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[Pharmacokinetics and clinical evaluation of imipenem/cilastatin sodium in pediatric surgery]
Insights
Pharmacokinetic and clinical data show imipenem/cilastatin sodium (IPM/CS) is safe and effective for pediatric surgery. This antibiotic demonstrated good outcomes in neonates and infants, with no adverse reactions observed.
Area of Science:
- Pharmacology
- Pediatric Surgery
- Infectious Diseases
Context:
- Pediatric surgical patients often require antibiotic therapy.
- Imipenem/cilastatin sodium (IPM/CS) is a broad-spectrum antibiotic.
- Limited pharmacokinetic data exists for IPM/CS in neonates and infants.
Purpose:
- To evaluate the pharmacokinetics and clinical efficacy of imipenem/cilastatin sodium (IPM/CS) in pediatric surgical patients.
- To assess plasma, urinary, and bile levels of IPM/CS.
- To determine the safety and effectiveness of IPM/CS for infection prophylaxis and treatment in pediatric surgery.
Summary:
- Pharmacokinetic studies in neonates showed rapid absorption and elimination of IPM/CS, with dose-dependent plasma levels and predictable urinary recovery.
- Bile concentrations of IPM/CS were measurable, suggesting potential utility in biliary tract infections.
- Clinical use for prophylaxis prevented postoperative infections, and treatment of cholangitis resulted in good clinical outcomes and bacterial eradication without adverse events.
Impact:
- IPM/CS is confirmed as an effective and safe antibiotic option for pediatric surgical patients.
- The findings support the use of IPM/CS in neonates and infants, guiding appropriate dosing and administration.
- This study contributes valuable pharmacokinetic and clinical data for optimizing antibiotic strategies in pediatric surgery.
Abstract:
Pharmacokinetic and clinical studies on imipenem/cilastatin sodium (IPM/CS) in pediatric surgery were performed and the results obtained are summarized below. 1. Plasma and urinary levels of IPM/CS were measured in 9 neonate patients following drip-infusion for 1 hour of IPM/CS (dose of IPM 10 mg/kg for 5 patients, 20 mg/kg for 4 patients). In the 10 mg/kg group, peak plasma levels were observed at the end of infusion or after 1 hour of it. IPM 9.95-14.2 micrograms/ml, CS 7.7-30.1 micrograms/ml. In the 20 mg/kg group, peak levels were found at the end of the infusion, IPM 39.2-41.7 micrograms/ml, CS 48.1-58.8 micrograms/ml. In both groups, plasma levels of IPM/CS decreased rapidly, and plasma half-lives (T 1/2) in the 20 mg/kg group were 0.9-1.2 hours (IPM) and 0.8-1.1 hours (CS). Urinary recovery rates were 17.7-28.7% (10 mg/kg), 21.1-36.9% (20 mg/kg) for IPM and 27.1-43.8% (10 mg/kg) and 21.5-76.5% (20 mg/kg) for CS. 2. Bile levels of IPM/CS were measured in 3 patients with congenital biliary atresia and 1 patient with neonatal hepatitis. Peak levels of IPM/CS in bile were noted 1 hour after the end of infusion, and they were 3.01-12.3 micrograms/ml for IPM, and 2.5-13.1 micrograms/ml for CS. Recovery rates in bile in 7 hours after the end of infusion were 0.03-0.12% (IPM), 0.01-0.12% (CS). 3. IPM/CS was administered to 9 patients as prophylaxis against postoperative infections and to 2 patients with postoperative cholangitis. No infectious complications were observed in patients after the prophylactic use. In 1 patient with cholangitis, clinical effect was good and organisms were eradicated. No clinical or laboratory adverse reactions due to the administration of IPM/CS were noted. It is concluded that IPM/CS is an effective and safe antibiotic in pediatric surgery.