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Imipenem Cilastatin: Antibiotic Uses, Dosage, and Side Effects
Summary of Key Points
Imipenem/cilastatin is a powerful broad-spectrum antibiotic used to treat a range of serious bacterial infections, including pneumonia, urinary tract infections, and sepsis. It works by stopping bacterial growth and is commonly administered in hospital settings. Cilastatin helps prevent imipenem from being broken down in the kidneys, which enhances the medication’s effectiveness. Always consult your healthcare provider before starting or adjusting your imipenem/cilastatin dosage.
Names of Medication
US Brand Name: Primaxin
Generic Name: Imipenem/cilastatin
The generic name refers to the active ingredients in the medication and is listed in parentheses next to the brand name.
Pharmacologic Category
Category: Carbapenem Antibiotic
Dosing for Imipenem/Cilastatin
Imipenem/cilastatin is prescribed for various serious bacterial infections. The dosage depends on the type and severity of the infection. Always consult your doctor before adjusting your dose. You can also schedule a telemedicine appointment with one of our providers for personalized advice on imipenem/cilastatin dosage.
Pneumonia
Dose: 500 mg to 1 g every 6 to 8 hours
Duration: 7 to 14 days, depending on severity
Urinary Tract Infections (UTIs)
Dose: 500 mg every 6 hours
Duration: 7 to 10 days
Intra-abdominal Infections
Dose: 500 mg to 1 g every 6 to 8 hours
Duration: 5 to 14 days
Skin and Soft Tissue Infections
Dose: 500 mg every 6 to 8 hours
Duration: 7 to 14 days
Bacteremia
Dose: 500 mg to 1 g every 6 to 8 hours
Duration: 7 to 14 days
Meningitis
Dose: 1 g every 6 hours
Duration: 10 to 14 days
Endocarditis
Dose: 500 mg to 1 g every 6 to 8 hours
Duration: 4 to 6 weeks
Bone and Joint Infections
Dose: 500 mg to 1 g every 6 to 8 hours
Duration: 4 to 6 weeks
Sepsis
Dose: 500 mg to 1 g every 6 to 8 hours
Duration: 7 to 14 days
Gynecological Infections
Dose: 500 mg every 6 to 8 hours
Duration: 7 to 14 days
Dosage Forms and Strengths
Imipenem/cilastatin is available in the following forms:
- Injection: 250 mg/250 mg (imipenem/cilastatin)
- Injection: 500 mg/500 mg (imipenem/cilastatin)
Administration Instructions for Imipenem/Cilastatin
Imipenem/cilastatin is typically administered as an intravenous (IV) infusion in a hospital or clinical setting. The infusion is given slowly over 20 to 60 minutes, depending on the dose. It is essential to complete the full course of treatment, even if you start feeling better, to ensure the infection is fully treated. If you have any concerns about your treatment, consult one of our telemedicine providers for guidance.
Adverse Reactions and Side Effects of Imipenem/Cilastatin
Like all broad-spectrum antibiotics, imipenem/cilastatin may cause side effects. Some are common, while others are less frequent but more serious. Contact your healthcare provider if you experience any side effects.
Common side effects: Nausea, vomiting, diarrhea, and rash. These are usually mild and tend to resolve on their own.
Less common but serious side effects: Seizures, allergic reactions, liver issues, and kidney problems. Seek medical attention if you experience any of these symptoms.
Contraindications for Imipenem/Cilastatin
A contraindication is a specific condition where a treatment or medication should not be used due to potential harm. For imipenem/cilastatin, several contraindications should be considered before starting treatment:
- Allergy to Imipenem, Cilastatin, or other Beta-lactam antibiotics: If you are allergic to beta-lactam antibiotics (e.g., penicillins or cephalosporins), taking imipenem/cilastatin could trigger a severe allergic reaction, including life-threatening anaphylaxis.
- Severe Renal Impairment (without hemodialysis): Imipenem/cilastatin is primarily eliminated through the kidneys. In patients with severe kidney disease not on dialysis, the drug may accumulate, leading to toxicity.
- Seizure Disorders: Imipenem/cilastatin can increase the risk of seizures, especially in patients with a history of seizures or those on medications that lower the seizure threshold.
Drug-to-Drug Interactions with Imipenem/Cilastatin
Imipenem/cilastatin can interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. Notable interactions include:
- Valproic Acid (Depakote): Imipenem/cilastatin can lower valproic acid levels, reducing its effectiveness in controlling seizures.
- Ganciclovir (Cytovene): Using ganciclovir with imipenem/cilastatin may increase the risk of seizures.
