Imipenem-Cilastatin

C. diff Risk

Medium

Oral Bioavailability

NA

Approximate Cost

$28/day

Spectrum Of Activity

Dosing

Infants, children 3 months and older: IV 60-100 mg/kg/DAY divided q6h.MAX daily dose 4 g.

Infants less than 3 months: IV: 100 mg/kg/DAY divided q6h

Dosage recommendations are based on imipenem component.

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing. Patient weight less than 30 kg and impaired renal function, use not recommended.

General Information

Common Usage

multidrug-resistant gram-negative infection of the lower respiratory tract, urinary tract, intra-abdominal, gynecologic, bone and joint, septicemias, endocarditis, and skin; treatment of multiple organism infection in which other agents have an insufficient spectrum of activity or are contraindicated due to toxic potential; therapeutic alternative for treatment of gram-negative sepsis in immunocompromised patients. Has also been used for the treatment of peritonitis in patients with peritoneal catheters

Drug Monitoring

Renal and hepatic function, CBC.

Adverse Effects

phlebitis, tachycardia, seizure, rash, GI upset, decrease blood counts, hepatic dysfunction, acute renal failure, cytopenias, bone marrow suppression

Major Interactions

May alter cyclosporine levels, cyclosporine may enhance neurotoxic effect. Ganciclovir/Valganciclovir may increase seizure risk. Valproic acid - carbapenems decrease valproate levels and may decrease seizure threshold.

Pharmacology

Antimicrobial class: carbapenem

Average serum half life:

  • Prolonged with renal insufficiency (both drugs) Neonates:

  • Imipenem: 1.7-2.4 hours.<br>Cilastatin: 3.9-6.3 hours.

  • Infants and children: Imipenem: 1.2 hours

  • Adults, both drugs: 1 hour

Route of Elimination: When imipenem is given with cilastatin, urinary excretion of unchanged imipenem increases to 70%; 70% to 80% of a cilastatin dose is excreted unchanged in the urine