Imipenem Cilastatin Brand Name– Primaxin
What is Imipenem Cilastatin
Imipenem is a beta-lactam antibiotic derived from thienamycin and is the first drug to be classified as a carbapenem antibiotic.
Cilastatin is added as an inhibitor of dehydropeptidase-1, an enzyme found in the renal tubule border that metabolizes imipenem. Without cilastatin, imipenem is rapidly metabolized and causes toxicity to the proximal tubule.
Cilastatin itself has no antibacterial activity.
Imipenem possesses several traits that make it an effective antibiotic including: a) more efficient penetration through the bacterial cell wall, b) resistance to bacterial enzymes, and c) affinity for all bacterial PBPs.
Imipenem has a broader spectrum of activity than do many other beta-lactam antibiotics.
Clinically, the combination of imipenem-cilastatin is used to treat severe or resistant infections, especially those that are nosocomial in origin.
The FDA approved imipenem-cilastatin in November 1985.
Indications
- Acinetobacter calcoaceticus
- Acinetobacter sp.
- Aeromonas hydrophila
- Alcaligenes sp.
- anthrax
- appendicitis
- Bacillus sp.
- Bacteroides fragilis
- Bacteroides intermedius
- Bacteroides sp.
- Bacteroides thetaiotaomicron
- Bifidobacterium sp.
- bone and joint infections
- Capnocytophaga sp.
- cellulitis
- Citrobacter sp.
- Clostridium perfringens
- Clostridium sp.
- community-acquired pneumonia
- cystic fibrosis
- diabetic foot ulcer
- endocarditis
- Enterobacter cloacae
- Enterobacter sp.
- Enterococcus faecalis
- Escherichia coli
- Eubacterium sp.
- febrile neutropenia
- Fusobacterium sp.
- Gardnerella vaginalis
- gynecologic infections
- Haemophilus ducreyi
- Haemophilus influenzae (beta-lactamase negative)
- Haemophilus influenzae (beta-lactamase positive)
- Haemophilus parainfluenzae
- intraabdominal infections
- Klebsiella oxytoca
- Klebsiella pneumoniae
- Klebsiella sp.
- Listeria monocytogenes
- lower respiratory tract infections
- melioidosis
- Morganella morganii
- Neisseria gonorrhoeae
- Nocardia sp.
- nosocomial pneumonia
- Pantoea agglomerans
- Parabacteroides distasonis
- Pasteurella sp.
- Peptococcus sp.
- Peptostreptococcus sp.
- peritonitis
- pneumonia
- Prevotella bivia
- Prevotella disiens
- Prevotella melaninogenica
- Propionibacterium sp.
- Proteus mirabilis
- Proteus vulgaris
- Providencia rettgeri
- Providencia stuartii
- Pseudomonas aeruginosa
- sepsis
- Serratia marcescens
- Serratia sp.
- skin and skin structure infections
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Staphylococcus saprophyticus
- Streptococcus agalactiae (group B streptococci)
- Streptococcus pneumoniae
- Streptococcus pyogenes (group A beta-hemolytic streptococci)
- Streptococcus sp. (Group C)
- Streptococcus sp. (Group G)
- urinary tract infection (UTI)
- Veillonella sp.
- Viridans streptococci
Side Effects
- abdominal pain
- acute generalized exanthematous pustulosis (AGEP)
- agitation
- agranulocytosis
- anaphylactoid reactions
- angioedema
- anuria
- arthralgia
- asthenia
- azotemia
- candidiasis
- chest pain (unspecified)
- colitis
- confusion
- cyanosis
- diarrhea
- dizziness
- drowsiness
- dysgeusia
- dyskinesia
- dyspnea
- elevated hepatic enzymes
- encephalopathy
- eosinophilia
- erythema
- erythema multiforme
- fever
- flushing
- glossitis
- hallucinations
- headache
- hearing loss
- hemolytic anemia
- hepatic failure
- hepatitis
- hyperbilirubinemia
- hyperchloremia
- hyperhidrosis
- hyperkalemia
- hypersalivation
- hyperventilation
- hyponatremia
- hypotension
- infection
- injection site reaction
- jaundice
- leukopenia
- myoclonia
- nausea
- neutropenia
- oliguria
- palpitations
- pancytopenia
- paresthesias
- phlebitis
- polyuria
- proteinuria
- pruritus
- pseudomembranous colitis
- pyrosis (heartburn)
- rash
- renal failure (unspecified)
- seizures
- sinus tachycardia
- Stevens-Johnson syndrome
- superinfection
- thrombocytopenia
- thrombocytosis
- tinnitus
- tongue discoloration
- tooth discoloration
- toxic epidermal necrolysis
- tremor
- urine discoloration
- urticaria
- vertigo
- vomiting
- weakness
Monitoring Parameters
- CBC
- LFTs
- serum creatinine/BUN
Contraindications
- breast-feeding
- carbapenem hypersensitivity
- cephalosporin hypersensitivity
- colitis
- dialysis
- diarrhea
- geriatric
- GI disease
- head trauma
- inflammatory bowel disease
- laboratory test interference
- neurological disease
- penicillin hypersensitivity
- pregnancy
- pseudomembranous colitis
- renal failure
- renal impairment
- seizure disorder
- seizures
- ulcerative colitis
Interactions
- Colchicine; Probenecid
- Disulfiram
- Ganciclovir
- Oral Contraceptives
- Probenecid
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Theophylline, Aminophylline
- Valganciclovir
- Valproic Acid, Divalproex Sodium
- Warfarin
