Imipenem/Cilastatin Kabi (Cilastatin Sodium, Imipenem Monohydrate)

Imipenem/Cilastatin is a carbapenem antibiotic used for severe bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides broad‑spectrum coverage against aerobic and anaerobic pathogens, facilitating clinical cure.
• Complicated urinary tract infections: eradicates resistant Gram‑negative and Gram‑positive organisms, improving urinary sterility.
• Hospital‑acquired or community‑acquired lower respiratory tract infections: treats pneumonia caused by susceptible bacteria, supporting respiratory recovery.
• Skin and soft‑tissue infections: combats mixed flora in severe cellulitis or wound infections, aiding healing.
• Febrile neutropenia: offers empiric therapy for neutropenic patients at risk of bacterial sepsis, reducing fever duration.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages of bacterial cell wall peptidoglycan synthesis, which leads to cell lysis. Cilastatin, co‑formulated in the same preparation, inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem and thereby increasing its urinary concentration and systemic exposure.

Adverse reactions to Imipenem/Cilastatin may vary in frequency and severity.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: often self‑limiting, may be caused by altered gut flora.
• Vomiting: occasional emesis following infusion.
• Injection site pain: discomfort at the IV site.
• Headache: transient cranial discomfort.
• Elevated liver enzymes: mild, reversible changes in hepatic function tests.

Serious or Rare Side Effects

• Seizures: risk increases with high doses or renal impairment.
• Severe allergic reactions: anaphylaxis or Stevens‑Johnson syndrome.
• Clostridioides difficile‑associated diarrhea: may lead to colitis.
• Renal dysfunction: acute kidney injury in susceptible patients.
• Thrombophlebitis: inflammation of veins at infusion site.

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

• Renal function assessment: adjust dose in patients with impaired clearance.
• History of seizures: avoid or monitor closely in individuals with CNS disorders.
• Allergy evaluation: confirm no known hypersensitivity to β‑lactams or carbapenems.
• Concomitant valproic acid use: anticipate reduced antiepileptic levels.
• Pregnancy and lactation: use only if benefits outweigh potential risks (Category B1).
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Valproic acid: reduces antiepileptic concentrations, risking seizure breakthrough.
• Carbapenem antibiotics with other β‑lactams: may increase risk of additive toxicity.
• Probenecid: may elevate plasma levels, enhancing toxicity.

Moderate Interactions (Monitor Closely)

• Diuretics (e.g., furosemide): monitor renal function and electrolytes.
• Aminoglycosides: watch for nephrotoxicity when combined.
• Oral contraceptives: possible reduction in effectiveness, advise backup contraception.