Spectrum: Local Antimicrobial Stewardship, for Prisma Health Children’s Hospital-Midlands

Imipenem-Cilastatin

Restricted
Restricted

C. diff Risk

Medium

Oral Bioavailability

NA

Approximate Cost

$$$$$

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Pediatric

25 mg/kg/dose, q6hr. Infuse over 60 minutes. Max dose = 1000mg

Neonatal

Renal

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

If patient weight less than 30 kg and impaired renal function, use not recommended

General Information

Common Usage

Common Usage

  • Multidrug-resistant gram-negative infection of:

    • Lower respiratory tract
    • Urinary tract
    • Intra-abdominal
    • Bone
    • Joint

  • Septicemias

  • Endocarditis

  • 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

Drug Monitoring

Drug Monitoring

  • Renal and hepatic function

  • CBC

Adverse Effects

Adverse Effects

  • Phlebitis

  • Tachycardia

  • Seizure

  • Rash

  • GI upset

  • Decreased blood counts

  • Hepatic dysfunction

  • Acute renal failure

  • Cytopenias

  • Bone marrow suppression

Major Interactions

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

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