Imipenem/Cilastatin: Difference between revisions
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*Type: [[Carbapenems]] | *Type: [[Carbapenems]] | ||
*Dosage Forms: | *Dosage Forms: | ||
*Common Trade Names: | *Common Trade Names: Primaxin | ||
==Adult Dosing== | ==Adult Dosing== | ||
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*Moderately-susceptible organisms: 1g IV q6-8 hours | *Moderately-susceptible organisms: 1g IV q6-8 hours | ||
*Max: Lower of 50mg/kg or 4 g/day | *Max: Lower of 50mg/kg or 4 g/day | ||
===UTI=== | |||
*500mg IV q6h | |||
===[[Pneumonia]], hospital acquired=== | |||
*500mg IV q6h x7 days | |||
===[[Anthrax]], systemic=== | |||
*1g IV q6h for at least 2wk | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===General<ref>Red Book, 2012</ref>=== | ===General<ref>Red Book, 2012</ref>=== | ||
*60-100mg/kg/day IV divided q6 hours | *60-100mg/kg/day IV divided q6 hours | ||
*First Dose: 10-16. | *First Dose: 10-16.6mg/kg IV x 1 | ||
*Max: 4000mg/day | *Max: 4000mg/day | ||
===[[Anthrax]], systemic=== | |||
*Neonates >32 wk gestation | |||
**40-75 mg/kg/day IV divided q8-12h for at least 2wk | |||
*1 month and older | |||
**100 mg/kg/day IV divided q6h for at least 2wk | |||
==Special Populations== | ==Special Populations== | ||
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*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
***If usual dose 500mg q6h | |||
****CrCl 60-89: 400mg q6h | |||
****CrCl 30-59: 300mg q6h | |||
****CrCl 15-29: 200mg q6h | |||
****CrCl <15: Avoid unless HD w/in 48h | |||
****HD: 200mg q6h, give dose after dialysis, no supplement | |||
****PD: No supplement | |||
***If usual dose 1000mg q8h | |||
****CrCl 60-89: 500mg q6h | |||
****CrCl 30-59: 500mg q8h | |||
****CrCl 15-29: 500mg q12h | |||
****CrCl <15: Avoid unless HD w/in 48h | |||
****HD: 500mg q12h, give dose after dialysis, no supplement | |||
****PD: No supplement | |||
***If usual dose 1000mg q6h | |||
****CrCl 60-89: 750mg q8h | |||
****CrCl 30-59: 500mg q6h | |||
****CrCl 15-29: 500mg q12h | |||
****CrCl <15: Avoid unless HD w/in 48h | |||
****HD: 500mg q12h, give dose after dialysis, no supplement | |||
****PD: No supplement | |||
**Pediatric | **Pediatric | ||
***< 30 kg: Avoid use in renal impairment | |||
***> 30 kg: | |||
****CrCl 41-70: Decrease dose 50% | |||
****CrCl 21-40: Decrease dose 63%; give q8h | |||
****CrCl 6-20: Decrease dose 75%, give q12h | |||
****CrCl <5: Avoid unless HD w/in 48h | |||
****HD: Give dose after dialysis, no supplement | |||
****PD: No supplement | |||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult: Not defined | ||
**Pediatric | **Pediatric: Not defined | ||
==Contraindications== | ==Contraindications== | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Hypersensitivity reaction | |||
*[[Anaphylaxis]] | |||
*[[Stevens-Johnson syndrome]]/[[Toxic epidermal necrolysis]] | |||
*Erythema multiforme | |||
*Neurotoxicity | |||
*[[Seizure]] | |||
*Superinfection | |||
*C. diff associated [[diarrhea]] | |||
*Hemorrhagic [[colitis]] | |||
*Myelosuppression | |||
*[[Hemolytic anemia]] | |||
*Hepatotoxicity | |||
*[[Acute renal failure]] | |||
===Common=== | ===Common=== | ||
*LFT Increase | |||
*[[Seizure]] | |||
*Platelet abnormality | |||
