imipenem

Imipenem is a beta-lactam type antibiotic drug belonging to the carbapenem class.

Imipenem - Chemical Structure

It is important to know that imipenem is never administered alone, but is marketed in pharmaceutical formulations in which it is found in association with cilastatin .

Cilastatin is an inhibitor of dehydropeptidase-1, an enzyme capable of hydrolyzing the beta-lactam ring contained in the chemical structure of imipenem, thus preventing it from carrying out its antibiotic activity. Therefore, the task of cilastatin is to "protect" the imipenem from the possible degradation by the aforementioned enzyme.

Indications

For what it uses

Imipenem is used to treat infections caused by microorganisms sensitive to it.

In particular, the imipenem is indicated in the treatment of:

Complicated intra-abdominal infections;
Pneumonia;
Complicated urinary tract infections;
Complicated skin and soft tissue infections;
Infections that women can encounter before, or after, childbirth.

Warnings

Before starting treatment with imipenem it is necessary to inform your doctor if you are in one of the following conditions:

If you are allergic to other types of antibiotics or any other type of medicine;
If you suffer from colitis or other gastrointestinal diseases;
If you suffer from any central nervous system disorder, including localized tremors and seizures;
If you are on valproic acid (a drug used to treat epilepsy);
If you have liver, kidney and / or urinary tract disorders.

Imipenem could alter the results of the Coombs test causing false positives.

Imipenem should not be used in children under one year of age or in children with kidney disease.

Imipenem can cause an aggravation of myasthenia gravis (a neuromuscular disease) in patients who have it.

Imipenem can cause side effects that can alter the ability to drive and / or use machinery, so great care should be taken.

Interactions

Concomitant intake of ganciclovir (an antiviral drug) and imipenem may increase the risk of seizures.

Due to the possible interactions that may occur, it is necessary to inform your doctor if you are taking valproic acid or oral anticoagulants, such as, for example, warfarin .

In any case, you must tell your doctor if you are taking - or have recently been taken - drugs of any kind, including non-prescription medicines and homeopathic and / or herbal products.

Side effects

Imipenem can induce various types of side effects, although not all patients experience them. This is due to the different sensitivity that each person has towards the drug. Therefore, it is not said that the adverse effects occur all with the same intensity in each individual.

Below are the main side effects that may occur during imipenem therapy.

Allergic reactions

Like any other drug, imipenem can also trigger allergic reactions in sensitive individuals. These reactions can occur with symptoms such as:

Skin eruptions;
Swelling of the face, lips, tongue and / or throat with consequent difficulty in breathing and swallowing;
Hypotension.

In the event of any type of allergic reaction, treatment with imipenem should be stopped immediately and adequate treatment should be performed.

Skin and subcutaneous tissue disorders

Imipenem therapy can cause skin rashes, local redness, itching, hives, cyanosis and increased sweating that becomes excessive.

Furthermore, more severe skin reactions may also occur requiring immediate interruption of treatment with imipenem; these reactions are toxic epidermal necrolysis, Stevens-Johnson syndrome and exfoliative dermatitis.

Gastrointestinal disorders

Imipenem treatment can cause:

Nausea and vomit;
Diarrhea;
Inflammation of the colon accompanied by severe diarrhea;
Hemorrhagic colitis;
gastroenteritis;
Stomach pain.

Nervous system disorders

Imipenem therapy can cause:

Headache;
dizziness;
Dizziness;
Drowsiness;
Weakness;
Tingling and localized tremors;
Uncontrolled muscle tremors and spasms;
Seizures.

Psychiatric disorders

Imipenem treatment can cause mental confusion, hallucinations, mood changes and impaired judgment.

Hepatobiliary disorders

Imipenem therapy can cause various liver disorders, including changes in liver function and fulminant hepatitis.

Lung and respiratory tract disorders

Imipenem treatment can cause chest pain, difficulty breathing, abnormally rapid breathing and sore throat.

Kidney and urinary tract disorders

Imipenem therapy can cause changes in renal function and changes in the amount and color of excreted urine.

Blood and lymphatic system disorders

Treatment with imipenem can cause disorders of the blood and lymphatic system (ie the system used to produce blood cells). Such disturbances can cause:

Eosinophilia, ie an increase in the blood concentration of eosinophils.
Anemia;
Plateletopenia (ie the decrease in the number of platelets in the bloodstream), with a consequent increase in the risk of bleeding;
Leukopenia, ie the reduction in the number of leukocytes in the bloodstream;

Fungal infections

Imipenem therapy may favor the appearance of fungal infections. More precisely, the drug can promote the onset of candidiasis.

Ear disorders

Imipenem treatment can cause:

Hearing loss;
Tinnitus, that is an auditory disorder characterized by the perception of buzzing, whistling, rustling, tinkling, etc.

Cardiovascular disorders

Imipenem therapy can cause hypotension, arrhythmias and strong or accelerated heartbeats.

Other side effects

Other side effects that may occur during treatment with imipenem are:

Swelling and redness along the vein in which the drug was administered;
Local pain and hardening at the injection site;
Temperature;
Chromatic changes in teeth and / or tongue;
Tongue red and swollen;
Alterations in the sense of taste;
arthralgia;
Vulvar itching in women;
Worsening of myasthenia gravis in patients with this condition.

Action mechanism

Imipenem works by interfering with the synthesis of the bacterial cell wall, the peptidoglycan.

Peptidoglycan is a polymer made up of parallel chains of nitrogenated carbohydrates, joined together by transverse bonds between amino acid residues.

These bonds are formed thanks to the action of enzymes belonging to the peptidase family.

Imipenem binds to some of these peptidases, preventing the formation of the above transverse bonds. In doing so, weak areas are created inside the peptidoglycan that lead to the lysis of the bacterial cell and, consequently, to its death.

Mode of Use - Posology

Imipenem is available for intravenous administration in the form of a powder that must be dissolved in a special solvent just before its use.

Imipenem is given as an intravenous infusion by a doctor or nurse.

Following are some indications on doses of imipenem that are usually administered.

In patients with kidney disease, the doctor may decide to decrease the usual dose of medication.

Adults and adolescents

The dose of imipenem usually administered is 500-1000 mg of antibiotic every 6-8 hours.

In patients with a body weight of less than 70 kg, the doctor may decide to administer a lower dose of the drug.

children

In children aged one year or more, the dose of imipenem usually used is 15-25 mg / kg of body weight every six hours.

Pregnancy and breastfeeding

Since there are no studies able to demonstrate the safety in use of imipenem by pregnant women, the drug should be used by pregnant women only if the doctor considers it absolutely essential and only after a careful evaluation of the relationship between the expected benefits for the mother and the potential risks to the fetus.

Imipenem is excreted in breast milk and may cause harm to the baby, therefore, before taking the antibiotic, mothers who are breast-feeding should seek medical advice.

Contraindications

The use of imipenem is contraindicated in the following cases:

In patients with hypersensitivity known to the same imipenem;
In patients with known hypersensitivity to cilastatin;
In patients with known hypersensitivity to other beta-lactam antibiotics, such as penicillins, cephalosporins or monobactams;
In children under one year of age;
In children with kidney disease.