title: Review of imipenem.
abstract: Imipenem, a new carbapenem beta-lactam broad-spectrum antibiotic, is highly active in vitro against most aerobic and anaerobic gram-positive and gram-negative bacteria isolated from infectious diseases of human beings. Except for enterococci and methicillin-resistant staphylococci most gram-positive cocci are inhibited by less than 2 micrograms/ml. Although the MIC-90 of methicillin-resistant staphylococci may be less than 4 micrograms/ml, these bacteria are usually resistant to imipenem by modified testing methods. The enterococcus, S. faecalis, has an MIC-90 of less than 8 micrograms/ml but bactericidal concentration may be much higher. Most Enterobacteriaceae are highly susceptible to imipenem with MIC-90 of 0.5 to 2.0 micrograms/ml. Proteus species are less susceptible with MICs of 4 to 8 micrograms/ml. Isolates of P. aeruginosa have variable susceptibility with MICs ranging from 0.25 to 16 micrograms/ml. Pseudomonas maltophilia and P. cepacia are usually resistant to imipenem. Except for Clostridium species, most strict anaerobes are susceptible to less than 1.0 micrograms/ml of imipenem. When combined with cilastatin (1:1 ratio), the renal elimination of the active form is increased. The serum halflife in normal renal function is about 1 hour and increases to 3.4 hours in anuria. Major adverse effects are similar to those of cephalosporins except for seizures in some patients. Colonization with fungi and drug-resistant bacteria occurs in about 5% of imipenem-treated patients. Clinical studies have demonstrated efficacy in 79% to 96% of patients treated.
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D001421:Bacteria, Anaerobic / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy; D055598:Chemical Phenomena; D002621:Chemistry; D004352:Drug Resistance, Microbial; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D015378:Imipenem; D012640:Seizures / Q000139:chemically induced; D013845:Thienamycins / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015378:Imipenem