Uses of Imbac: - Severe bacterial infections Cystic fibrosis, Bacterial septicemia, Endocarditis, Susceptible infections, Lower Respiratory Tract Infections, Gonorrhea, Skin and skin structure infections, Urinary tract infections, Bone and Joint Infections, Surgical Prophylaxis Hypersensitivity.

Other beta-lactam Antibiotics

Imipenem acts as an antimicrobial through the inhibition of cell wall synthesis of various gram-positive and gram-negative bacteria. This inhibition of cell wall synthesis in gram-negative bateria is attained by binding to pencillin binding proteins (PBPs). In E. coli and selected strains of P. aeruginosa, imipenem has shown to have the highest affinity to PBP-2, PBP-1a, and PBP-1b. This preferential binding to PBP-2 and PBP-1b results in the direct conversion of the individual cell to a spheroblast, which leads to rapid cell lysis and death without filament formation.Cilastatin is a specific and reversible renal dehydropeptidase-I inhibitor. Since the antibiotic, imipenem, is hydrolyzed by dehydropeptidase-I, which resides in the brush border of the renal tubule, cilastatin is administered with imipenem to block the metabolism and thus the inactivation of imipenem so that antibacterial levels of imipenem can be attained in the urine. The drug also prevents the metabolism of leukotriene D4 to leukotriene E4 through the inhibition of leukotriene D4 dipeptidase.

How to use Imipenem + Cilastatin: Your doctor or nurse will give you this medicine. Kindly do not self administer. Administration: IV Preparation Reconstitute infusion bottles with 100 mL of compatible diluent Reconstitute vials with a portion (usually 10 mL) of IV fluid withdawn from the IV container, dissolve, and return to container; repeat Reconstituted solutions are stable for 4 hours at room temperature and 24 hours refrigerated (4 C) in NS Normal color ranges from clear to yellow; these variations do not affect potency, but solution should be discarded if brown IV Administration Do not administer by IV push Final concentration should not exceed 5 mg/mL Infuse <500 mg over 20-30 minutes (15-30 minutes in children); infuse >500 mg over 40-60 min Vial contents must be transferred to 100 mL of infusion solution Adult Dose: Lower Respiratory Tract, Skin/Skin Structure, & Gynecologic Infections Mild to moderate: 500-750 mg IV q12hr Intra-abdominal Infections Mild to moderate: 250-500 mg IV q6hr Severe: 500 mg IV q6hr or 1 g q8hr for 4-7 days, provided that infection is brought under control Pseudomonas Infections 500 mg IV q6hr; higher dosages may be administered, depending on organism sensitivity Urinary Tract Infections Uncomplicated: 250 mg IV q6hr Complicated: 500 mg IV q6hr Susceptible infections Moderate infections IV: Fully susceptible organisms: 500 mg IV q6-8hr Moderately susceptible organisms: 500 mg IV q6hr or 1 g IV q8hr Severe infections Fully susceptible organisms: 500 mg IV q6hr Moderately susceptible organisms: 1 g IV q6-8hr; not to exceed 50 mg/kg/day or 4 g/day, whichever is lower Child Dose: Child: IV, IM 60–100 mg/kg/day q6h IM form not approved for <12 y Renal Dose: Renal impairment: CrCl (ml/min) 31-70 500 mg every 6-8 hr 21-30 500 mg every 8-12 hr 6-20 250 mg or 3.5 mg/kg (whichever is lower) every 12 hr <5 Only give if haemodialysis started within 48 hr

Concurrent admin with probenecid may increase the half-life of cilastatin. Increased risk of generalised seizures when used concurrently with ganciclovir.

Hypersensitivity.

Common - Nausea - Vomiting - Diarrhea - Rash 1-10% Phlebitis (2-5%),Eosinophilia (4%),Miscellaneous dermatologic effects (<3%),Potentially false-positive Coombs test (2%),Miscellaneous hematologic effects (<2%),Transient increase in blood urea nitrogen (BUN) or serum creatinine (<2%),Seizures (1.5%),Nausea, diarrhea, vomiting (1-2%) <1% Abnormal urinalysis,Agitation,Anaphylaxis,Anemia,Confusion (acute),Dizziness,Dyskinesia,Emergence of resistant strains of Pseudomonas aeruginosa,Fever,Hypersensitivity,Hypotension,Elevated liver function test (LFT) results,Increased prothrombin time (PT),Neutropenia (including agranulocytosis),Palpitations,Pruritus,Pseudomembranous colitis Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis.

Pregnancy: Category C. There are no adequate and well controlled studies in pregnant women. Cispenam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.Lactation: Imipenem has been detected in human milk. If the use of Cispenam is deemed essential, the patient should stop nursing.

Precaution: Caution when used in patients with known hypersensitivity to other beta-lactams due to possibility of cross-sensitivity. CNS disorders such as epilepsy; renal, hepatic impairment; pregnancy, lactation. Lactation: Drug distributed in breast milk; use with caution

In the case of overdosage, discontinue Imipenem/Cilastatin, treat symptomatically, and institute supportive measures as required. Imipenem/Cilastatin Sodium is hemodialyzable.

Store at or below 25° C temperature. Keep away from light and wet place. Keep out of reach of children.

Other beta-lactam Antibiotics

Imipenem is a potent inhibitor of bacterial cell wall synthesis and is bactericidal against a broad spectrum of pathogens. It is resistant to degradation by bacterial beta-lactamases. Cilastatin is an inhibitor of dehydropeptidase I, an enzyme found in the brush border of the renal tubules. It is given as the sodium salt with imipenem to prevent its renal metabolism and protect against nephrotoxic effects.

Pregnancy Category C. There are no adequate and well-controlled studies of this combination in pregnant women. This combination should be used during pregnancy only if the potential benefit justifies the potential risk to the mother and fetus. It is not known whether Imipenem-Cilastatin sodium is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when this combination is administered to a nursing woman.