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Imipenem + Cilastatin: Brands, Price & Uses in Bangladesh
Imipenem + Cilastatin is a broad-spectrum carbapenem antibiotic combination indicated for the treatment of serious bacterial infections caused by susceptible organisms and more.
About Imipenem + Cilastatin
Indications of Imipenem + Cilastatin
Imipenem + Cilastatin is a broad-spectrum carbapenem antibiotic combination indicated for the treatment of serious bacterial infections caused by susceptible organisms, particularly when multi-drug-resistant or polymicrobial pathogens are suspected or confirmed. Because of its broad spectrum and role as a reserve/last-line agent, it is generally used for moderate to severe infections rather than as first-line therapy for mild infections.
Established / FDA-approved uses
- Lower respiratory tract infections (including pneumonia)
- Complicated and uncomplicated urinary tract infections
- Intra-abdominal infections
- Gynecologic infections (e.g., endometritis, pelvic inflammatory disease)
- Bacterial septicemia (bloodstream infections)
- Bone and joint infections
- Skin and skin-structure infections
- Endocarditis caused by susceptible organisms
- Polymicrobial infections involving both aerobic and anaerobic organisms
Guideline-supported / adjunct use
- Empiric therapy in febrile neutropenic patients, generally as part of an institutional protocol and sometimes combined with other antimicrobials depending on local resistance patterns.
Note: Imipenem + Cilastatin is not recommended for the treatment of meningitis because of an increased risk of seizures with poor central nervous system tolerability, and it should be reserved for infections where susceptibility testing supports its use whenever possible, consistent with antimicrobial stewardship principles.
Dosage & Administration of Imipenem + Cilastatin
Imipenem + Cilastatin is given only by intravenous infusion under medical supervision; dosing is individualized based on the severity and site of infection, the susceptibility of the causative organism, and renal function. The table below summarizes typical adult dosing by infection type (based on imipenem content); actual dose selection and duration must be determined by the treating physician.
| Infection severity/type | Typical adult dose (IV) | Frequency |
|---|---|---|
| Mild infections | 250-500 mg | Every 6-8 hours |
| Moderate infections | 500 mg-1 g | Every 6-8 hours |
| Severe/life-threatening infections | Up to 1 g | Every 6-8 hours (not to exceed the maximum recommended daily dose) |
The total daily dose should generally not exceed 50 mg/kg/day or 4 g/day (based on imipenem), whichever is lower, except in select severe infections where higher doses may be used under close specialist supervision. Each dose is infused intravenously over 20 to 60 minutes depending on the dose administered; it must not be given as a rapid intravenous bolus.
Renal impairment
Dose and/or dosing interval must be reduced according to creatinine clearance, following an established renal dosing nomogram; Imipenem + Cilastatin should not be used in patients with severe renal impairment (very low creatinine clearance) who are not receiving hemodialysis within the recommended timeframe, because of an increased risk of seizures from drug accumulation.
Antibiotic stewardship
Take exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice. Completing the full prescribed course, even if symptoms improve early, helps prevent treatment failure and antibiotic resistance.
Side Effects of Imipenem + Cilastatin
Common and important adverse effects reported with Imipenem + Cilastatin include:
- Gastrointestinal: nausea, vomiting, diarrhea (including the possibility of Clostridioides difficile-associated diarrhea/colitis)
- Local reactions: pain, erythema, and phlebitis/thrombophlebitis at the injection site
- Skin: rash, pruritus, urticaria
- Hypersensitivity reactions, including rare anaphylaxis (see Contraindications)
- Central nervous system: seizures, myoclonic activity, confusion, dizziness, particularly at higher doses, in patients with CNS disorders, or with renal impairment and inadequate dose adjustment (see Precautions and Warnings)
- Laboratory abnormalities: elevated liver transaminases, eosinophilia, changes in blood counts
- Fever
Patients should seek prompt medical attention for signs of a severe allergic reaction, seizures, or severe/persistent diarrhea.
Contraindications of Imipenem + Cilastatin
Imipenem + Cilastatin is contraindicated in patients with a known history of hypersensitivity (e.g., anaphylaxis, severe skin reactions) to imipenem, cilastatin, or any component of the formulation. Because of known cross-reactivity within beta-lactam antibiotics, Imipenem + Cilastatin should also be avoided in patients with a documented severe hypersensitivity reaction to other beta-lactam antibiotics, including penicillins and cephalosporins.
Frequently Asked Questions about Imipenem + Cilastatin
What is Imipenem + Cilastatin used for?
Imipenem + Cilastatin is a broad-spectrum antibiotic combination used to treat serious bacterial infections such as pneumonia, complicated urinary tract infections, intra-abdominal infections, skin and soft tissue infections, bone and joint infections, and bloodstream infections caused by susceptible bacteria, especially when the infection is severe, resistant, or involves multiple types of bacteria.
How is Imipenem + Cilastatin given?
Imipenem + Cilastatin is given only as an intravenous (IV) infusion in a hospital or clinical setting under medical supervision, usually every 6 to 8 hours, with the dose and infusion time depending on the severity of infection and the patient's kidney function. It is not taken by mouth.
Can Imipenem + Cilastatin cause seizures?
Yes. Imipenem + Cilastatin carries a well-documented risk of seizures, which is higher with higher doses, in patients with existing seizure disorders or other central nervous system problems, and in patients with kidney impairment whose dose has not been properly reduced. Report any unusual movements, confusion, or seizure activity to your doctor immediately.
Is it safe to use Imipenem + Cilastatin with valproic acid?
No, this combination should generally be avoided. Imipenem + Cilastatin can significantly lower valproic acid blood levels, which may cause loss of seizure control and breakthrough seizures in patients being treated with valproic acid. Tell your doctor if you are taking valproic acid or divalproex before starting Imipenem + Cilastatin, so an alternative can be considered or levels can be closely monitored.
Can Imipenem + Cilastatin be used during pregnancy or breastfeeding?
Imipenem + Cilastatin should be used during pregnancy only if clearly needed, when the benefit of treating a serious infection outweighs the potential risk to the baby, and only under a physician's guidance. It passes into breast milk in small amounts, so breastfeeding mothers should consult their physician, who will weigh the benefits of treatment against possible effects on the nursing infant.
What should I tell my doctor before starting Imipenem + Cilastatin?
Tell your doctor about any allergies to penicillins, cephalosporins, or other antibiotics, any history of seizures or other neurological conditions, your kidney function status, and all medications you are taking, especially valproic acid, divalproex, ganciclovir, or probenecid, since these interact with Imipenem + Cilastatin.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.