Mosby's 2014 Nursing Drug Reference (213 page)

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Authors: Linda Skidmore-Roth

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imipenem/cilastatin (Rx)

(i-me-pen′em sye-la-stat′in)

Primaxin IM, Primaxin IV

Func. class.:
Antiinfective—miscellaneous

Chem. class.:
Carbapenem

Do not confuse:
imipenem
/Omnipen
Primaxin
/Premarin

ACTION:

Interferes with cell-wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure; addition of cilastatin prevents renal inactivation that occurs with high urinary concentrations of imipenem

USES:

Serious infections caused by gram-positive
Streptococcus pneumoniae
, group A β-hemolytic streptococci,
Staphylococcus aureus
, enterococcus; gram-negative
Klebsiella, Proteus, Escherichia coli, Acinetobacter, Serratia, Pseudomonas aeruginosa, Salmonella, Shigella, Haemophilus influenzae, Listeria
sp.

CONTRAINDICATIONS:

Hypersensitivity to this product or amide local anesthetics, or carbapenems; AV block, shock (IM)

Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, seizure disorders, renal disease, head trauma; hypersensitivity to cephalosporins, penicillins; pseudomembranous colitis, ulcerative colitis

DOSAGE AND ROUTES
Calculator
Intraabdominal, gynecologic, lower respiratory tract, skin and skin structure, bone and joint infections; septicemia, endocarditis, febrile neutropenia (unlabeled), and polymicrobial infections for fully susceptible organisms including gram-positive or gram-negative aerobes and anaerobes

• Adult ≥70 kg: IV
250 mg every 6 hr (mild infections); 500 mg every 6–8 hr (moderate infections); 500 mg every 6 hr (severe life-threatening infections)

• Adult 60 kg: IV
250 mg IV every 8 hr (mild infections); 250 mg every 6 hr (moderate or severe life-threatening infections)

• Adult 50 kg: IV
125 mg every 6 hr (mild infections) 250 mg every 6 hr (moderate or severe life-threatening infections)

• Adult 40 kg: IV
125 mg every 6 hr (mild infections); 250 mg every 6–8 hr (moderate infections); 250 mg every 6 hr (severe life-threatening infections)

• Adult 30 kg: IV
125 mg every 8 hr (mild infections); 125 mg every 6 hr or 250 mg every 8 hr (moderate infections); 250 mg every 8 hr (severe life-threatening infections)

• Adolescent/child/infant ≥3 mo: IV
15–25 mg/kg every 6 hr

• Infant 1–3 mo and ≥1500 g: IV
25 mg/kg every 6 hr

• Neonate 1–4 wk and ≥1500 g: IV
25 mg/kg every 8 hr

• Neonate <7 days and ≥1500 g: IV
25 mg/kg every 12 hr

Moderately susceptible organisms, primarily some strains of
P. aeruginosa

• Adult ≥70 kg: IV
500 mg every 6 hr (mild infections); 500 mg every 6 hr or 1 g every 8 hr (moderate infections); 1 g every 6–8 hr (life-threatening infections)

• Adult 60 kg: IV
500 mg every 8 hr (mild infections); 500 mg every 8 hr or 750 mg every 8 hr (moderate infections); 0.75–1 g every 8 hr (life-threatening infections)

• Adult 50 kg: IV
250 mg every 6 hr (mild infections); 250–500 mg every 6 hr (moderate infections); 500 mg every 6 hr or 750 mg every 8 hr (life-threatening infections)

• Adult 40 kg: IV
250 mg every 6 hr (mild infections); 250 mg every 6 hr or 500 mg every 8 hr (moderate infections); 500 mg every 6–8 hr (life-threatening infections)

• Adult 30 kg: IV
250 mg every 8 hr (mild infections); 250 mg every 6–8 hr; 250 mg every 6 hr or 500 mg every 8 hr (life-threatening infections)

• Adolescent/child/infant ≥3 mo: IV
15–25 mg/kg every 6 hr

• Infant 1–3 mo weighing ≥1500 g: IV
25 mg/kg every 6 hr

• Neonate 1–4 wk weighing ≥1500 g: IV
25 mg/kg every 8 hr

• Neonate <7 days weighing ≥1500 g: IV
25 mg/kg every 12 hr

Mild to moderate lower respiratory tract, skin and skin structure, or gynecologic infections

• Adult/adolescent/child ≥12 yr: IM
500 or 750 mg every 12 hr, max 1.5 g/day

Mild to moderate intraabdominal infections, including acute gangrenous or perforated appendicitis and appendicitis with peritonitis

