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Imipenem
1Division of Infectious Diseases and Internal Medicine, Mayo Clinic Jacksonville, Florida.
Abstract:
Imipenem is the first of a new class of beta-lactam antibiotics, the carbapenems, to be released for clinical use. It has the broadest antibacterial activity of all antibiotics available for systemic use in humans. It is active against streptococci, methicillin-sensitive staphylococci, Neisseria, Haemophilus, anaerobes, and the common aerobic gram-negative nosocomial pathogens including Pseudomonas. Resistance to imipenem may emerge during treatment of P. aeruginosa infections, as has occurred with other beta-lactam agents; P. maltophilia and P. cepacia are typically resistant to it. Like the penicillins, imipenem has inhibitory activity against enterococci. Daily doses may range from 500 mg to 1 g, every 6 to 8 hours, in patients with normal renal function. The principal toxic effects have been nausea and vomiting, which occur during intravenous infusion, and seizures, which develop in 1 to 3% of treated patients and are likely to occur in the setting of renal insufficiency and underlying disease of the central nervous system. Imipenem should be considered for treatment of mixed bacterial infections and treatment of resistant aerobic gram-negative bacteria that are not susceptible to other beta-lactam agents. In addition to provoking unnecessary toxicity, indiscriminate use of this agent will promote dissemination of resistance against it.
Insights
Imipenem, a novel carbapenem antibiotic, offers broad-spectrum activity against many bacteria, including difficult-to-treat gram-negative pathogens. Careful use is advised to prevent resistance and manage potential side effects like seizures.
Area of Science:
- Pharmacology
- Microbiology
- Infectious Diseases
Background:
- Imipenem represents the first carbapenem antibiotic, a new class of beta-lactam antimicrobials.
- It exhibits the broadest spectrum of antibacterial activity among systemically available antibiotics for human use.
Purpose of the Study:
- To review the clinical profile of imipenem, including its antibacterial spectrum, dosing, and toxicity.
- To provide guidance on appropriate use in treating specific bacterial infections.
Main Methods:
- Review of existing literature on imipenem's pharmacological and clinical properties.
- Analysis of its activity against various bacterial pathogens, including common nosocomial isolates.
Main Results:
- Imipenem is active against streptococci, methicillin-sensitive staphylococci, Neisseria, Haemophilus, anaerobes, and aerobic gram-negative pathogens like Pseudomonas.
- Resistance can emerge during P. aeruginosa treatment; P. maltophilia and P. cepacia are typically resistant.
- It also shows inhibitory activity against enterococci, similar to penicillins.
Conclusions:
- Imipenem is indicated for mixed bacterial infections and infections caused by resistant aerobic gram-negative bacteria unresponsive to other beta-lactams.
- Judicious use is crucial to avoid unnecessary toxicity and prevent the spread of imipenem resistance.
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