Formulary review of the carbapenems: comparison of imipenem/cilastatin and meropenem.
In comparison with imipenem, meropenem exhibits closely similar microbiological activity. Although meropenem has slightly greater gram-negative activity against organisms, like Pseudomonas aeruginosa and Burkholderia cepacia, imipenem demonstrates more intense gram-positive activity, particularly towards Enterococcus faecalis which may reduce or even cancel out, the clinical relevance of these microbiological differences. However, an aminoglycoside is usually added in the treatment of serious infections from these bacteria. The pharmacokinetics of these two agents are also closely similar both in normal healthy volunteers and in patients with normal or impaired renal function. Moreover, there is little, if any, difference in the acquisition costs for meropenem and imipenem in most hospitals. Cost-avoidance with meropenem is, therefore, mainly the result of less frequent dosing and the ability to administer meropenem by rapid intravenous injection. Additionally, meropenem's FDA approved indication for central nervous system infection offers an additional advantage when compared to imipenem/cilastatin. It was for these reasons that our hospital's Pharmacy and Therapeutics Committee replaced imipenem/cilastatin with meropenem.
Richerson
M A
MA
Department of Pharmacy Research, Hartford Hospital, USA.
Ambrose
P G
PG
Quintiliani
R
R
Nightingale
C H
CH
D015780:Carbapenems; D015377:Cilastatin / Q000494:pharmacology*; D004338:Drug Combinations; D016527:Drug Costs; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D011480:Protease Inhibitors / Q000494:pharmacology; D013845:Thienamycins / Q000494:pharmacology*
D015780:Carbapenems; D004338:Drug Combinations; D011480:Protease Inhibitors; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077731:Meropenem