- Intra-abdominal infections
- Lower respiratory tract infections
- Gynaecological infections
- Genitourinary tract infections
- Bone and joint infections
- Skin and soft tissue infections
Cilastatin is a specific and reversible renal dehydropeptidase-I inhibitor. Since the antibiotic, imipenem, is hydrolyzed by dehydropeptidase-I, which resides in the brush border of the renal tubule, cilastatin is administered with imipenem to block the metabolism and thus the inactivation of imipenem so that antibacterial levels of imipenem can be attained in the urine. The drug also prevents the metabolism of leukotriene D4 to leukotriene E4 through the inhibition of leukotriene D4 dipeptidase.
Dosage & Administration
Imipenem & Cilastatin IV: Up to 500 mg dose should be given over 20 to 30 minutes; > 500 mg dose should be infused over 40 to 60 minutes. In patients who develop nausea during the infusion, the rate of infusion may be slowed.
Adult: Normal daily dose is 1-2 g administered in 3-4 divided doses. For the treatment of moderate infection, a 1 g b.i.d. dosage regimen may also be used. In infections due to less susceptible organisms, the daily dosage may be increased to a maximum of 4 g/day or 50 mg/kg/day, whichever is lower.
- Mild infection: 250 mg 6 hourly (1 gm/day)
- Moderate infection: 500 mg 8 hourly or 1 gm 12 hourly (1.5-2 gm/day)
- Severe infection with fully susceptible microorganism: 500 mg 6 hourly (2gm/day)
- Severe infection with less susceptible organisms (primarily some strains of P. aeruginosa): 1 gm 3-4 times daily (3-4 gm/day)
Paediatric Dosing Schedule:
- ≥ 3 months of age: the recommended dose for non-CNS infections is 15-25 mg/kg/dose administered every six hours. The maximum daily dose for treatment of infections with fully susceptible organisms is 2.0 g per day, and of infections with moderately susceptible organisms is 4.0 g/day. Higher doses (up to 90 mg/kg/day in older children) have been used in patients with cystic fibrosis.
- ≤3 months of age: Following dosage schedule is recommended for non-CNS infections:
- <1 week of age: 25 mg/kg every 12 hrs
- 1-4 weeks of age: 25 mg/kg every 8 hrs
- 4 weeks-3 months of age: 25 mg/kg every 6 hrs.
Imipenem is not recommended for the therapy of meningitis. If meningitis is suspected, an appropriate antibiotic should be used. Imipenem and cilastatin for injection is not recommended in pediatric patients <30 kg with impaired renal function, as no data are available.