• Adult/adolescent/child ≥12 yr: IM
750 mg every 12 hr, max 1.5 g/day

Community-acquired pneumonia (CAP) in ICU patients with risk factors for
Pseudomonas
infection

• 
Imipenem; cilastatin in combination with ciprofloxacin or an aminoglycoside plus a respiratory fluoroquinolone or an advanced macrolide

• Adult ≥70 kg: IV
500 mg every 6–8 hr

• Adult 60 kg: IV
250 mg every 6 hr

• Adult 50 kg: IV
250 mg every 6 hr

• Adult 40 kg: IV
250 mg every 6–8 hr

• Adult 30 kg: IV
125 mg every 6 hr or 250 mg every 8 hr

Empiric treatment of aspiration pneumonia

• Adult: IV
500–1000 mg every 6 hr × 10 days

Renal dose

•
 
Adult ≥70 kg (reduce normal dose of 1 g/day to): IV
CCr 41-70 ml/min, 250 mg q8hr; CCr 6-40 ml/min, 250 mg q12hr;
(reduce normal dose of 1.5 g/day to):
CCr 41-70 ml/min, 250 mg q6hr; CCr 21-40 ml/min, q8hr; CCr 6-20 ml/min, 250 mg q12hr;
(reduce normal dose of 2 g/day to):
CCr 41-70 ml/min, 500 mg q8hr; CCr 21-40 ml/min, 250 mg q6hr; CCr 6-20 ml/min, 250 mg q12hr

Available forms:
Powder for sol inj 250, 500 mg; powder for susp 500 mg

Administer:

• 
After C&S is taken

IM route

• 
Reconstitute 500 mg/2 ml lidocaine without EPINEPHrine; shake

• 
Inject deeply in large muscle, aspirate, product for IM is not for IV use

IV route

• 
After reconstitution of 250 or 500 mg with 10 ml of diluent and shake; add to ≥100 ml of same inf sol

• 
250-500 mg over 20-30 min; ≥750 mg over 40-60 min; give through
Y
-tube or 3-way stopcock; do not give by IV bolus or if cloudy

Y-site compatibilities:
Acyclovir, amifostine, aztreonam, cefepime, cisatracurium, diltiazem, famotidine, fludarabine, foscarnet, granisetron, IDArubicin, insulin (regular), melphalan, methotrexate,
ondansetron, propofol, remifentanil, tacrolimus, teniposide, thiotepa, vinorelbine, zidovudine

SIDE EFFECTS

CNS:
Fever, somnolence,
seizures,
confusion, dizziness, weakness, myoclonus

CV:
Hypotension, palpitations, tachycardia

GI:
Diarrhea, nausea, vomiting
,
pseudomembranous colitis, hepatitis,
glossitis

GU:
Renal toxicity/failure

HEMA:
Eosinophilia, neutropenia,
decreased Hgb, Hct

INTEG:
Rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site

RESP:
Chest discomfort, dyspnea, hyperventilation

SYST:
Anaphylaxis, Stevens-Johnson syndrome

PHARMACOKINETICS

IV:
Onset immediate, peak 1/2-1 hr, half-life 1 hr, 70%-80% excreted unchanged in urine

INTERACTIONS

Increase:
imipenem plasma levels—probenecid

Increase:
antagonistic effect—β-lactam antibiotics

Increase:
seizure risk—ganciclovir, theophylline, aminophylline, cycloSPORINE

Decrease:
effect of valproic acid

Drug/Lab Test

Increase:
AST, ALT, LDH, BUN, alk phos, bilirubin, creatinine

False positive:
direct Coombs’ test

NURSING CONSIDERATIONS
Assess:

• 
Renal studies: creatinine/BUN

• 
Infection:
increased temp, WBC, characteristics of wounds, sputum, urine or stool culture

• 
Sensitivity to penicillin—may have sensitivity to this product

• 
Renal disease: lower dose may be required

• 
Bowel pattern daily; if severe diarrhea occurs, product should be discontinued; may indicate pseudomembranous colitis

 
Allergic reactions, anaphylaxis:
rash, urticaria, pruritus, wheezing, laryngeal edema; may occur a few days after therapy begins; have epinephrine, antihistamine, emergency equipment available

• 
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Evaluate:

• 
Therapeutic response: negative C&S; absence of signs and symptoms of infection

Teach patient/family:

 
To report severe diarrhea; may indicate pseudomembranous colitis

 
To report sore throat, bruising, bleeding, joint pain; may indicate blood dyscrasias (rare)

TREATMENT OF ANAPHYLAXIS:

EPINEPHrine, antihistamines; resuscitate if needed

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

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