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Safety of imipenem/cilastatin in neurocritical care patients

Jason Hoffman1, Jason Trimble, Gretchen M Brophy

  • 1Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA.

Neurocritical Care
|January 1, 2009
PubMed
Abstract

Insights

Imipenem/cilastatin can be safely used for serious infections in neurocritical care patients when dosed correctly. While seizures are a risk with carbapenems, imipenem/cilastatin has a low risk in this population.

Area of Science:

  • Infectious Diseases
  • Neurocritical Care
  • Pharmacology

Background:

  • Intensive care unit (ICU) infections necessitate broad-spectrum antibiotics.
  • Imipenem/cilastatin, a potent antibiotic, is associated with a potential increased risk of seizures compared to other penicillins and carbapenems.
  • Neurocritical care patients with CNS disorders or injuries often require aggressive infection management.

Purpose of the Study:

  • To evaluate the safety of imipenem/cilastatin in treating infections, including meningitis, within neurocritical care settings.
  • To assess the risk of seizures associated with imipenem/cilastatin use in this vulnerable patient population.

Main Methods:

  • A comprehensive literature review was conducted using MEDLINE.
  • Search terms included imipenem, seizure, carbapenem, and meropenem.
  • The review synthesized findings on carbapenem antibiotic use and associated adverse events.

Main Results:

  • Carbapenems are effective against a wide range of pathogens and frequently used in critically ill patients.
  • Seizures are a rare but serious adverse effect linked to carbapenems.
  • Seizure rates for imipenem/cilastatin and meropenem are comparable, with risk factors including low body weight, advanced age, and renal impairment.

Conclusions:

  • Appropriate dosing of imipenem/cilastatin allows for safe use in critically ill patients with CNS conditions, with minimal seizure risk.
  • While generally safe, specific safety data for imipenem/cilastatin in meningitis is limited, warranting cautious administration.

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