From the Guidelines
Imipenem/Cilastatin Dosage and Duration for ESBL Infections Imipenem/cilastatin is recommended at a dose of 500mg every 6 hours or 1g every 8 hours, with a maximum daily dose of 4g 1.
Key Considerations
- The duration of therapy typically ranges from 7 to 14 days, depending on the severity and site of infection, as well as clinical response 1.
- In cases of complicated intra-abdominal infections or complicated urinary tract infections, a duration of 10 to 14 days is often recommended 1.
- It is essential to consider the pharmacokinetic/pharmacodynamic properties of the employed antibiotics, including the need for loading doses and extended or prolonged infusion for beta-lactam antibiotics 1.
- Therapeutic drug monitoring (TDM) may be beneficial in certain cases, particularly for drugs with a narrow ratio between efficacy and toxicity 1.
- Increased doses of imipenem may be required to reach adequate concentrations in patients with severe intra-abdominal infections 1.
Important Notes
- The choice of antibiotic and duration of therapy should be individualized based on the specific infection, patient factors, and clinical response 1.
- It is crucial to monitor patients for signs of toxicity and adjust the antibiotic regimen as needed 1.
From the FDA Drug Label
The dosage of Imipenem and Cilastatin for Injection (I.V.) in adult patients should be based on suspected or confirmed pathogen susceptibility For adult patients with normal renal function (creatinine clearance of greater than or equal to 90 mL/min), the recommended dosage regimens are: 500 mg every 6 hours OR 1,000 mg every 8 hours OR 1,000 mg every 6 hours
The FDA drug label does not provide specific dosage recommendations for ESBL infections.
- Dosage: The recommended dosage regimens for adult patients with normal renal function are 500 mg every 6 hours or 1,000 mg every 8 hours or 1,000 mg every 6 hours.
- Duration: The label does not specify the duration of treatment for ESBL infections. 2 2
From the Research
Dosage and Duration of Imipenem for ESBL Infections
- The approved dosage of imipenem for the treatment of complicated urinary tract infections (cUTIs) and complicated intra-abdominal infections (cIAIs) is a 30-minute infusion of imipenem 500 mg-cilastatin 500 mg-relebactam 250 mg every 6 hours, along with dosage adjustments based on renal function 3.
- The duration of treatment with imipenem is typically 7-14 days, but may vary depending on the specific infection and patient response 3, 4.
- Imipenem is often used in combination with other antibiotics, such as cilastatin and relebactam, to enhance its effectiveness against ESBL-producing organisms 3.
- The dosage and duration of imipenem may need to be adjusted based on the severity of the infection, the patient's renal function, and the presence of other underlying medical conditions 3, 4, 5.
Comparison with Other Antibiotics
- Imipenem has been compared to other antibiotics, such as meropenem and ceftazidime/avibactam, in the treatment of serious bacterial infections, including those caused by ESBL-producing organisms 3, 4, 5.
- Imipenem has been shown to be effective against a wide range of Gram-negative pathogens, including ESBL-producing Enterobacteriaceae 3, 5.
- The choice of antibiotic and dosage regimen may depend on the specific infection, the patient's medical history, and the presence of other underlying medical conditions 3, 4, 5.