Imipenem/Cilastatin Eberth (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/Cilastatin is a carbapenem antibiotic used to treat serious infections by targeting bacterial cell wall synthesis.

• Complicated intra‑abdominal infections: effective in achieving clinical cure and microbiological eradication.
• Complicated urinary tract infections: resolves infection and prevents recurrence in hospitalized patients.
• Skin and soft tissue infections: reduces lesion size and promotes healing.
• Hospital‑acquired and ventilator‑associated pneumonia: improves survival and clears pulmonary infection.
• Febrile neutropenia: provides rapid bacterial coverage in immunocompromised patients.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final transpeptidation step of peptidoglycan synthesis, which weakens the bacterial cell wall and leads to lysis. Cilastatin, co‑administered, inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby maintaining therapeutic concentrations in the bloodstream. This broad‑spectrum activity covers many Gram‑positive, Gram‑negative and anaerobic organisms, including many resistant strains. The combination allows higher plasma levels of imipenem without renal toxicity.

Imipenem/Cilastatin may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Vomiting: occasional emesis.
• Diarrhea: loose stools, may be self‑limiting.
• Rash: skin erythema or pruritus.
• Headache: transient cranial discomfort.
• Elevated liver enzymes: mild transaminase increase.

Serious or Rare Side Effects

• Seizures: risk increased, especially in patients with CNS disorders or renal impairment.
• Clostridioides difficile colitis: severe diarrhea due to bacterial overgrowth.
• Anaphylaxis: acute, potentially life‑threatening allergic reaction.
• Severe neutropenia: marked reduction in white blood cells.
• Stevens‑Johnson syndrome: rare mucocutaneous eruption.
• Renal toxicity: acute kidney injury in susceptible individuals.

Before initiating Imipenem/Cilastatin, clinicians should consider several safety precautions.

• Assess renal function: adjust dose in patients with impaired clearance.
• Monitor for seizures: avoid in patients with a history of epilepsy or CNS disease.
• Evaluate allergy history: discontinue if signs of hypersensitivity appear.
• Use cautiously in CNS disorders: increased risk of neurotoxicity.
• Adjust dose in renal impairment: follow renal dosing guidelines.
• Store at 2‑8°C: keep refrigerated, protect from light, do not freeze.

Imipenem/Cilastatin can interact with other medicines, affecting efficacy or safety.

Major Interactions (Avoid)

• Valproic acid: carbapenems reduce serum levels, risking seizure breakthrough.
• Probenecid: may increase imipenem concentrations, heightening toxicity risk.
• Other carbapenems: concurrent use can lead to additive toxicity without added benefit.

Moderate Interactions (Monitor Closely)

• Diuretics: may exacerbate renal dysfunction.
• NSAIDs: increase risk of renal impairment.
• Anticoagulants (warfarin): monitor INR for possible changes.
• Rifampin: enzyme induction may lower imipenem levels.
• Aminoglycosides: combined nephrotoxic potential.