Imipenem/Cilastatin
(Redirected from Imipenem-cilastatin)
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
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Acute cystitis | 500mg IV q8hr | Inpatient |
| Anthrax | 1g IV q6h for at least 2wk | Anthrax, systemic |
| Ascending cholangitis | 500mg IV q6hrs | |
| Diabetic foot infection | 500mg IV q6hrs | Inpatient DFI |
| Ludwig's angina | 500mg (20mg/kg) IV q6 hours | Immunocompromised |
| Neutropenic fever | 1g IV q8hrs | Inpatient monotherapy |
| Osteomyelitis | 500mg IV q6h | Elderly/Hematogenous |
| Osteomyelitis | 500mg IV q6h | DM/Vascular insufficiency |
| Osteomyelitis | 500mg IV q6h | Human bite |
| Osteomyelitis | 500mg IV q6h | Animal bites |
| Pneumonia (main) | 500mg q6h | ICU, Risk of Pseudomonas |
| Pneumonia (main) | 500mg q6h | HAP, High Risk |
| Pneumonia (main) | 500mg q6h | VAP, High Risk |
| Pyelonephritis | 500mg IV q8hr | Adult Inpatient |
Pediatric Dosing
General[1]
- 60-100mg/kg/day IV divided q6 hours
- First Dose: 10-16.6mg/kg IV x 1
- Max: 4000mg/day
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Anthrax | 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 | Anthrax, systemic |
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
- If usual dose 500mg q6h
- 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
- Adult
- Hepatic Dosing
- Adult: Not defined
- Pediatric: Not defined
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Hypersensitivity reaction
- Anaphylaxis
- Stevens-Johnson syndrome/Toxic epidermal necrolysis
- Erythema multiforme
- Neurotoxicity
- Seizure
- Superinfection
- C. diff associated diarrhea
- Hemorrhagic colitis
- Myelosuppression
- Hemolytic anemia
- Hepatotoxicity
- Acute renal failure
Common
- LFT Increase
- Seizure
- Platelet abnormality
- Diarrhea
- Thrombophlebitis
- Oliguria/Anuria
- Rash
- Nausea
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
Antibiotic Sensitivities[2]
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