Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-29T16:39:39.672Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Pharmacology of Antibiotics: Review of Imipenem

Published online by Cambridge University Press:  02 January 2015

Mark Eggleston ,
Soon-young Park  and
Richard H. Parker
Mark Eggleston
Affiliation:
College of Pharmacy and Pharmacal Sciences, Howard University, Washington, D.C
Soon-young Park*
Affiliation:
College of Pharmacy and Pharmacal Sciences, Howard University, Washington, D.C
Richard H. Parker*
Affiliation:
College of Pharmacy and Pharmacal Sciences, Howard University, Washington, D.C
*
College of Medicine, Howard University, Washington, D.C. 20059
College of Medicine, Howard University, Washington, D.C. 20059
Get access Rights & Permissions [Opens in a new window]

Abstract

Imipenem, a new carbapenem ß-lactam broad-spectrum antibiotic, is highly active in vitro against most aerobic and anaerobic gram-positive and gram-negative bacteria isolated from infectious diseases of human beings. Except for enterococci and methicillin-resistant staphylococci most gram-positive cocci are inhibited by <2 μg/ml. Although the MIC-90 of methicillin-resistant staphylococci may be <4 μg/ml, these bacteria are usually resistant to imipenem by modified testing methods. The enterococcus, S. faecalis, has an MIC-90 of <8 μg/ml but bactericidal concentration may be much higher. Most Enterobacteriaceae are highly susceptible to imipenem with MIC-90 of 0.5 to 2.0 μg/ml. Proteus species are less susceptible with MICs of 4 to 8 μg/ml. Isolates of P. aeruginosa have variable susceptibility with MICs ranging from 0.25 to 16 μg/ml. Pseudomonas maltophilia and P. cepacia are usually resistant to imipenem. Except for Clostridium species, most strict anaerobes are susceptible to <1.0 μg/ml of imipenem. When combined with cilastatin (1:1 ratio), the renal elimination of the active form is increased. The serum half-life in normal renal function is about 1 hour and increases to 3.4 hours in anuria. Major adverse effects are similar to those of cephalosporins except for seizures in some patients. Colonization with fungi and drug-resistant bacteria occurs in about 5% of imipenem-treated patients. Clinical studies have demonstrated efficacy in 79% to 96% of patients treated.

