Imipenem

Indications
 Intravenous
Susceptible infections
Adult: Combined with cilastatin: (as anhydrous imipenem) 1-2 g daily in divided doses every 6-8 hr, given via IV infusion. Doses 250 or 500 mg are infused over 20-30 min, and doses of 750 mg or 1 g over 40-60 min. Max: 4 g/day or 50 mg/kg.
Child: >40 kg: same as adult dose. Child >3 mth and <40 kg: 15-25 mg/kg every 6 hr by IV infusion. Doses up to 90 mg/kg may be given to older children with cystic fibrosis. Neonates and infants <3 mth: 4 wk-3 mth, 25 mg/kg every 6 hr; 1-4 wk, 25 mg/kg every 8 hr; up to 1 wk, 25 mg/kg every 12 hr. Max: >40 kg: 4 g/day or 50 mg/kg; <40 kg: 2 g/day.
Renal impairment: Max doses based on CrCl.
CrCl (ml/min)Dosage Recommendation
31-70500 mg every 6-8 hr.
21-30500 mg every 8-12 hr.
6-20250 mg or 3.5 mg/kg (whichever is lower) every 12 hr.
≤5Only give if haemodialysis is started within 48 hr.

Intravenous
Prophylaxis of surgical infections
Adult: 1 g may be given on induction of anaesthesia, followed by 1 g 3 hr later, with additional doses of 500 mg at 8 and 16 hr after induction if necessary.
Intramuscular
Mild to moderate susceptible infections
Adult: 500 or 750 mg every 12 hr.
Intramuscular
Uncomplicated gonorrhoea
Adult: 500 mg as a single dose.

Special Populations: Max IV doses in renal impairment: CrCl 31-70 ml/min: 500 mg every 6-8 hr CrCl 21 to 30 ml/min: 500 mg every 8-12 hr CrCl 6-20 ml/min: 250 mg (or 3.5 mg/kg, whichever is the lower) every 12 hr or occasionally 500 mg every 12 hr. CrCl ≤5 ml/min: should only be given imipenem if haemodialysis is started within 48 hr. Imipenem and cilastatin are cleared from the body by haemodialysis and doses should be given after a dialysis session and then every 12 hr.
Contraindications
 Hypersensitivity.
Warnings / Precautions
 Caution when used in patients with known hypersensitivity to other β-lactams due to possibility of cross-sensitivity. CNS disorders such as epilepsy; renal, hepatic impairment; pregnancy, lactation.
Adverse Reactions
 Skin rashes, urticaria, eosinophilia, fever, nausea, vomiting, diarrhoea, tooth or tongue discoloration, and altered taste. Erythema multiforme, exfoliative dermatitis. Pain and thrombophlebitis may occur at the inj site.
Potentially Fatal: Severe anaphylactic reactions. Stevens-Johnson syndrome and toxic epidermal necrolysis.
Drug Interactions
 Increased risk of seizures when used with ganciclovir. Ciclosporin may increase neurotoxicity of ifosfamide; ifosfamide may also raise serum levels of ciclosporin. Serum levels may be increased by uricosuric agents. May reduce efficacy of valproic acid; monitor.
See Below for More imipenem Drug Interactions
Mechanism of Actions
 Imipenem is bactericidal and acts by inhibiting bacterial cell wall synthesis. It has a very broad spectrum of activity in vitro, including activity against Gram-positive and Gram-negative aerobic and anaerobic organisms, and is stable to hydrolysis by β-lactamases.
Distribution: Widely distributed in body tissues and fluids.
Metabolism: Partially hydrolised in the kidneys.
Excretion: In the urine via glomerular filtration and tubular secretion.
Storage Conditions
 Intramuscular: Dry powder: Store below 25°C. When reconstituted, satisfactory potency is maintained for 4 hr at room temperature and for 24 hr under refrigeration (5°C). Solutions should not to be frozen. Intravenous: Dry powder: Store below 25°C. When reconstituted, satisfactory potency is maintained for 4 hr at room temperature and for 24 hr under refrigeration (5°C). Solutions should not to be frozen.
Storage
 Intramuscular: Dry powder: Store below 25°C. When reconstituted, satisfactory potency is maintained for 4 hr at room temperature and for 24 hr under refrigeration (5°C). Solutions should not to be frozen. Intravenous: Dry powder: Store below 25°C. When reconstituted, satisfactory potency is maintained for 4 hr at room temperature and for 24 hr under refrigeration (5°C). Solutions should not to be frozen.
Available As
  • Imipenem 1000 mg
  • Imipenem 125 mg
  • Imipenem 250 mg
  • Imipenem 500 mg

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