Safety of imipenem/cilastatin in neurocritical care patients.
BACKGROUND
Infection in the intensive care unit (ICU) empirically requires broad-spectrum antibiotics. Imipenem/cilastatin, often reserved for more serious hospital-acquired infections, is thought to be associated with a higher risk of seizures than other penicillins and carbapenems. We sought to evaluate the safety of imipenem/cilastatin in the treatment of infections, including meningitis, in neurocritical care patients.


METHODS
Pertinent literature was identified through MEDLINE (1966-2007) using search terms imipenem, seizure, carbapenem, and meropenem. A review of the literature is presented.


RESULTS
Carbapenem antibiotics remain active against most Gram-positive and Gram-negative organisms, and are often used in critically ill patients. Drug-induced seizures are a rare but serious adverse effect, with carbapenems being one of the most common classes of antibiotics associated with seizures. Seizure rates in patients treated with imipenem/cilastatin and meropenem are similar. One small pediatric study of 21 patients showed a high incidence of seizures and is often cited as the reason imipenem should not be used in meningitis. However, many studies noting seizures with both meropenem and imipenem/cilastatin attribute this to patients with lower body weight, elderly, or those with impaired renal function.


CONCLUSIONS
When dosed appropriately, imipenem/cilastatin may be used to treat serious infections in critically ill patients with central nervous system (CNS) disorders or injury with minimal seizure risk. Imipenem/cilastatin safety data is lacking for meningitis and cautious use is warranted.
Hoffman
Jason
J
Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA.
Trimble
Jason
J
Brophy
Gretchen M
GM
D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D015377:Cilastatin / Q000009:adverse effects; D000077728:Cilastatin, Imipenem Drug Combination; D003422:Critical Care; D004338:Drug Combinations; D006801:Humans; D015378:Imipenem / Q000009:adverse effects; D009422:Nervous System Diseases / Q000382:microbiology / Q000628:therapy*; D011480:Protease Inhibitors / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D011480:Protease Inhibitors; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination