Related Experiment Videos
Renal clearance of imipenem in children
Insights
Pediatric imipenem renal clearance significantly exceeds creatinine clearance, indicating tubular secretion. Developmental differences in imipenem handling may exist between children and adults.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Pediatric Nephrology
- Antimicrobial Drug Metabolism
Background:
- Imipenem is a broad-spectrum carbapenem antibiotic.
- Understanding imipenem's renal handling is crucial for pediatric dosing.
- Existing data on imipenem renal clearance primarily comes from adult studies.
Purpose of the Study:
- To investigate imipenem renal clearance in pediatric patients.
- To compare pediatric imipenem renal clearance to creatinine clearance.
- To explore potential developmental differences in renal imipenem handling.
Main Methods:
- Single intravenous dose of imipenem/cilastatin administered to six children.
- Urine and plasma samples collected over a six-hour period.
- Measurement of unchanged imipenem excretion and calculation of renal and plasma clearance.
Main Results:
- 65.3% of the imipenem dose was excreted unchanged in urine within six hours.
- Pediatric imipenem renal clearance was 1.95-fold greater than estimated creatinine clearance.
- Evidence suggests both tubular secretion and potential tubular reabsorption of imipenem in children.
Conclusions:
- Imipenem renal clearance in children is significantly influenced by tubular secretion.
- Pediatric renal handling of imipenem differs from adult patterns.
- Developmental factors play a significant role in imipenem's renal excretion.
Abstract:
Imipenem renal clearance was studied in six children (three males, three females; 2.9-11.2 years of age) following a single intravenous dose (21.7 +/- 5.1 mg/kg) of imipenem/cilastatin (1:1). In an approximately six-hour period following drug administration, 65.3 +/- 9.7% of the imipenem dose was excreted in the urine unchanged. The renal clearance (280.03 +/- 24.34 ml/min/1.73 m2) of imipenem was found to account for 69.2% of the corresponding plasma imipenem clearance (404.89 +/- 24.83 ml/min/1.73 m2). Contrary to existing adult data, the imipenem renal clearance in our subjects was 1.95-fold greater than the estimated creatinine clearance, suggesting significant tubular secretion of imipenem in children. Examination of urinary imipenem excretion rate versus plasma concentration relationships in three of the children revealed a potential renal tubular reabsorption component for imipenem in children. Comparison of renal imipenem clearance data in these children to similar data from adults suggests that quantitatively important developmental differences may exist for the renal handling of imipenem.