Imipenem and Cilastatin USP
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Pharmacology
Imipenem restrains bacterial cell wall synthesis. Cilastatin averts metabolism of Imipenem, ensuing in increased urinary recovery and decreased renal toxicity.

Indications and Usage
Dealing of solemn infections of lower respiratory tract plus urinary tract, intra-abdominal and gynecologic infections, bacterial septicemia, bone and joint infections, skin and skin structure infections, endocarditis, and polymicrobic infections due to susceptible microorganisms.

Contraindications
IM use with hypersensitivity to local anesthetics of amide type or with severe shock or heart block
IV use with patients with meningitis (safety and efficacy have not been established).

Dosage and Administration
Adults

IV 125, 250, or 500 mg dose over 20 to 30 min. Infuse a 750 mg or 1 g dose over 40 to 60 min. If nausea develops, slow the infusion rate. Max: 50 mg/kg/day or 4 g/day, whichever is lower.

Adults
IM 500 to 750 mg every 12 h. Max: 1,500 mg/day.

Children less than 40 kg
IM 60 mg/kg/day

Children at least 40 kg
IM Adult dose
 
 

Premature Infants (at least 36 wk Gestational Age)
IM 20 mg/kg every 12 h

General Advice

  • Do not combine with or physically add to antibiotics. However, it may be administered concomitantly with other antibiotics (e.g., amino glycosides).
  • For IV administration, reconstitute with 100 mL of compatible diluents. Shake until suspension is clear; add suspension to 100 mL of appropriate infusion solution. Then add 10 mL of infusion to vial shake well to ensure that all medication is used and transfer resulting suspension to infusion solution. Color of solution may range from colorless to yellow. Solution is stable for 4 h at room temperature and for 24 h when refrigerated. Do not administer if solution is cloudy.
  • For IM administration, prepare with 1% lidocaine HCl solution (without epinephrine). Prepare 500 mg vial with 2 mL and 750 mg vial with 3 mL of lidocaine. Agitate to form suspension. Color of solution may range from white to light tan. Withdraw and inject entire contents of vial IM. Use within 1 h of preparation.
  • Do not use IM preparation for IV administration.
Storage/Stability
Accumulates unreconstituted powder at or below 77°F.

Drug Interactions

Cyclosporine
CNS side effects (e.g., myoclonia, seizures) may be increased.

Ganciclovir
Comprehensive seizures may occur; avoid use.

Probenecid
Nominal increases in Imipenem levels and half-life; do not give probenecid concomitantly.

Incompatibility

Do not physically mix imipenem-cilastatin with other antibiotics.
 
 

Laboratory Test Interactions
May cause positive Coombs test results.

Adverse Reactions

Cardiovascular
Hypotension; palpitations; tachycardia; phlebitis; thrombophlebitis.

CNS
Seizures.

GI
Nausea; diarrhea; vomiting; pseudo membranous colitis; hemorrhagic colitis; hepatitis

Genitourinary:
Presence of RBCs, WBCs, casts, and bacteria in urine; increased BUN and creatinine

Hematologic:
Decreased Hgb and Hct; eosinophilia; increased or decreased WBCs and platelets; decreased erythrocytes.

Hepatic:
Increased AST, ALT, alkaline phosphatase, and bilirubin.

Miscellaneous:
Pain at injection site.

Precautions

Pregnancy
Category C

Lactation
Undetermined

Children
Security and efficiency in children younger than 12 yr of age are not established with IM use. IV use in newborns to 16 yr of age (with non-CNS infections) is sustained by confirmation from sufficient and well-controlled studies. IV use is not optional in pediatric patients with CNS infections because of the risk of seizures, or in pediatric patients less than 30 kg with impaired renal function, as no data are available.

Hypersensitivity
Administer drug with caution to penicillin-sensitive patients due to possible cross-activity.

Renal Function
Dosage reduction or alteration of dosage interval is required.

Super infection
May result in bacterial or fungal overgrowth of no susceptible organisms.

Benzyl alcohol
Benzyl alcohol as a preservative has been associated with toxicity in newborns, especially those younger than 3 mos. Do not use diluents containing benzyl alcohol when IV is constituted for administration to pediatric patients.

CNS
IV administration may result in myoclonic activity confusional states or seizures.

Pseudo membranous colitis
Consider possibility in patients with diarrhea

Over dosage

Symptoms

Seizures

Patient Information
Initiate patient to report the following to health care provider: itching; rash; hives; difficulty breathing; diarrhea; black “furry” tongue; loose, foul-smelling stools; vaginal itching or discharge.
 
 
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