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imipenem cilastatin (Primaxin)
Imipenem is derived from a compound produced by Streptomyces cattleya. The compound thienamycin is unstable, but the N-formimidoyl derivative imipenem is stable. Imipenem is the most active non-penicillin, non-cephalosporin antibiotic against a wide variety of bacteria. It is marketed in combination with cilastatin, a drug that inhibits the degradation of imipenem with formation of a nephrotoxic metabolite by a renal tubular dipeptidase.
Indications:
- bacterial infections due to susceptible organisms
- cutaneous anthrax, inhalation anthrax [4]
- intra-abdominal infection
- gastrointestinal infections
- bacterial peritonitis
- abdominal abscess
- urogenital infection
- pelvic inflammatory disease
- endometritis
- respiratory tract infections
- lower respiratory tract infections
- pneumonia
- meliodosis
- skin or soft tissue infection
- diabetic foot infection
- infectious arthritis, osteomyelitis
- endocarditis
- empiric treatment for fever of unknown origin
- empiric treatment of febrile neutropenia [4]
Dosage: 0.5 g IV every 6 hours
Dosage adjustment in renal failure:
creatinine clearance dosage
> 50-90 mL/min 250-500 mg every 6-8 hours
10-50 mL/min* 250 mg every 8-12 hours
< 10 mL/min# 125-250 mg every 12 hours
* same dose for continuous arteriovenous hemofiltration
# dose after hemodialysis
Pharmacokinetics: 1/2life 0.25 hours
Antimicrobial activity:
Gram positive
- Streptococcus
- Streptococcus group A
- Streptococcus group B
- Streptococcus group C
- Streptococcus group G
- Streptococcus pneumonia
- Streptococcus viridans, milleri
- Enterococcus faecalis
- Enterococcus faecium (+/-)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Listeria monocytogenes
Gram negative
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia species
- Salmonella species
- Shigella species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Citrobacter species
- Aeromonas species
- Acinetobacter species
- Pseudomonas aeruginosa
- Pseudomonas cepacia
- Yersinia enterocolitica
- Pasteurella multocida
- Campylobacter fetus [4]
Anaerobes
- Actinomyces
- Bacteroides fragilis
- Bacteroides melaninogenicus
- Clostridium difficile
- Clostridium species
- Peptostreptococcus species
Adverse effects:
1) dose-related neurotoxicity in the elderly
- seizures
2) accumulates in patients with renal insufficiency
3) superinfection with Xanthomonas maltophilia
Drug interactions:
- coadministration of ganciclovir increases likelihood of seizures
Laboratory:
- antibiotic susceptibility imipenem
Interactions
drug interactions
Related
cilastatin
General
carbapenem (thienamycin)
Properties
MISC-INFO: elimination route KIDNEY
elimination by hemodialysis +
1/2life 0.25 HOURS
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 8th ed.
Gilman et al, eds. Permagon Press/McGraw Hill pg 1092
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Sanford Guide to antimicrobial therapy 1997, 2001
- Deprecated Reference
- Department of Veterans Affairs, VA National Formulary
Component-of
cilastatin/imipenem
imipenem cilastatin/relebactam (Recarbrio)