consult your doctor.

Overdose: May cause seizures, CNS toxicity, nausea, vomiting, diarrhea; provide symptomatic supportive treatment; hemodialysis may be effective.