Carbapenems, often in combination with other agents, remain a mainstay of therapy in patients with serious hospital-acquired infection.
Carbapenems can be grouped as (2),
Group 1 includes broad-spectrum Carbapenems, with limited activity against non-fermentative Gram-negative bacilli, particularly suitable for community acquired infections (e.g. ertapenem).
Group 2 includes broad-spectrum Carbapenems, with activity against non-fermentative Gram-negative bacilli that are particularly suitable for nosocomial infections (e.g. imipenem and meropenem).
Group 3 includes Carbapenems with clinical activity methicillin-resistant Staphylococcus aureus
Amongst these the most widely used Carbapenems include:
- Meropenum
- Imipenum +Cilastin
Clinical Indications:
Meropenem: Drug of Choice for the treatment for respirator-associated and/or aspiration nosocomial pneumonia in the ICU (3).
Meropenem is known to be highly potent against Enterobacteriacae, Pseudomonas spp, Acinetobacter spp, H. influenza and anaerobic bacteria, with a fairly good potency against gram positive cocci. Meropenems is known to be active against resistant organisms this has stimulated its use for treatment of serious hospital acquired infections.(2)
Meropenem is uased in the treatment of intra-abdominal infections (complicated appendicitis and peritonitis); treatment of bacterial meningitis in pediatric patients caused by S. pneumoniae, H. influenzae, and N. meningitides and in the treatment of complicated skin and skin structure infections caused by susceptible organisms. (3)
Imipenem/ Cilastin:Imipenem and cilastatin sodium is a fixed combination of imipenem monohydrate (a semisynthetic carbapenem -lactam antibiotic) and cilastatin sodium. Cilastin is used in combination with IMipenem as it prevents renal metabolism of imipenem by dehydropeptidase I (DHP I). (2)
Imipenem and cilastatin sodium solution is used as IV in the treatment of serious infections caused by susceptible organisms including lower respiratory tract, skin and skin structure, intra-abdominal, gynecologic, or bone and joint infections. The drug also is used as IV in the treatment of serious complicated or uncomplicated urinary tract infections, septicemia, or endocarditis caused by susceptible organisms. (2)
Imipenem/Cilastatin and meropenem (group 2)(2)
| Appropriate use | Inappropriate use |
| Empiric treament of severe nosocomial infections in critically ill patients or in ICU | Routine treatment of otitis media |
| Failure of first-line antibiotics for Gram-negative bacterial (GNB) infections | Routine treatment of acute exacerbations of chronic bronchitis |
| Directed treatment according to results of culture and susceptibility testing | Surgical prophylaxis |
| Chronic multiresistant pseudomonal infections | Routine treatment of community-acquired pneumonia (CAP) |
| In certain settings of neutropenic sepsis, severe nosocomial intra-abdominal sepsis and meningitis | Routine treatment of community-acquired gynaecological infections |
| Routine treatment of community-acquired urological infections | |
| Nosocomial or communityacquired Gram-positive sepsis |
- Meropenem for Injection (500mg and 1g)
- Imipenem & Cilastatin Sodium for Injection (500mg + 500mg)
2 comments:
Imipenem is an intravenous β-lactam antibiotic. It was the first member of the carbapenem class of antibiotics. Imipenem was discovered via a lengthy trial-and-error search for a more stable version of the natural product thienamycin, Imipenem, Monohydrate
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