II. Indications

  1. See Carbapenem
  2. Avoid in Meningitis and other CNS Infections
  3. Avoid in MRSA Infections (not active)
  4. Complicated Infections
    1. Sepsis
    2. Pneumonia
    3. Endocarditis
    4. Intraabdominal Infections
    5. Bone and joint infections
    6. Pelvic or gynecologic infections
    7. Urinary Tract Infections
    8. Skin and Soft Tissue Infections
    9. Empiric Febrile Neutropenia coverage (not FDA approved)

III. Mechanism

  1. See Carbapenem
  2. Imipenem is typically combined with Cilastin (Primaxin)
    1. Imipenem alone is rapidly inactivated by renal DHP-1
    2. Cilastin is added to Imipenem to prolong its half life by slowing renal excretion

IV. Dosing: Imipenem-Cilastin (Primaxin)

  1. Infuse over 20-30 minutes (over 40 to 60 minutes if dose >500 mg or Nausea occurs)
  2. Adult
    1. High dose (intermediately sensitive Bacteria)
      1. CrlCl >=90 ml/min: 1000 mg IV/IM every 6 hours
      2. CrCl 60-90 ml/min: 750 mg IV/IM every 8 hours
    2. Low dose (suscepible Bacteria, empiric Febrile Neutropenia coverage)
      1. CrlCl >=90 ml/min: 500 mg every 6 hours or 1000 mg every 8 hours IV/IM
      2. CrCl 60-90 ml/min: 500 mg IV/IM every 6 hours
  3. Child (3 months and older)
    1. Avoid in renal Impairment if weight <30 kg
    2. Dose: 15 to 25 mg/kg IV every 6 hours (maximum: 4 g/day)
  4. Infant (birth to 3 months)
    1. Avoid in renal Impairment
    2. Age <1 week: 25 mg/kg every 12 hours
    3. Age 1 to 4 weeks: 25 mg/kg every 8 hours
    4. Age 1 to 3 months: 25 mg/kg every 6 hours

V. Drug Interactions

VI. Adverse Effects

  1. See Carbapenem
  2. Gastrointestinal Effects (Diarrhea, Nausea or Vomiting)
    1. More common with Imipenem-Cilastin
  3. Seizures
    1. Highest risk of Seizures of the Carbapenems (as well as other beta lactamases)
    2. Higher risk in elderly, underlying CNS disorders or Epilepsy, impaired Renal Function or high doses
    3. Also seen with Imipenem-Cilastin (Primaxin) when combined with Ganciclovir

VII. Safety

  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation

IX. References

  1. LiverTox (2017), accessed online 1/2/2023
    1. https://www.ncbi.nlm.nih.gov/books/NBK548705/
  2. Hamilton (2020) Tarascon Pharmacopeia
  3. (2012) Presc Lett, Resource #231205, Comparison of CarbapenemAntibiotics
  4. Zhanel (2007) Drugs: 67(7): 1027-52 [PubMed]

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Related Studies

Ontology: Imipenem (C0020933)

Definition (NCI) A broad-spectrum, semi-synthetic beta-lactam carbapenem derived from thienamycin, produced by Streptomyces cattleya. Imipenem binds to and inactivates penicillin-binding proteins (PBPs) located on the inner membrane of the bacterial cell wall. PBPs are enzymes that are involved in the last stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. This inactivation results in the weakening of the bacterial cell wall and eventually causes cell lysis. Imipenem has the greatest affinity for PBP 1A, 1B, and 2, and its lethal effect is related to binding to PBP 2 and 1B. This antibiotic is active against a wide range of gram-positive and gram-negative organisms and is stable in the presence of beta-lactamases. (NCI05)
Definition (NCI_NCI-GLOSS) An antibiotic drug used to treat severe or very resistant infection. It belongs to the family of drugs called carbapenems.
Definition (MSH) Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with CILASTATIN, a renal dipeptidase inhibitor.
Definition (PDQ) A broad-spectrum, semi-synthetic beta-lactam carbapenem derived from thienamycin, produced by Streptomyces cattleya. Imipenem binds to and inactivates penicillin-binding proteins (PBPs) located on the inner membrane of the bacterial cell wall. PBPs are enzymes that are involved in the last stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. This inactivation results in the weakening of the bacterial cell wall and eventually causes cell lysis. Imipenem has the greatest affinity for PBP 1A, 1B, and 2, and its lethal effect is related to binding to PBP 2 and 1B. This antibiotic is active against a wide range of gram-positive and gram-negative organisms and is stable in the presence of beta-lactamases. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42116&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42116&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C570" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D015378
SnomedCT 424285002, 46558003
LNC LP15795-5, MTHU007072
English Imipemide, Imipenem, N Formimidoylthienamycin, N-Formimidoylthienamycin, 1-Azabicyclo(3.2.0)hept-2-ene-2-carboxylic acid, 6-(1-hydroxyethyl)-3-((2-((iminomethyl)amino)ethyl)thio)-7-oxo-, (5R-(5alpha,6alpha(R*)))-, imipenem, Imipenem (product), FORMIMIDOYLTHIENAMYCIN N, Imipenem [Chemical/Ingredient], IMIPENEM, N-F-thienamycin, N-formimidoythienamycin, Imipenem (substance), imipemide
Swedish Imipenem
Spanish imipenem (producto), N-F-tienamicina, imipemida, imipenem (sustancia), imipenem, n-formimidoitienamicina, Imipemida, Imipenem, N-Formimidoiltienamicina
Czech imipenem
Finnish Imipeneemi
Russian N-FORMIMIDOILTIENAMITSIN, IMIPEMID, IMIPENEM, N-ФОРМИМИДОИЛТИЕНАМИЦИН, ИМИПЕМИД, ИМИПЕНЕМ
Japanese N-ホルムイミドイルチエナマイシン, イミペネム, イミペミド
French Imipénem
German FORMIMIDOYLTHIENAMYCIN N, Imipemid, Imipenem, N-Formimidoylthienamycin
Polish Imipenem
Italian Imipenem
Portuguese Imipemida, Imipenem, N-Formimidoiltienamicina

Ontology: Cilastatin / Imipenem (C0071972)

Concepts Organic Chemical (T109) , Antibiotic (T195)
MSH C044650
SnomedCT 323964004
LNC LP15812-8, MTHU008093
English CILASTATIN/IMIPENEM, Cilastatin + Imipenem, cilastatin, imipenem drug combination, imipenem-cilastatin, Cilastatin / Imipenem, imipenem - cilastatin, cilastatin imipenem, imipenem cilastatin, Imipenem+Cilastatin, Imipenem + cilastatin, Imipenem + cilastatin (product), Imipenem + cilastatin (substance)
Spanish imipenem+cilastatina (producto), imipenem+cilastatina