Cilastatin / Imipenem Dosage

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Usual Adult Dose for Aspiration Pneumonia

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: Parenteral therapy should be continued until the patient's clinical condition stabilizes and fever subsides. Oral antibiotic therapy may then be initiated according to microbiologic sensitivity data. Therapy of documented anaerobic pleuropulmonary infections should be continued until the infiltrate is cleared or a residual scar forms, sometimes requiring 2 to 4 months.

Usual Adult Dose for Bacteremia

500 mg IV every 6 hours or 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Septicemia

500 mg IV every 6 hours or 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Bronchitis

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less

IM:
Mild to moderate infections: 500 to 750 mg IM every 12 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 1500 mg/day

Usual Adult Dose for Pelvic Infections

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less

IM:
Mild to moderate infections: 500 to 750 mg IM every 12 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 1500 mg/day

Usual Adult Dose for Endometritis

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less

IM:
Mild to moderate infections: 500 to 750 mg IM every 12 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 1500 mg/day

Usual Adult Dose for Deep Neck Infection

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 3 to 4 weeks, depending on the nature and severity of the infection

Usual Adult Dose for Endocarditis

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Febrile Neutropenia

500 mg IV every 6 hours if suspected causative organism is fully susceptible, 1 g IV every 8 hours if other suspected causative organisms are moderately susceptible, or 1 g IV every 6 hours if Pseudomonas aeruginosa is suspected causative organism (based on imipenem content)
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: Once the patient is stable and afebrile for at least 24 hours, and the absolute neutrophil count is at least 500 cells/mm3, oral antimicrobial therapy, based on susceptibility patterns, may be initiated. Then duration of therapy is dependent on the clinical situation.

Usual Adult Dose for Intraabdominal Infection

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 7 to 14 days, depending on the nature and severity of the infection

IM:
Mild to moderate infections: 750 mg IM every 12 hours
Maximum dose: 1500 mg/day

Usual Adult Dose for Joint Infection

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 3 to 4 weeks, depending on the nature and severity of the infection
Longer therapy, 6 weeks or more, may be required for prosthetic joint infections.

Usual Adult Dose for Meningitis

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 14 days, depending on the nature and severity of the infection
Treatment of meningitis due to Listeria species should be continued for 3 to 6 weeks.

Usual Adult Dose for Nosocomial Pneumonia

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Osteomyelitis

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 4 to 6 weeks, depending on the nature and severity of the infection
Chronic osteomyelitis may require additional oral antimicrobial therapy, possibly for up to 6 months. Surgical debridement of devitalized bone is also critical.

Usual Adult Dose for Peritonitis

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 10 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Pneumonia

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 7 days if pneumococcal pneumonia is suspected and up to 21 days for other infecting organisms, depending on the nature and severity of the infection

IM:
Mild to moderate infections: 500 to 750 mg IM every 12 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 1500 mg/day

Usual Adult Dose for Pyelonephritis

250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Skin or Soft Tissue Infection

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 7 to 10 days, or for 3 days after acute inflammation resolves, depending on the nature and severity of the infection
For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

IM:
Mild to moderate infections: 500 to 750 mg IM every 12 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 1500 mg/day

Usual Adult Dose for Skin and Structure Infection

IV: 250 mg IV every 6 hours or 500 mg to 1 g IV every 6 to 8 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 7 to 10 days, or for 3 days after acute inflammation resolves, depending on the nature and severity of the infection
For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

IM:
Mild to moderate infections: 500 to 750 mg IM every 12 hours (based on imipenem content), depending on the nature and severity of the infection
Maximum dose: 1500 mg/day

Usual Adult Dose for Urinary Tract Infection

Uncomplicated: 250 mg IV every 6 hours (based on imipenem content)
Complicated: 500 mg IV every 6 hours (based on imipenem content)

Maximum dose: 50 mg/kg/day or 4 g/day, whichever is less
Duration: 3 to 7 days, depending on the nature and severity of the infection

Usual Pediatric Dose for Bacteremia

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Endocarditis

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Intraabdominal Infection

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Joint Infection

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Osteomyelitis

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Peritonitis

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Pneumonia

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Pyelonephritis

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Septicemia

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Bacterial Infection

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Urinary Tract Infection

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Skin and Structure Infection

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Bronchitis

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Pelvic Infections

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Endometritis

IV:
Non-CNS infections: (based on imipenem content)
Less than 7 days, less than 1500 g: 20 to 25 mg/kg IV every 12 hours
Less than 7 days, 1500 g or more: 25 mg/kg IV every 12 hours
1 to 4 weeks, less than 1200 g: 25 mg/kg IV every 12 hours
1 to 4 weeks, 1200 g or more: 25 mg/kg IV every 8 hours
4 weeks to 3 months: 25 mg/kg IV every 6 hours
3 months or older: 15 to 25 mg/kg IV every 6 hours

Maximum dose: 2 g/day for fully susceptible organisms and 4 g/day for moderately susceptible organisms

IM: Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients below the age of 12 years.

