Imipenem and Cilastatin (Intravenous)

Overview

Imipenem and cilastatin treat infections triggered by antibiotic resistant bacteria. In most cases, individuals are hospitalized and receive treatment intravenously. These two medicines help to reduce the risks caused by drug-resistant bacteria, which sometimes result from an individual taking antibiotics over an extended period, building resistance of the bacteria. They are also used when standard practices relating to antibiotics have failed to treat the condition.

Imipenem is a carbapenem (antibiotic) used to fight the bacteria. Cilastatin is a dehydropeptidase inhibitor, working to delay the breakdown of imipenem by the kidneys. The action allows imipenem to remain in the body longer, stopping new growth and destroying active bacteria.

Your doctor will take precautions when using this medicine if you have been diagnosed with any of the following disorders:

  • Adverse reactions to penicillin antibiotics
  • Allergies
  • Brain tumors
  • Head injuries
  • Kidney disease
  • Seizures

It's rare, but individuals have experienced severe diarrhea when taking this medicine. The effect may continue for several months after you stop taking the medicine.

Conditions Treated

  • Intra-abdominal infections
  • Drug-resistant bacterial infections
  • Endocarditis infections
  • Gynecological infections
  • Pneumonia
  • Lower respiratory tract infections
  • Sepsis
  • Septic arthritis bone and joints
  • Urinary infections

Type Of Medicine

  • Antibiotic

Side Effects

Varying levels of side effects occur with treatment of imipenem and cilastatin. The severity of each side effect suffered depends on a number of factors, including the individual's age, health, and the condition being treated. Any existing disorders treated with other medicines, the side effects of this medication or your condition itself could worsen.

Here's a list of the most common, least common and rarest reported side effects. If you experience these effects and they worsen or persist beyond a week, tell your doctor immediately. There are other effects not listed that may occur. If you suffer other effects, talk to your doctor.

Most common

  • Confusion
  • Diarrhea
  • Hives
  • Itching
  • Pain at injection site
  • Seizures
  • Skin rash
  • Trouble breathing

Least common

Rare

  • Abdominal pain
  • Fever
  • Severe diarrhea

Talk with your doctor about the effects you experience - what the doctor knows about how your body is responding to the medicine can make a difference in maintaining your health. Not all situations need medical attention, but it's important for your doctor to know how you are feeling. Don't stop taking any of your medicines or change the doses without your doctor's approval.

Adverse effects

Some individuals have experienced seizures during treatment with these medicines. If you have a history of seizures or you are taking anticonvulsants, let your doctor know. If you suffer from diarrhea, talk with the doctor. Do not self-treat the side effect as it could worsen the condition and extend the duration of the effect.

Dosage

Doses of this medicine may differ for each person. The following information includes only the average doses of the medicine. Your doctor will prescribe the strength and dosage schedule to be taken each day based on each individual condition. To help stop the infection from recurring, treatment will continue even after you are feeling better.

The volume of medicine and the duration of treatment depend on the doctor's diagnoses, the age of the patient and the severity of the infection. The intervals of doses taken each day vary according to the medical condition and the patient's response.

For Bacterial Infections IV

Adults and children over 12 years of age

  • 250 milligrams (mg) to 1 gram (g) every six to eight hours based on imipenem quantity.
  • Maximum is 50 mg per day or 4 g - per the doctor's instructions.

Children younger than 12 years of age

The doctor will decide the dose. These are average doses for children less than three months of age with non-central nervous system (CNS) infections.

  • Younger than one week of age - 25 mg every 12 hours
  • One to four weeks of age - 25 mg every eight hours
  • Four weeks to three months of age - 25 mg every six hours

To help maintain the effectiveness of imipenem and cilastatin, this medicine should only be used to treat or prevent infections caused by drug resistant bacteria. Health conditions administering adult IV doses include:

  • Bronchitis inflammation of the lining of the bronchial tubes
  • Endocarditis - infection in the inner lining of the heart chambers and valves
  • Endometritis - infection in the uterus
  • Intra-abdominal infection - perforation of the gastrointestinal tract
  • Bone or joint infections
  • Meningitis - infection of brain and spinal cord membranes
  • Pelvic infections - infection of reproductive organs
  • Peritonitis - infection of the membrane lining the abdominal wall
  • Pneumonia - infection in the air sacs of one or both lungs
  • Pyelonephritis - kidney infection
  • Skin or soft tissue infections
  • Urinary tract infection

Interactions

Medicines have become part of our daily routine for improving our health, and most work well together, yet certain medications can have serious or unpleasant interactions when used together. Imipenem and cilastatin work with other medicines to manage different bacterial infections. Your doctor may adjust the doses, because different medicines interact with each other, causing secondary disorders or prompting serious effects to existing health conditions.

