[Pharmacokinetics and clinical evaluation of imipenem/cilastatin sodium in pediatric surgery].
Pharmacokinetic and clinical studies on imipenem/cilastatin sodium (IPM/CS) in pediatric surgery were performed and the results obtained are summarized below. 1. Plasma and urinary levels of IPM/CS were measured in 9 neonate patients following drip-infusion for 1 hour of IPM/CS (dose of IPM 10 mg/kg for 5 patients, 20 mg/kg for 4 patients). In the 10 mg/kg group, peak plasma levels were observed at the end of infusion or after 1 hour of it. IPM 9.95-14.2 micrograms/ml, CS 7.7-30.1 micrograms/ml. In the 20 mg/kg group, peak levels were found at the end of the infusion, IPM 39.2-41.7 micrograms/ml, CS 48.1-58.8 micrograms/ml. In both groups, plasma levels of IPM/CS decreased rapidly, and plasma half-lives (T 1/2) in the 20 mg/kg group were 0.9-1.2 hours (IPM) and 0.8-1.1 hours (CS). Urinary recovery rates were 17.7-28.7% (10 mg/kg), 21.1-36.9% (20 mg/kg) for IPM and 27.1-43.8% (10 mg/kg) and 21.5-76.5% (20 mg/kg) for CS. 2. Bile levels of IPM/CS were measured in 3 patients with congenital biliary atresia and 1 patient with neonatal hepatitis. Peak levels of IPM/CS in bile were noted 1 hour after the end of infusion, and they were 3.01-12.3 micrograms/ml for IPM, and 2.5-13.1 micrograms/ml for CS. Recovery rates in bile in 7 hours after the end of infusion were 0.03-0.12% (IPM), 0.01-0.12% (CS). 3. IPM/CS was administered to 9 patients as prophylaxis against postoperative infections and to 2 patients with postoperative cholangitis. No infectious complications were observed in patients after the prophylactic use. In 1 patient with cholangitis, clinical effect was good and organisms were eradicated. No clinical or laboratory adverse reactions due to the administration of IPM/CS were noted. It is concluded that IPM/CS is an effective and safe antibiotic in pediatric surgery.
Yura
J
J
First Department of Surgery, Nagoya City University Medical School.
Kamiya
Y
Y
Suzuki
T
T
Murata
Y
Y
Narita
H
H
Tsuruga
N
N
D001424:Bacterial Infections / Q000517:prevention & control*; D001646:Bile / Q000378:metabolism; D001656:Biliary Atresia / Q000378:metabolism / Q000601:surgery; D055598:Chemical Phenomena; D002621:Chemistry; D002761:Cholangitis / Q000188:drug therapy; D015377:Cilastatin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004341:Drug Evaluation; D004359:Drug Therapy, Combination / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D006207:Half-Life; D006505:Hepatitis / Q000378:metabolism / Q000601:surgery; D006801:Humans; D015378:Imipenem / Q000493:pharmacokinetics* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication
D015377:Cilastatin; D015378:Imipenem