II. Indications
- See Carbapenem
- Avoid in Meningitis and other CNS Infections
- Avoid in MRSA Infections (not active)
- Complicated Infections
- Sepsis
- Pneumonia
- Endocarditis
- Intraabdominal Infections
- Bone and joint infections
- Pelvic or gynecologic infections
- Urinary Tract Infections
- Skin and Soft Tissue Infections
- Empiric Febrile Neutropenia coverage (not FDA approved)
III. Mechanism
- See Carbapenem
- Imipenem is typically combined with Cilastin (Primaxin)
- Imipenem alone is rapidly inactivated by renal DHP-1
- Cilastin is added to Imipenem to prolong its half life by slowing renal excretion
IV. Dosing: Imipenem-Cilastin (Primaxin)
- Infuse over 20-30 minutes (over 40 to 60 minutes if dose >500 mg or Nausea occurs)
- Adult
- High dose (intermediately sensitive Bacteria)
- CrlCl >=90 ml/min: 1000 mg IV/IM every 6 hours
- CrCl 60-90 ml/min: 750 mg IV/IM every 8 hours
- Low dose (suscepible Bacteria, empiric Febrile Neutropenia coverage)
- CrlCl >=90 ml/min: 500 mg every 6 hours or 1000 mg every 8 hours IV/IM
- CrCl 60-90 ml/min: 500 mg IV/IM every 6 hours
- High dose (intermediately sensitive Bacteria)
- Child (3 months and older)
- Avoid in renal Impairment if weight <30 kg
- Dose: 15 to 25 mg/kg IV every 6 hours (maximum: 4 g/day)
- Infant (birth to 3 months)
- Avoid in renal Impairment
- Age <1 week: 25 mg/kg every 12 hours
- Age 1 to 4 weeks: 25 mg/kg every 8 hours
- Age 1 to 3 months: 25 mg/kg every 6 hours
V. Drug Interactions
- See Carbapenem
VI. Adverse Effects
- See Carbapenem
- Gastrointestinal Effects (Diarrhea, Nausea or Vomiting)
- More common with Imipenem-Cilastin
-
Seizures
- Highest risk of Seizures of the Carbapenems (as well as other beta lactamases)
- Higher risk in elderly, underlying CNS disorders or Epilepsy, impaired Renal Function or high doses
- Also seen with Imipenem-Cilastin (Primaxin) when combined with Ganciclovir
VII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
VIII. Resources
- Imipenem Cilastin (DailyMed)
IX. References
- LiverTox (2017), accessed online 1/2/2023
- Hamilton (2020) Tarascon Pharmacopeia
- (2012) Presc Lett, Resource #231205, Comparison of Carbapenem Antibiotics
- Zhanel (2007) Drugs: 67(7): 1027-52 [PubMed]