Usual Pediatric Dose for Pneumonia with Cystic Fibrosis

Greater than 12 years with normal renal function: Up to 90 mg/kg/day IV in divided doses (based on imipenem content)
Maximum dose: 4 g/day

Renal Dose Adjustments

IV:
Adult:
CrCl 41 to 70 mL/min:
70 kg or more:
Normal dose is 1 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 2 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 6 hours.
Normal dose is 4 g/day: Reduce dose to 750 mg IV every 8 hours.

60 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 750 mg IV every 8 hours.

50 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 6 hours.

40 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 8 hours.

30 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 6 hours.

CrCl 21 to 40 mL/min:
70 kg or more:
Normal dose is 1 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 6 hours.

60 kg or more:
Normal dose is 1 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 8 hours.

50 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 8 hours.

40 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 6 hours.

30 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 8 hours.

CrCl 6 to 20 mL/min: For most pathogens, these patients should be treated with 125 to 250 mg IV every 12 hours. There may be an increased risk of seizures when dosages of 500 mg IV every 12 hours are used.

70 kg or more:
Normal dose is 1 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 12 hours.

60 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 12 hours.

50 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 12 hours.

40 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 12 hours.

30 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 12 hours.

CrCl 5 mL/min or less: Patients should not receive imipenem-cilastatin unless hemodialysis is instituted within 48 hours.

Pediatric: IV imipenem-cilastatin is not recommended for pediatric patients less than 30 kg with renal impairment.

IM: The safety and effectiveness of IM imipenem-cilastatin have not been established in patients with CrCl less than 20 mL/min.

Liver Dose Adjustments

Data not available

Dose Adjustments

If the patient weighs less than 70 kg and has normal renal function (CrCl 71 mL/min or more):

60 kg or more:
Normal dose is 1 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 2 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 750 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 1 g IV every 8 hours.

50 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 6 hours.
Normal dose is 4 g/day: Reduce dose to 750 mg IV every 8 hours.

40 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 8 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 6 hours.

30 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 8 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 6 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 8 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 6 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 8 hours.

Precautions

IM imipenem-cilastatin is contraindicated in patients with severe shock or heart block due to the lidocaine diluent.

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, IV fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Imipenem-cilastatin has been associated with seizures and other CNS side effects such as confusion, most commonly in patients with CNS disorders such as brain lesions, history of seizures, bacterial meningitis, or renal impairment. Recommended dosages should not be exceeded, especially in patients with risk factors. IV imipenem-cilastatin is not recommended in pediatric patients with CNS infections due to the risk of seizures. Neurologic evaluation, anticonvulsant therapy, and imipenem dosage adjustment or discontinuation are recommended for patients who experience tremors, myoclonus or seizures.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following imipenem-cilastatin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Renal, hepatic, and hematopoietic monitoring is recommended periodically during prolonged therapy.

Imipenem-cilastatin should not be physically mixed with other antibiotics.

Moderate accumulation of cilastatin may occur after multiple doses of IV imipenem-cilastatin in neonates. The safety of this accumulation is unknown.

Safety and efficacy of IM imipenem-cilastatin have not been established in pediatric patients less than 12 years.

Dialysis

Patients with creatinine clearance 5 mL/min or less should not receive imipenem-cilastatin unless hemodialysis is instituted within 48 hours.

CrCl 5 mL/min or less with hemodialysis: For most pathogens, these patients should be treated with 125 to 250 mg IV every 12 hours. There may be an increased risk of seizures when dosages of 500 mg IV every 12 hours are used.

70 kg or more:
Normal dose is 1 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 12 hours.

60 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 500 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 12 hours.

50 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 500 mg IV every 12 hours.

40 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 12 hours.

30 kg or more:
Normal dose is 1 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 1.5 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 2 g/day: Reduce dose to 125 mg IV every 12 hours.
Normal dose is 3 g/day: Reduce dose to 250 mg IV every 12 hours.
Normal dose is 4 g/day: Reduce dose to 250 mg IV every 12 hours.

Both imipenem and cilastatin are cleared from the circulation during hemodialysis. The patient should receive a dose after hemodialysis and at 12 hour intervals timed from the end of that hemodialysis session. For patients on hemodialysis, imipenem-cilastatin is recommended only when the benefit outweighs the potential risk of seizures.

Peritoneal dialysis: There is insufficient information in the medical literature to recommend a safe dosage.

Continuous renal replacement therapy: Clearance may be significantly increased; therefore, dose adjustments may be necessary which should be individualized based on the estimated imipenem-cilastatin clearance. Some studies have suggested initial doses of 500 mg every 6 hours for patients undergoing continuous venovenous hemofiltration or continuous venovenous hemodiafiltration.

Other Comments

The maximum recommended IV dose is 50 mg/kg/day or 4 g/day, whichever is less. Total daily IM dose greater than 1.5 g is not recommended.

IV doses of 125 mg, 250 mg, and 500 mg in adults and 500 mg or less in pediatric patients should be administered over 20 to 30 minutes and 15 to 30 minutes, respectively. IV doses of 750 mg and 1 g in adults and greater than 500 mg in pediatric patients should be administered over 40 to 60 minutes. The infusion rate may be slowed in patients developing nausea during administration.

Treatment duration depends on the nature and severity of the infection. In general, IM imipenem-cilastatin should be continued for at least 2 days after the signs and symptoms of infection have resolved. Safety and efficacy of IM therapy beyond 14 days have not been established.

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