Imipenem/Cilastatin Eberth (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/Cilastatin is a broad‑spectrum carbapenem used for serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infection: provides bacterial eradication in the abdominal cavity.
• Complicated urinary tract infection: clears resistant uropathogens in the urinary system.
• Skin and soft‑tissue infection: treats deep or extensive bacterial skin involvement.
• Community‑acquired and hospital‑acquired pneumonia: combats Gram‑negative and Gram‑positive respiratory pathogens.
• Severe sepsis: offers rapid bactericidal activity in systemic infection.

• Imipenem binds to multiple penicillin‑binding proteins, inhibiting the final stages of bacterial cell‑wall peptidoglycan synthesis, leading to cell lysis. Cilastatin, co‑administered, inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby maintaining effective plasma and urinary concentrations.

Adverse reactions may occur with any antimicrobial therapy and should be monitored.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: may be watery and self‑limiting.
• Headache: transient and usually resolves.
• Rash: erythematous skin eruption.
• Elevated liver enzymes: transient increase in hepatic transaminases.
• Injection site pain: local discomfort at the infusion site.

Serious or Rare Side Effects

• Seizures: risk increases with high doses or renal impairment.
• Anaphylaxis: severe hypersensitivity reaction requiring immediate intervention.
• Clostridioides difficile colitis: antibiotic‑associated colitis presenting with profuse diarrhea.
• Renal toxicity: acute kidney injury in susceptible patients.
• Severe allergic reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Thrombophlebitis: inflammation of the vein at the infusion site.

Careful assessment and monitoring are required before and during therapy.

• Renal function monitoring: adjust dosing in patients with impaired renal clearance.
• Allergy assessment: avoid in individuals with known carbapenem hypersensitivity.
• Seizure risk: use cautiously in patients with a history of seizures or CNS disorders.
• Drug interaction review: evaluate concomitant medications that may lower seizure threshold.
• Pregnancy and lactation: prescribe only when the potential benefit justifies the potential risk.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/Cilastatin may interact with several drugs; awareness helps prevent reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Valproic acid: may lower serum valproate levels, increasing seizure risk.
• Phenobarbital, carbamazepine, phenytoin: may induce hepatic enzymes, reducing imipenem concentrations.
• Renal dehydropeptidase inhibitors: can increase imipenem toxicity.

Moderate Interactions (Monitor Closely)

• Aminoglycosides: additive nephrotoxicity; monitor renal parameters.
• Loop diuretics: may heighten ototoxic risk when combined with other ototoxic agents.
• Proton pump inhibitors: limited relevance for IV use but may affect gastric pH if oral formulations are used.