Imipenem/Cilastatin Kabi (Cilastatin, Imipenem)

Imipenem/Cilastatin Kabi is employed for severe bacterial infections that require broad‑spectrum intravenous therapy.

• Complicated intra‑abdominal infections: achieves bacterial eradication in severe abdominal sepsis.
• Complicated urinary tract infections: clears resistant uropathogens in hospitalized patients.
• Skin and soft tissue infections: resolves deep or necrotizing infections caused by Gram‑negative and Gram‑positive bacteria.
• Febrile neutropenia: provides empiric coverage against high‑risk pathogens in neutropenic fever.
• Meningitis: penetrates the cerebrospinal fluid to treat bacterial meningitis caused by susceptible organisms.

• Imipenem binds to penicillin‑binding proteins, inhibiting the final stages of bacterial cell‑wall peptidoglycan synthesis, which leads to cell lysis. Cilastatin inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem in the kidneys and thereby extending its antibacterial activity and plasma concentration.

Adverse reactions may occur with any intravenous antibiotic and should be monitored.

Common Side Effects

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

Serious or Rare Side Effects

• Seizures: especially in patients with pre‑existing CNS disorders or high doses.
• Anaphylaxis: severe, potentially life‑threatening hypersensitivity reaction.
• Clostridioides difficile‑associated diarrhea: may result in colitis.
• Severe hypersensitivity: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Renal toxicity: acute kidney injury in susceptible individuals.
• Neutropenia: marked reduction in white blood cell count.

Use of Imipenem/Cilastatin Kabi requires careful clinical assessment and monitoring.

• Renal function: adjust dosing in patients with impaired renal clearance.
• Seizure risk: monitor patients with a history of seizures or CNS disorders.
• Allergy: avoid in individuals with known hypersensitivity to carbapenems or cilastatin.
• Pregnancy: prescribe only when the potential benefit justifies the potential risk to the fetus.
• Drug interactions: review concomitant medications for possible interactions that may affect efficacy or safety.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/Cilastatin Kabi can interact with several medicines, influencing safety or effectiveness.

Major Interactions (Avoid)

• Valproic acid: may increase the risk of seizures.
• CNS stimulants (e.g., methylphenidate): may lower seizure threshold.
• Nephrotoxic agents (e.g., aminoglycosides): may exacerbate renal injury.

Moderate Interactions (Monitor Closely)

• Diuretics: may alter renal clearance and affect drug levels.
• Probenecid: can increase plasma concentrations of imipenem.
• Anticoagulants (e.g., warfarin): may require INR monitoring due to potential interaction.