Imipénem
antibiotic
Third-party optionBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Imipenem is a medicine in the 'antibiotic' category. Antibiotics treat infections caused by bacteria. They are taken as a course, over a defined period, to the end of the prescription.
In the case of Imipenem, this means: Treats a bacterial infection. Its use is generally limited in time, adjusted to the situation.
Under which brands it is found
In France, about 8 reimbursable presentations containing Imipenem are recorded. It comes under various trade names and in generic form.
- Imipenem Cilastatine Panpharma
- Imipenem Cilastatine Viatris
- Imipenem/Cilastatine Acs Dobfar
- Imipenem/Cilastatine Arrow
- Imipenem/Cilastatine Hikma
- Imipenem/Cilastatine Sun
- Imipenem/Cilastatine Tamrisa
- Recarbrio
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
On the plate: vitamin K and gut flora
An antibiotic acts on bacteria, including those that inhabit the gut. Vitamin K clearly illustrates the link between this flora and diet: part of it is made by the bacteria in the lower intestine, the rest comes from food. Focusing on the foods that provide it remains the simplest habit to keep up day to day.
Vitamin K is concentrated in leafy green vegetables: kale, spinach and broccoli are its best sources, along with cabbage in general. Vegetable oils also provide it. These foods are easy to cook, raw or cooked, and fit into almost any meal.
By varying the green vegetables from one meal to the next, you cover the dietary share of your vitamin K intake. A drizzle of vegetable oil on a salad or during cooking rounds out the intake. It is a simple foundation to put in place, in addition to your treatment.
How imipenem works
Imipenem is an antibiotic from the carbapenem family, a subgroup of the beta-lactams. Its bactericidal action comes from inhibiting the synthesis of the bacterial cell wall. It binds to penicillin-binding proteins, the PBPs, enzymes that assemble peptidoglycan, the framework that gives the wall its rigidity. Its strongest affinity is for several of these proteins. The lethal effect stems from binding to PBP 2 and 1B, which blocks transpeptidation, the step that locks the wall's mesh together. Deprived of this framework, the bacterium can no longer withstand its own internal pressure and dies.
The medicine combines imipenem with cilastatin, which has no antibacterial activity of its own. Cilastatin inhibits dehydropeptidase-I in the kidney, the enzyme that would otherwise break down imipenem, and thereby maintains active urinary concentrations. Imipenem also shows strong stability against beta-lactamases, both the penicillinases and the cephalosporinases produced by Gram-positive and Gram-negative bacteria. This resistance to bacterial defense enzymes broadens its spectrum of action.
Why this medicine is prescribed
Imipenem-cilastatin treats serious bacterial infections. The indications cover the lower respiratory tract, urinary, intra-abdominal and gynecological infections, septicemia, bone and joint infections, skin and soft tissue infections, as well as endocarditis. This wide range corresponds to a broad-spectrum antibiotic, reserved for situations where the infection is severe or difficult to treat.
Its use most often takes place in a hospital setting, sometimes when other antibiotics are not enough or the germ is resistant. The medicine is not indicated for meningitis: its diffusion and profile are not suited to that location. The choice of imipenem therefore addresses a specific infection, identified by the doctor, and is not a first-line prescription for common infections.
How it is given
Imipenem-cilastatin is given by intravenous infusion, never as a rapid direct injection into the vein. A 500 mg dose is infused over 20 to 30 minutes, a 1000 mg dose over 40 to 60 minutes, generally every 6 to 8 hours. An intramuscular administration every 12 hours exists for certain forms. The rhythm of the infusions is set by the care team and closely monitored during treatment.
Because the medicine is given by injection, it does not interact with meals: the usual diet continues, unless the doctor advises otherwise. The plasma half-life is about one hour for both imipenem and cilastatin, and close to 70 percent of imipenem is recovered in the urine within ten hours. The regularity of the doses keeps the antibiotic at an effective level. The treatment is not shortened or interrupted on one's own initiative, even if the signs of infection ease, because stopping early promotes relapse and resistance.
The effects to know about
In adults, the adverse effects reported in clinical trials and their frequencies are as follows: phlebitis or thrombophlebitis at the infusion site in 3.1 percent of cases, nausea 2.0 percent, diarrhea 1.8 percent, vomiting 1.5 percent, skin rash 0.9 percent, fever 0.5 percent, seizures 0.4 percent and hypotension 0.4 percent. Digestive disorders and the local venous reaction are among the most frequently reported effects.
The risk of seizures depends on the individual context. In infants from birth to 3 months, they were reported with a frequency of 5.9 percent, well above the 0.4 percent in adults, and central nervous system involvement is among the monitored effects. Severe diarrhea, with watery or bloody stools, may also occur up to two months, or even longer, after the treatment is stopped: this antibiotic-associated colitis calls for urgent medical advice.
Interactions and monitoring
Several combinations call for caution. With valproic acid or divalproex, imipenem-cilastatin causes the valproate concentration to fall below the therapeutic threshold, which exposes the person to breakthrough seizures: the combination is not advised. Generalized seizures have been reported with ganciclovir, whose concomitant use should be avoided unless the benefit outweighs the risk. Probenecid, for its part, increases the plasma concentrations and lengthens the half-life of imipenem, so that giving them together is not recommended.
The treatment is accompanied by laboratory monitoring. The trials showed electrolyte variations: a drop in serum sodium, a rise in potassium and chloride. Elevations of liver enzymes are also seen, ALT, AST, alkaline phosphatase and bilirubin, along with eosinophilia, a Coombs test that may become positive, as well as a rise in urea and creatinine. These parameters justify regular blood tests, which make it possible to adjust care and to monitor the kidney and the liver.
Sources
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What is imipenem used for?
Imipenem is a broad-spectrum antibiotic from the carbapenem family, used in hospital settings by injection for severe bacterial infections. It is given in combination with cilastatin. The exact indications are set out in the package leaflet and decided by the physician.
What are the side effects of imipenem?
The package leaflet lists in particular nausea, vomiting, diarrhea, skin rashes and reactions at the injection site. A risk of seizures is described, especially in cases of kidney impairment, high doses or a history of neurological conditions. For any reaction, refer to the package leaflet and speak to your doctor or pharmacist.
Why is imipenem always combined with cilastatin?
Cilastatin blocks a kidney enzyme that would otherwise break down imipenem, which keeps its active concentration in the body and in the urine. This combination is part of the medicine as it is prescribed. Your pharmacist can explain how it works.
Imipenem and valproic acid: is there an interaction?
The package leaflet notes that imipenem can lower the blood level of valproic acid (an antiepileptic), with a risk of seizures returning; this combination is generally not recommended. If you take a treatment for epilepsy, tell your doctor or pharmacist before any adjustment, never on your own.
Can imipenem be used during pregnancy?
The package leaflet limits its use to situations where the physician considers the benefit justified, with the assessment made on a case-by-case basis. This decision rests with the prescribing physician. Refer to the package leaflet and to their advice.
What to consider for gut flora during imipenem treatment?
Broad-spectrum antibiotics alter the balance of the gut microbiome, and studies link taking probiotics to better digestive tolerance during courses of antibiotics. The most studied actives are the yeast Saccharomyces boulardii and certain lactic ferments such as Lactobacillus rhamnosus, in capsule or sachet form. The timing, usually spaced apart from the antibiotic, should be confirmed with your doctor or pharmacist.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.