- Probenecid: Probenecid can raise imipenem/cilastatin levels, potentially leading to toxicity.
- Cyclosporine (Neoral, Sandimmune): Taking cyclosporine with imipenem/cilastatin may heighten the risk of seizures.
Imipenem/Cilastatin in Pregnancy
Is it safe to take Imipenem/Cilastatin when pregnant?
Imipenem/cilastatin is classified as a Pregnancy Category C drug by the FDA. This means that while there are no well-controlled studies in pregnant women, animal studies have shown potential risks to the fetus. The medication should only be used during pregnancy if the potential benefits outweigh the risks. If you are pregnant or planning to become pregnant, it is crucial to discuss this with your healthcare provider before starting imipenem/cilastatin. Our telemedicine providers are available to help you carefully weigh the risks and benefits based on your individual circumstances.
Imipenem/Cilastatin While Breastfeeding
Is it safe to take Imipenem/Cilastatin while breastfeeding?
Imipenem/cilastatin is excreted in small amounts into breast milk. Although the effects on a nursing infant are not well studied, there is a potential risk for side effects such as diarrhea, yeast infections, or allergic reactions in the baby. If you are breastfeeding, it is important to consult your healthcare provider to assess the potential risks and benefits. You may need to explore alternative treatments or consider temporarily stopping breastfeeding while taking this medication.
Estimated Cost of Imipenem/Cilastatin
The estimated cost of a 30-day supply of Imipenem/Cilastatin without insurance can vary. However, with a GoodRX coupon, the price typically ranges from $300 to $500 for a standard dose. Prices may fluctuate depending on your location and the pharmacy you use. Be sure to check with your pharmacy for the most current pricing information.
Possible Alternatives to Imipenem/Cilastatin
If imipenem/cilastatin is not suitable for you, there are alternative treatments or lifestyle changes that may help manage your condition. Always discuss these alternatives with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these options.
Alternatives for Pneumonia
Other broad-spectrum antibiotics, such as azithromycin (Zithromax) or levofloxacin (Levaquin), may be considered. Lifestyle changes, including quitting smoking and getting vaccinated against pneumonia, can also help prevent future infections.
Alternatives for Urinary Tract Infections (UTIs)
Common alternatives include antibiotics like nitrofurantoin (Macrobid) or trimethoprim-sulfamethoxazole (Bactrim). Staying well-hydrated and practicing good hygiene can help prevent recurrent UTIs.
Alternatives for Intra-abdominal Infections
Other antibiotics, such as piperacillin/tazobactam (Zosyn) or metronidazole (Flagyl), may be used. Maintaining a healthy diet and managing underlying conditions like diabetes can reduce the risk of these infections.
Alternatives for Skin and Soft Tissue Infections
Alternatives include clindamycin (Cleocin) or doxycycline. Proper wound care and hygiene are essential for preventing skin infections.
Alternatives for Bacteremia
Treatment depends on the underlying cause, but alternatives may include vancomycin or ceftriaxone (Rocephin). Prompt treatment of infections and maintaining a healthy immune system can help prevent bacteremia.
Alternatives for Meningitis
Depending on the cause, ceftriaxone or vancomycin may be used as alternatives. Vaccination and avoiding close contact with infected individuals can reduce the risk of meningitis.
Alternatives for Endocarditis
Alternatives include vancomycin or daptomycin (Cubicin). Good dental hygiene and prompt treatment of infections can help prevent endocarditis.
Alternatives for Bone and Joint Infections
Treatment may include antibiotics like clindamycin or vancomycin. Maintaining good bone health through diet and exercise can help reduce the risk of these infections.
Alternatives for Sepsis
Alternatives depend on the source of infection but may include broad-spectrum antibiotics like piperacillin/tazobactam or vancomycin. Early detection and treatment of infections are key to preventing sepsis.
Alternatives for Gynecological Infections
Alternatives include metronidazole or clindamycin. Practicing safe sex and maintaining good hygiene can help prevent these infections.
Recent Updates on Imipenem/Cilastatin Research
Recent research on Imipenem/Cilastatin has focused on its use in treating multidrug-resistant infections. Studies show that imipenem/cilastatin remains effective against many resistant bacteria, making it a valuable option for treating severe infections. Ongoing research is exploring combination therapies to enhance its effectiveness and reduce the risk of resistance. Additionally, newer formulations, such as imipenem/cilastatin/relebactam (Recarbrio), are being studied for their ability to treat highly resistant infections. If you have concerns about antibiotic resistance or want to learn more about the latest treatment options, our telemedicine providers are available to discuss your care plan.