Type
Special Sections
Information
Infection Control & Hospital Epidemiology , Volume 7 , Issue 6 , June 1986 , pp. 333 - 338
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kahan, FM, Kropp, H, Sundelof, FG, et al: Thienamycin development of imipenem-cilastatin. J Antimicrob Chemother 1983; 12:1–35.Google Scholar
2. Barza, M: Imipenem; First of a new class of activity of imipenem. Am J Med 1985; 78:22–32.Google Scholar
3. Norrby, SR: Imipenem/cilastatin: Rationale for a fixed combination. Rev Infect Dis 1985;7(Suppl 3):S447–S457.Google Scholar
4. Kropp, H, Gerckens, L, Sundelof, S, et al: Antibacterial activity of imipenem: The first thienamycin antibiotic. Rev Infect Dis 1985;7(Suppl 3):S389–S410.Google Scholar
5. Muytjens, HL, Van de Repe, J: Comparative activities of 13 beta-lactam antibiotics. Antimicrob Agents Chemother 1982; 21:925–934.Google Scholar
6. Neu, HC: The new beta-lactamase stable cephalosporins. Ann Intern Med 1982; 97:408–419.Google Scholar
7. Jones, RN: Review of the in vitro spectrum of activity of imipenem. Am J Med 1985; 78:22–32.Google Scholar
8. Braveny, I: In vitro activity of imipenem—A review. Eur J Clin Microbiol 1984; 3:456–462.Google Scholar
9. Neu, HC, Labtharikul, P: Comparative in vitro activity of N-formimidoyl thienamycin against gram-positive and gram-negative aerobic and anaerobic species and its beta-lactamase stability. Antimicrob Agents Chemother 1982; 21:180–187.Google Scholar
10. Blumethal, RM, Raeden, R, Takemoto, CD, et al: Occurrence and expression of imipemide (N-formimidoyl thienamycin) resistance in clinical isolates of coag-ulase-negative staphylococci. Antimicrob Agents Chemother 1983; 24:61–69.Google Scholar
11. Howard, JA, Hince, CJ: The activity of N-Formimidoyl Thienamycin (MK0787) against Haemophilus influenzae and Streptococcus pneumoniae . J Antimicrob Chemother 1982; 10:383–390.Google Scholar
12. Williams, JD: Activity of imipenem against Pseudomonas and Bacteroides species. Rev Infect Dis 1985; 7(Suppl 3):S411–S415.Google Scholar
13. Chau, PY, Ling, J, Ng, WS: Cefoperazone against carbenicillin-resistant isolates of Pseudomonas aeruginosa; Comparison with other newer cephalosporins and N-formimidoyl thienamycin. J Antimicrob Chemother 1983; 12:337–345.Google Scholar
14. Bustamante, CI, Drusno, GL, Tatem, BA, et al: Post-antibiotic effect of imipenem on Pseudomonas aeruginosa . Antimicrob Agents Chemother 1984; 26:678–682.Google Scholar
15. Wexler, HM, Finegold, SM: In vitro activity of imipenem against anaerobic bacteria. Rev Infect Dis 1985; 7(Suppl 3):S417–S425.CrossRefGoogle ScholarPubMed
16. Roger, JD, Mesinger, AP, Ferber, F, et al: Imipenem/cilastatin versus gentamicin/clindamycin for treatment of serious bacterial infections. Lancet 1984; 868–871.Google Scholar
17. Wang, C, Calandra, GB, Aziz, MA, et al: Efficacy and safety of imipenem/cilastatin: A review of worldwide clinical experience. Rev Infect Dis 1985; 7(Suppl 3):S528–S536.Google Scholar
18. Calandra, GB, Brown, KR, Grad, LC, et al: Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin. Am J Med 1985; 78(6A):73–78.Google Scholar
19. Shah, PM: Clinical experience in imipenem/cilastatin: Analysis of a multicenter study. Rev Infect Dù 1985; 7(Suppl 3):S471–S475.CrossRefGoogle ScholarPubMed
20. Trumbore, D, Pontzer, R, Levison, ME, et al: Multicenter study of the clinical efficacy of imipenem/cilastatin for treatment of serious infections. Rev Infect Dis 1985; 7(Suppl 3):S476–S481.Google Scholar
21. Schreiner, A, Olsen, T, Madsen, S, et al: Imipenem/Cilastatin versus gentamicin/clindamycin for treatment of serious bacterial infections. Lancet 1984; 868–871.Google Scholar
22. Eron, LJ, Hixon, DL, Park, CH, et al: Imipenem versus moxalactam in the treatment of serious infections. Antimicrob Agents Chemother 1983; 24:841–846.CrossRefGoogle ScholarPubMed
23. Heseltine, PNR, Yellin, AE, Appleman, MD, et al: Imipenem therapy for perforated and gangrenous appendicitis. Surg Gynecol Obstet 1986; 162:43–48.Google Scholar
24. Nielsen, DM, Katz, JR, AhLoy, RD, et al: Imipenem/cilastatin therapy for serious bacterial infections. Rev Infect Dis 1985; 7(Suppl 3):S506–S511.Google Scholar
25. Kagu, L, Nord, CE: Imipenem/cilastatin in the treatment of intra-abdominal infections: A review of worldwide experience. Rev Infect Dis 1985; 7(Suppl 3):S518–S521.Google Scholar
26. Brooks, RG, McCabe, RE, Vosti, KL, et al: Open trial of imipenem/cilastatin therapy for serious bacterial infections. Rev Infect Dis 1985; 7(Suppl 3):S496–S505.Google Scholar
27. Guerra, JG, Casalino, E, Palomino, JC, et al: Imipenem/cilastatin vs. gentamicin/clindamycin for the treatment of moderate to severe infections in hospitalized patients. Rev Infect Dis 1985; 7(Suppl 3):S463–S470.Google Scholar
28. Stamboulian, D, Arguello, EA, Jasovich, A, et al: Comparative clinical evaluation of imipenem/cilastatin vs cefotaxime in treatment of severe bacterial infections. Rev Infect Dis 1985; 7(Suppl 3):S458–S462.Google Scholar
29. Cox, CE, Corrado, ML: Safety and efficacy of imipenem/cilastatin in treatment of complicated urinary tract infections. Am J Med 1985; 78(6A):92–94.Google Scholar
30. Solomkin, JS, Fant, WK, Rivera, JO, et al: Randomized trial of imipenem/cilastatin versus gentamicin and clindamycin in mixed flora infections. Am J Med 1985; 78(6A):85–91.CrossRefGoogle ScholarPubMed