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General
- Type: Carbapenems
- Dosage Forms:
- Common Trade Names: Primaxin
Adult Dosing
General
- Fully-susceptible organisms: 500mg IV q6 hours
- Moderately-susceptible organisms: 1g IV q6-8 hours
- Max: Lower of 50mg/kg or 4 g/day
UTI
Pneumonia, hospital acquired
- 1g IV q6h for at least 2wk
Pediatric Dosing
General[1]
- 60-100mg/kg/day IV divided q6 hours
- First Dose: 10-16.6mg/kg IV x 1
- Max: 4000mg/day
- Neonates >32 wk gestation
- 40-75 mg/kg/day IV divided q8-12h for at least 2wk
- 1 month and older
- 100 mg/kg/day IV divided q6h for at least 2wk
Special Populations
- Pregnancy: C
- Lactation: Use caution
- Renal Dosing
- Adult
- If usual dose 500mg q6h
- CrCl 60-89: 400mg q6h
- CrCl 30-59: 300mg q6h
- CrCl 15-29: 200mg q6h
- CrCl <15: Avoid unless HD w/in 48h
- HD: 200mg q6h, give dose after dialysis, no supplement
- PD: No supplement
- If usual dose 1000mg q8h
- CrCl 60-89: 500mg q6h
- CrCl 30-59: 500mg q8h
- CrCl 15-29: 500mg q12h
- CrCl <15: Avoid unless HD w/in 48h
- HD: 500mg q12h, give dose after dialysis, no supplement
- PD: No supplement
- If usual dose 1000mg q6h
- CrCl 60-89: 750mg q8h
- CrCl 30-59: 500mg q6h
- CrCl 15-29: 500mg q12h
- CrCl <15: Avoid unless HD w/in 48h
- HD: 500mg q12h, give dose after dialysis, no supplement
- PD: No supplement
- Pediatric
- < 30 kg: Avoid use in renal impairment
- > 30 kg:
- CrCl 41-70: Decrease dose 50%
- CrCl 21-40: Decrease dose 63%; give q8h
- CrCl 6-20: Decrease dose 75%, give q12h
- CrCl <5: Avoid unless HD w/in 48h
- HD: Give dose after dialysis, no supplement
- PD: No supplement
- Hepatic Dosing
- Adult: Not defined
- Pediatric: Not defined
Contraindications
Adverse Reactions
Serious
Common
Pharmacology
- Half-life: 1h
- Metabolism:
- Imipenem: Kidney
- Cilastatin: Unknown
- Excretion: Urine 70%
- Mechanism of Action:
- Bactericidal
- Imipenem inhibits cell wall synthesis
- Cilastatin inhibits renal dihydropeptidase I, preventing imipenem metabolism
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Red Book, 2012
- ↑ Sanford Guide to Antimicrobial Therapy 2014