Some health conditions require multiple medications and doctors watch the interactions for any change in effects or increased health risks. If you are taking any of the medicines listed below, tell your doctor. There are medications not listed that interact with imipenem and cilastatin altering the outcomes. Your doctor will check your medications to be sure this medicine is risk-free for you.

  • Cholera vaccine
  • Cyclosporine
  • Ganciclovir
  • Probenecid
  • Theophylline
  • Valganciclovir
  • Valproic acid

There are 567 brand name and generic drugs known to interact with this medicine. Drug interactions are classified as major, moderate and minor, each with the potential to increase the severity of side effects.

  • 68 major drug interactions
  • 482 moderate drug interactions
  • 17 minor drug interactions

Prescription medicines can also cause or exacerbate side effects when used together with health supplements, over the counter (OTC) treatments and herbal remedies. Lifestyle choices about alcohol, tobacco, exercise routines and specific foods affect your body's response to medications. Your doctor will watch how this medicine works for you.

If you have been taking a single drug for a long time, whether it's prescription or non-prescription, let your doctor know. It could change how you respond to this medication. If you detect changes, tell your doctor.

Other medical problems

If you suffer from other disorders and take prescription medicines for treatment, let your doctor know. In this case, other medical conditions may affect or limit the use of this medicine. The following conditions require precautions when taking this medicine.

  • Individuals with CNS disorders linked to brain diseases, epilepsy or seizures are at risk of experiencing severe to complicated side effects.
  • Kidney disease patients are more likely to encounter life-threating incidents.
  • Colitis may occur with antibacterial medicines, ranging from mild to severe after treatment.
  • The sodium content of this medicine may affect individuals treated for congestive heart failure, hypertension and fluid retention.

If you have a history of adverse reactions to this medicine, talk with your doctor. It is important for the doctor to check your progress and response to this medicine throughout the term of your treatment. If you are prescribed this medication long-term, remember that any changes to your health or lifestyle can alter its effects.

Warnings

The US Food and Drug Administration (FDA) have posted limitations on imipenem and cilastatin. FDA regulations and notices are intended to protect the public health and offer information for consumers and industry professionals when making health decisions involving the use of drugs or treatments.

Health warnings are based on the drug's benefits, which outweigh the risks for the condition the drug will treat for the majority population. When deciding to use this medicine, you need to understand the risks and the benefits associated with a drug and the potential effect it may have on your own health before starting treatment.

  • Safety and efficacy for meningitis has not been established.
  • Pediatric patients with CNS infections should not use this medicine due to the risk of seizures.
  • Patients weighing less than 30 kilograms (kg) or approximately 66 pounds with impaired renal functions should not use this medicine.

Pregnancy

Clinical studies and tests using animals have shown some adverse effects. If you are pregnant or planning to conceive, talk with your doctor.

Breastfeeding

It is unknown whether this medicine is passed on to the infant. Precautions should be taken if you are breastfeeding your baby. Talk to your doctor to consider the potential benefits and weigh the risks to your child before taking this medication.

Pediatric

The use of this medicine in children 12 years of age and older has proven to be effective. There are precautions for children younger than 12 years of age or children with existing health disorders that may interact with this medicine causing life-threatening side effects.

Geriatric

In most cases, this population responded similar or equal to younger adults. Because the kidney excretes this medicine, the risk of toxic reactions may be greater in older patients with impaired renal function. Elderly patients are more likely to have decreased renal functions and care should be taken in dose selections with follow-on monitoring of renal functions.

Sometimes, dose adjustments are necessary in patients with renal impairment. Adult patients with creatinine clearances of less than or equal to 30 ml/min have a higher risk of seizure than patients without impairment of renal functions.

Storage

Hospital and medical professionals are responsible for managing the storage of this medicine. The dry powder should be stored at 68 to 77 Fahrenheit. Mixed solutions should not be frozen.

Summary

A dose adjustment for patients with existing conditions and tolerances to this medicine is critical. An ongoing evaluation of the individual condition and response to treatment is necessary to prevent secondary infections during treatment.

The benefits of using imipenem and cilastatin increase with a full assessment of suspected bacterial infections, preventing the development of a drug-resistant bacterium.