Imipenem/Cilastatina Steriscience (Cilastatin, Imipenem)

Imipenem/cilastatin is a carbapenem antibiotic used to treat severe bacterial infections across several organ systems.

• Complicated intra‑abdominal infections: effective in eliminating mixed aerobic and anaerobic pathogens to achieve clinical cure.
• Complicated urinary tract infections: eradicates resistant Gram‑negative organisms to resolve infection.
• Hospital‑acquired bacterial pneumonia: provides broad‑spectrum coverage to improve respiratory outcomes.
• Skin and soft‑tissue infections: combats susceptible bacteria to promote healing.
• Severe sepsis and septic shock: rapid bactericidal activity helps control systemic infection.

• Imipenem exerts its antibacterial effect by binding to penicillin‑binding proteins, inhibiting the final stages of peptidoglycan cross‑linking and thereby disrupting bacterial cell‑wall synthesis. Cilastatin, co‑administered, inhibits renal dehydropeptidase I, preventing enzymatic degradation of imipenem in the kidneys and extending its plasma concentration and antimicrobial activity. This dual action results in a broad‑spectrum, time‑dependent bactericidal activity against Gram‑positive, Gram‑negative and anaerobic organisms, including many multidrug‑resistant strains. The combined formulation ensures therapeutic levels are maintained throughout the dosing interval, maximizing bacterial kill while minimizing renal clearance. Because the drug is administered intravenously, it achieves high plasma concentrations rapidly, which is critical in severe infections.

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

Common Side Effects

• Nausea: mild gastrointestinal upset.
• Diarrhea: loose stools, sometimes watery.
• Rash: mild skin erythema.
• Elevated liver enzymes: transient increase in ALT/AST.
• Injection site pain: discomfort at infusion site.
• Headache: mild to moderate.
• Fever: low‑grade temperature.

Serious or Rare Side Effects

• Seizures: central nervous system excitation, especially in renal impairment.
• Anaphylaxis: severe allergic reaction with hives, airway swelling.
• Stevens‑Johnson syndrome: severe skin and mucous membrane involvement.
• Clostridioides difficile colitis: antibiotic‑associated diarrhea.
• Hemolytic anemia: destruction of red blood cells.
• Renal dysfunction: worsening kidney function.

Before using Imipenem/cilastatin, clinicians should consider several precautionary measures to ensure safe administration.

• Renal function: assess creatinine clearance and adjust dose in impairment.
• History of seizures: avoid or monitor patients with prior CNS disorders.
• Hypersensitivity: verify no known allergy to β‑lactam antibiotics or cilastatin.
• Concomitant valproic acid: monitor for reduced seizure control.
• Pregnancy and lactation: weigh potential benefits against unknown risks.
• Store at 2‑8 °C: keep refrigerated, protect from light, do not freeze or shake.

Imipenem/cilastatin can interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Valproic acid: reduces antiepileptic effect, may precipitate seizures.
• Co‑administration with other β‑lactam antibiotics: increased risk of additive toxicity.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance nephrotoxic potential, monitor renal function.
• Probenecid: can increase plasma levels, adjust dosing if needed.
• Anticoagulants (warfarin): possible alteration of INR, check coagulation parameters.
• Aminoglycosides: additive nephrotoxicity, monitor kidney function.