subject: Imipenem And Cilastatin Sodium [print this page] INDICATIONS & DOSAGE INDICATIONS & DOSAGE
Serious infections of the lower respiratory and urinary tracts, intra-abdominal and gynecologic infections, bacterial septicemia, bone and joint infections, skin and softtissue infections, and endocarditis. Most known microorganisms are susceptible: Acinetobacter, Enterococcus, Staphylococcus, Streptococcus, Escherichia coli, Haemophilus, Klebsiella, Morganella, Proteus, Enterobacter, Pseudomonas aeruginosa, and Bacteroides, including B. fragilis-
Adults weighing over 70 kg (154 lb): 250 mg to 1 g by I.V. infusion q 6 to 8 hours. Maximum daily dose is 50 mg/ kg/day or 4 g/day, whichever is less. Or,
500 to 750 mg LM. q 12 hours. Maximum daily dose is 1,500 mg.
Dosage adjustment:
For children over age 12, patients under 70 kg, and those who are renally impaired, refer to package insert for dosage adjustments based on weight, creatinine clearance, and severity of infection.
Beta-lactam antibiotics: possible in vitro antagonism. Avoid concomitant use. Ganciclovir: may cause seizures. Avoid concomitant use.
Probenecid: increased serum levels of cilastatin. Avoid concomitant use.
EFFECTS ON DIAGNOSTIC TESTS
Drug may interfere with glucose determination by Benedict's solution or Clinitest.
CONTRAINDICATIONS
Contraindicated in patients with hypersensitivity to drug.
SPECIAL CONSIDERATIONS
Use cautiously in patients allergic to penicillins or cephalosporins because drug has similar properties.
Also, use cautiously in patients with history of seizure disorders, especially if they also have compromised renal function.
Use with caution in children under age 3 months.
Culture and sensitivity tests should be obtained before giving first dose. Therapy may begin pending results.
Dosage adjustment is necessary for patients with a creatinine clearance below 70 ml/minute. Renal function tests must be monitored.
Alert: Drug should be discontinued if seizures develop and persist despite anticonvulsant therapy.
Patient should be monitored for bacterial or fungal superinfections and resistant infections during and after therapy.
I.V. administration
The drug must not be administered by direct I.V. bolus injection. Each 250- or 500-mg dose should be given by I.V. infusion over 20 to 30 minutes. Each 1-g dose should be infused over 40 to 60 minutes. If nausea occurs, the infusion may be slowed.
When reconstituting powder, shake until the solution is clear. Solutions may range from colorless to yellow; variations of color within this range don't affect drug's potency. After reconstitution, solution is stable for 10 hours at room temperature and for 48 hours when refrigerated.
Patient teaching
Report adverse reactions promptly.
Alert health care provider if discomfort occurs at I.V. insertion site.
Notify health care provider if loose stool or diarrhea occurs.
