What are the details of Imipenem (Imipenem/Cilastatin) usage?

From the Guidelines

Imipenem/cilastatin is a broad-spectrum carbapenem antibiotic used for serious bacterial infections, particularly those caused by multi-drug resistant organisms, with a standard adult dosage of 500 mg every 6 hours or 1 g every 8 hours, as recommended by the most recent guidelines 1. The medication is administered intravenously over 20-30 minutes for each dose, and treatment duration typically ranges from 7-14 days depending on infection severity and site.

• Common indications include complicated intra-abdominal infections, pneumonia, sepsis, and complicated urinary tract infections.
• Imipenem is combined with cilastatin to prevent renal metabolism of imipenem, thereby maintaining therapeutic blood levels.
• Side effects include gastrointestinal disturbances, seizures (particularly at higher doses or in patients with CNS disorders or renal impairment), hypersensitivity reactions, and Clostridioides difficile-associated diarrhea.
• Regular monitoring of renal function, seizure precautions, and assessment for superinfections are essential during therapy.
• Imipenem should not be mixed with other medications in the same IV solution, and patients should be monitored for development of resistant organisms during prolonged therapy.
• The use of carbapenems, including imipenem, should be limited to preserve the activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
• In patients with complicated intra-abdominal infections, a short course of antibiotic therapy (3-5 days) after adequate source control is a reasonable option, but in critically ill patients with ongoing sepsis, an individualized approach should be taken 1.

From the FDA Drug Label

INDICATIONS AND USAGE Imipenem and Cilastatin for Injection, USP for intravenous use is a combination of imipenem, a penem antibacterial, and cilastatin, a renal dehydropeptidase inhibitor, indicated for the treatment of the following serious infections caused by designated susceptible bacteria: Lower respiratory tract infections. ( 1.1) Urinary tract infections. ( 1. 2) Intra-abdominal infections. ( 1.3) Gynecologic infections. ( 1.4) Bacterial septicemia. ( 1.5) Bone and joint infections. ( 1.6) Skin and skin structure infections. ( 1.7) Endocarditis. ( 1.8)

Imipenem/Cilastatin Usage Details:

• The combination of imipenem and cilastatin is used to treat various serious infections, including lower respiratory tract infections, urinary tract infections, and intra-abdominal infections.
• It is also used to treat gynecologic infections, bacterial septicemia, bone and joint infections, skin and skin structure infections, and endocarditis.
• Limitations of Use: Imipenem and Cilastatin for Injection, USP (I.V.) is not indicated in patients with meningitis, and is not recommended in pediatric patients with CNS infections or weighing less than 30 kg with impaired renal function.
• Usage: To reduce the development of drug-resistant bacteria, imipenem and cilastatin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria 2.

From the Research

Imipenem Usage Details

• Imipenem is a beta-lactam antibiotic of the carbapenem class, with broad antibacterial activity against streptococci, methicillin-sensitive staphylococci, Neisseria, Haemophilus, anaerobes, and common aerobic gram-negative nosocomial pathogens including Pseudomonas 3.
• The daily doses of imipenem may range from 500 mg to 1 g, every 6 to 8 hours, in patients with normal renal function 3.
• Imipenem is coadministered with cilastatin, a renal dehydropeptidase inhibitor that prevents renal metabolism of imipenem 4.
• Imipenem/cilastatin provides effective and well-tolerated treatment of moderate to severe infections in various body systems, including intra-abdominal, obstetric and gynaecological, lower respiratory tract, skin and soft tissue, and urinary tract infections 4.

Imipenem/Cilastatin/Relebactam Combination

• The combination of imipenem/cilastatin with relebactam can restore its activity against many imipenem-nonsusceptible Gram-negative pathogens 5.
• The most frequently reported adverse events (AEs) occurring in patients treated with imipenem/cilastatin plus relebactam were nausea, diarrhea, vomiting, and infusion site disorders 5.
• Treatment outcomes in high-risk patients receiving imipenem/cilastatin/relebactam were generally favorable, with 70.6% of patients reporting a favorable clinical response at follow-up 5.
• Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections, including complicated urinary tract infections, complicated intra-abdominal infections, hospital-acquired bacterial pneumonia, and ventilator-associated bacterial pneumonia 6.

Safety and Efficacy

• The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both imipenem/cilastatin/relebactam and established standard of care groups 6.
• Imipenem/cilastatin/relebactam is effective as initial monotherapy of a variety of infections, including infections in neutropenic patients, with a clear role in empirical treatment of mixed infection 4.
• Imipenem should be considered for treatment of mixed bacterial infections and treatment of resistant aerobic gram-negative bacteria that are not susceptible to other beta-lactam agents 3.