The prototype
carbapenem antibacterial agent imipenem has a very broad spectrum of antibacterial activity, encompassing most Gram-negative and Gram-positive aerobes and anaerobes, including most
beta-lactamase-producing species. It is coadministered with a renal dehydropeptidase inhibitor,
cilastatin, in order to prevent its renal metabolism in clinical use. Extensive clinical experience gained with
imipenem/cilastatin has shown it to provide effective monotherapy for septicaemia, neutropenic
fever, and intra-abdominal, lower respiratory tract, genitourinary, gynaecological, skin and soft tissues, and bone and joint
infections. In these indications,
imipenem/cilastatin generally exhibits similar efficacy to broad-spectrum
cephalosporins and other
carbapenems and is at least equivalent to standard
aminoglycoside-based and other combination regimens.
Imipenem/cilastatin is generally well tolerated by adults and children, with local
injection site events, gastrointestinal disturbances and dermatological reactions being the most common adverse events.
Seizures have also been reported, occurring mostly in patients with impaired renal function or CNS pathology, or with excessive dosage. Although it is no longer a unique compound, as newer
carbapenems such as
meropenem are becoming available,
imipenem/cilastatin nevertheless remains an important agent with established efficacy as monotherapy for moderate to severe
bacterial infections. Its particular niche is in treating
infections known or suspected to be caused by multiresistant pathogens.