*[[Diarrhea]] | |||
*[[Thrombophlebitis]] | |||
*[[Oliguria]]/Anuria | |||
*Rash | |||
*[[Nausea]] | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 1h | ||
*Metabolism: | *Metabolism: | ||
*Excretion: | **Imipenem: Kidney | ||
**Cilastatin: Unknown | |||
*Excretion: Urine 70% | |||
*Mechanism of Action: | *Mechanism of Action: | ||
**Bactericidal | |||
**Imipenem inhibits cell wall synthesis | |||
**Cilastatin inhibits renal dihydropeptidase I, preventing imipenem metabolism | |||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
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*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Latest revision as of 20:45, 22 September 2019
General
- Type: Carbapenems
- Dosage Forms:
- Common Trade Names: Primaxin
Adult Dosing
General
- Fully-susceptible organisms: 500mg IV q6 hours
- Moderately-susceptible organisms: 1g IV q6-8 hours
- Max: Lower of 50mg/kg or 4 g/day
UTI
- 500mg IV q6h
Pneumonia, hospital acquired
- 500mg IV q6h x7 days
Anthrax, systemic
- 1g IV q6h for at least 2wk
Pediatric Dosing
General[1]
- 60-100mg/kg/day IV divided q6 hours
- First Dose: 10-16.6mg/kg IV x 1
- Max: 4000mg/day
Anthrax, systemic
- Neonates >32 wk gestation
- 40-75 mg/kg/day IV divided q8-12h for at least 2wk
- 1 month and older
- 100 mg/kg/day IV divided q6h for at least 2wk
Special Populations
- Pregnancy: C
- Lactation: Use caution
- Renal Dosing
- Adult
- If usual dose 500mg q6h
- CrCl 60-89: 400mg q6h
- CrCl 30-59: 300mg q6h
- CrCl 15-29: 200mg q6h
- CrCl <15: Avoid unless HD w/in 48h
- HD: 200mg q6h, give dose after dialysis, no supplement
- PD: No supplement
- If usual dose 1000mg q8h
- CrCl 60-89: 500mg q6h
- CrCl 30-59: 500mg q8h
- CrCl 15-29: 500mg q12h
- CrCl <15: Avoid unless HD w/in 48h
- HD: 500mg q12h, give dose after dialysis, no supplement
- PD: No supplement
- If usual dose 1000mg q6h
- CrCl 60-89: 750mg q8h
- CrCl 30-59: 500mg q6h
- CrCl 15-29: 500mg q12h
- CrCl <15: Avoid unless HD w/in 48h
- HD: 500mg q12h, give dose after dialysis, no supplement
- PD: No supplement
- If usual dose 500mg q6h
- Pediatric
- < 30 kg: Avoid use in renal impairment
- > 30 kg:
- CrCl 41-70: Decrease dose 50%
- CrCl 21-40: Decrease dose 63%; give q8h
- CrCl 6-20: Decrease dose 75%, give q12h
- CrCl <5: Avoid unless HD w/in 48h
- HD: Give dose after dialysis, no supplement
- PD: No supplement
- Adult
- Hepatic Dosing
- Adult: Not defined
- Pediatric: Not defined
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Hypersensitivity reaction
- Anaphylaxis
- Stevens-Johnson syndrome/Toxic epidermal necrolysis
- Erythema multiforme
- Neurotoxicity
- Seizure
- Superinfection
- C. diff associated diarrhea
- Hemorrhagic colitis
- Myelosuppression
- Hemolytic anemia
- Hepatotoxicity
- Acute renal failure
Common
- LFT Increase
- Seizure
- Platelet abnormality
- Diarrhea
- Thrombophlebitis
- Oliguria/Anuria
- Rash
- Nausea
Pharmacology
- Half-life: 1h
- Metabolism:
- Imipenem: Kidney
- Cilastatin: Unknown
- Excretion: Urine 70%
- Mechanism of Action:
- Bactericidal
- Imipenem inhibits cell wall synthesis
- Cilastatin inhibits renal dihydropeptidase I, preventing imipenem metabolism
Antibiotic Sensitivities[2]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia