Successful use of higher-than-recommended dosage of imipenem in Pseudomonas aeruginosa endocarditis.
OBJECTIVE
To report a case of Pseudomonas aeruginosa endocarditis that was successfully treated with high-dose imipenem/cilastatin and to discuss dosage modification based on individual pharmacokinetic parameters.


METHODS
Clinical studies, review articles, and relevant laboratory and pharmacokinetic information.


METHODS
A 27-year-old man with right-sided P. aeruginosa endocarditis was successfully treated with long-term imipenem/cilastatin and tobramycin. The imipenem dose required to achieve therapeutic serum concentrations and cidal activity was 6 g/d. The manufacturer's recommended maximum dose is 4.0 g/d or 50 mg/kg/d. Because of the patient's large apparent volume of distribution, low serum imipenem concentrations, and lack of serum cidal activity, the clinical decision was made to increase the dose to 6 g/d or 54 mg/kg/d. Treatment was tolerated for seven weeks without any adverse effects. The patient remains free of symptoms 24 months after the diagnosis.


CONCLUSIONS
Careful and discriminate use of larger-than-recommended doses of imipenem may be indicated in certain clinical situations. Dosage may need to be adjusted to body size in order to obtain optimal serum concentrations and activity.
King
J H
JH
Department of Pharmacy, University of California Davis Medical Center, Sacramento.
Kailath
E J
EJ
Hrdy
D B
DB
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015377:Cilastatin / Q000008:administration & dosage* / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy*; D012307:Risk Factors; D014031:Tobramycin / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D014031:Tobramycin