cilastatin--imipenem-drug-combination and Nervous-System-Diseases

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

Topics: Anti-Bacterial Agents; Bacterial Infections; Cilastatin; Cilastatin, Imipenem Drug Combination; Critical Care; Drug Combinations; Humans; Imipenem; Nervous System Diseases; Protease Inhibitors