Imipenem belongs to the carbapenem class of antibiotics, acting through the inhibition of bacterial cell-wall synthesis by binding to
penicillin-binding proteins. It is co-administered IV with cilastatin, a renal dehydropeptidase inhibitor that reduces the renal metabolism of
imipenem. Imipenem has better Gram-positive activity coverage than meropenem. Carbapenems have one of the broadest antibacterial
spectra and should not be used to treat infections if a narrower spectrum antibiotic with a lower impact on antibacterial resistance is an option.
ANTIMICROBIAL SPEC TRUM
Gram-positive cocci: methicillin-susceptible Staphylococcus aureus
(penicillinase-producing), Staphylococcus epidermidis, enterococci, streptococci,
Streptococcus pneumoniae.
Gram-negative bacilli: Escherichia coli, Klebsiella spp., Morganella morganii, Proteus
vulgaris, Providencia rettgeri, Enterobacter spp., Serratia marcescens, Citrobacter spp.,
Acinetobacter spp, Pseudomonas aeruginosa (see comment below), Haemophilus
influenzae.
Anaerobes: Bacteroides spp., Clostridium spp., other than Clostridioides difficile and
Cutibacterium spp.
Other: Alcaligenes xylosoxidans, Gardnerella vaginalis, Nocardia spp., Rhodococcus
equi.
Imipenem has no or reduced activity against carbapenemase-producing Enterobacterales
(e.g., Klebsiella pneumoniae, Proteus spp., Enterobacter spp., Serratia marcescens). Due to
the risks of increasing daily dose (see adverse effects) and that the MIC of
Enterobacterales is usually higher than that of meropenem, the latter is
preferred in combination with another active drug (e.g., polymyxins) to
treat these infections. ROUTE
Additionally, Acinetobacter spp. and P. aeruginosa resistant to
carbapenems are increasing worldwide. IV
EXCRE TION
Approximately 70% excreted in urine unchanged.
MAIN INDICATIONS
May be used for the treatment of the following healthcare-associated infections:
Sepsis Intra-abdominal
Lower respiratory tract Bone and joint
Urinary tract Endocarditis
Skin and skin structure infections
A D U LT D O S E
Usual Dose: 500 mg q6h for most indications.
Reduced dose: 250 mg q6h for uncomplicated UTI.
RENAL IMPAIRMENT a,b,c,d
Caution advised if creatinine clearance less than 90 mL/minute.
SIDE EFFECTS
! Phlebitis (2-5%)
! Eosinophilia (4%)
! Transient increase in blood urea nitrogen (BUN) or serum
creatinine (<2%)
! Seizures (1.5%; significantly increases in patients with predisposing CNS
factors)
! Nausea, diarrhoea, vomiting (1-2%)
C AU T I O N S
Use with caution in CNS disorders (e.g., history of seizures); adjust
dosage in renal impairment to avoid risk of seizures.
M O N I TO R I N G PREGNANC Y
Monitor renal function. FDA Category Imipenem
D
crosses the
Observe for seizures in patients with any CNS disorder. placenta.
Present in milk
Observe for Clostridoides difficile-associated diarrhoea, but unlikely to
multi-drug resistant bacteria and fungal superinfection. be absorbed.
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The information (including but not limited to text, graphics, images and other materials) contained in this document are for informational
March 2023
purposes only. No material contained herein is intended to be a substitute for professional medical advice, diagnosis, treatment or national
/ local guidelines. Adherence to the information will not ensure successful treatment in every situation. The ultimate judgment regarding the
appropriateness of any specific therapy must be made by the physician in light of all the circumstances presented by the individual patient.
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