Intravenously (intravenously) is drip.
The following doses are calculated for body weight of 70 kg and more and KC 70 ml / min / 1.73 m2 and more. For patients with SC less than 70 ml / min / 1.73 m2 and / or less body weight, the dose should be proportionally reduced.
The average therapeutic dose for adults (calculation for imipenem) with iv introduction - 1-2 g / day, divided into 3-4 injections; the maximum daily dose is 4 g or 50 mg / kg, depending on which dose is lower.
Patients with mild infection - 250 mg 4 times a day, medium - 500 mg 3 times a day or 1 g 2 times a day, a heavy degree - 500 mg 4 times a day, with an infection that threatens the life of the patient - 1 g 3-4 times per day.
The dose of imipenem less than or equal to 500 mg should be administered iv in 20-30 minutes. A dose of more than 500 mg should be administered iv in 40-60 minutes. Patients who experience nausea during infusion should slow the rate of injection.
For the prevention of postoperative infections - 1 g during introductory anesthesia and 1 g in 3 hours. In the case of surgical intervention with a high risk of infection (surgery on the colon and rectum), 500 mg are administered additionally at 8 and 16 hours after general anesthesia.
Maximum daily doses for intravenous administration in patients with renal insufficiency depending on the degree of infection severity and QC values (ml / min / 1.73 m 2) and body weight> 70 kg:
- for a mild course of infection and CC 41-70 ml / min - 250 mg after 8 hours, CC 21-40 ml / min - 250 mg after 12 hours, CC 6-20 ml / min - 250 mg after 12 hours ;
- for infection of medium severity and CK 41-70 ml / min - 250 mg after 6 hours, KK 21-40 ml / min - 250 mg after 8 hours, KK 6-20 ml / min - 250 mg after 12 hours;
- in severe (highly sensitive strains) and KK 41-70 ml / min - 500 mg every 8 hours, KK 21-40 ml / min - 250 mg after 6 hours, KK 6-20 ml / min - 250 mg after 12 hours;
- In severe (moderately sensitive strains, incl. Pseudomonas aeruginosa) and KK 41-70 ml / min - 500 mg after 6 hours, KK 21-40 ml / min - 500 mg after 8 hours, KK 6-20 ml / min - 500 mg after 12 hours;
- with a serious course of life-threatening infection and CC 41-70 ml / min - 750 mg every 8 hours, CC 21-40 ml / min - 500 mg after 6 hours, CC 6-20 ml / min - 500 mg after 12 hours.
Patients with SC less than 5 ml / min are prescribed only if, not later than 48 hours after the infusion of the drug, hemodialysis is performed. The introduction of the drug to such patients is recommended only in cases when the benefit from its use exceeds the potential risk of seizures.
In the treatment of patients with SC less than 5 ml / min, on hemodialysis, doses should be used for patients with CC of 6-20 ml / min and body weight less than 70 kg (see below). The drug is administered after a hemodialysis session and then at 12-hour intervals from the end of the procedure, with careful monitoring of patients (especially if they have central nervous system diseases).
At present, there is insufficient data on the dosage regimen for preoperative prophylaxis of patients with SC less than 70 ml / min / 1.73 sq.m.
The following is the dosing regimen for patients with renal dysfunction and / or body weight less than 70 kg.
Table 1.Dosing regimen for renal dysfunction and / or body weight less than 70 kg
a) The maximum daily dose of 1 g
| Weight bodies | Creatinine clearance (ml / min / 1.73 m2) |
| (kg) | >71 | 41-70 | 21-40 | 6-20 |
| 60-69 | 250 mg every 8 hours | 125 mg every 6 hours | 250 mg every 12 hours | 125 mg every 12 hours |
| 50-59 | 125 mg every 6 hours | 125 mg every 6 hours | 125 mg every 8 hours | 125 mg every 12 hours |
| 40-49 | 125 mg every 6 hours | 125 mg every 8 hours | 125 mg every 12 hours | 125 mg every 12 hours |
| 30-39 | 125 mg every 8 hours | 125 mg every 8 hours | 125 mg every 12 hours | 125 mg every 12 hours |
b) The maximum daily dose of 1.5 g
| Weight bodies (kg) | Creatinine clearance (ml / min / 1.73 m2) |
| >71 | 41-70 | 21-40 | 6-20 |
| 60-69 | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 8 hours | 250 mg every 12 hours |
| 50-59 | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 12 hours | 250 mg every 12 hours |
| 40-49 | 250 mg every 8 hours | 125 mg every 6 hours | 125 mg every 8 hours | 125 mg every 12 hours |
| 30-39 | 125 mg every 6 hours | 125 mg every 8 hours | 125 mg every 8 hours | 125 mg every 12 hours |
c) The maximum daily dose of 2.5 g
| Weight bodies | Creatinine clearance (ml / min / 1.73 m2) |
| (kg) | >71 | 41-70 | 21-40 | 6-20 |
| 60-69 | 500 mg every 8 hours | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 12 hours |
| 50-59 | 250 mg every 6 hours | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 12 hours |
| 40-49 | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 12 hours | 250 mg every 12 hours |
| 30-39 | 250 mg every 8 hours | 125 mg every 6 hours | 125 mg every 8 hours | 125 mg every 12 hours |
d) The maximum daily dose of 3 g
| Weight bodies | Creatinine clearance (ml / min / 1.73 m2) |
| (kg) | >71 | 41-70 | 21-40 | 6-20 |
| 60-69 | 750 mg every 8 hours | 500 mg every 8 hours | 500 mg every 8 hours | 500 mg every 12 hours |
| 50-59 | 500 mg every 6 hours | 500 mg every 8 hours | 250 mg every 6 hours | 250 each mi every 12 hours |
| 40-49 | 500 mg every 8 hours | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 12 hours |
| 30-39 | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 8 hours | 250 mg every 12 hours |
e) the maximum daily dose of 4 g
| Weight bodies | Creatinine clearance (ml / min / 1.73 m2) |
| (kg) | >71 | 41-70 | 21-40 | 6-20 |
| 60-69 | 1000 mg every 8 hours | 750 mg every 8 hours | 500 mg every 8 hours | 500 mg every 12 hours |
| 50-59 | 750 mg every 8 hours | 500 mg every 6 hours | 500 mg every 8 hours | 500 mg every 12 hours |
| 40-49 | 500 mg every 6 hours | 500 mg every 8 hours | 250 mg every 6 hours | 250 mg every 12 hours |
| 30-39 | 500 mg every 8 hours | 250 mg every 6 hours | 250 mg every 8 hours | 250 mg every 12 hours |
At present, there is insufficient data to recommend the use of the drug for patients on peritoneal dialysis.
Application in pediatric practice
In children older than 3 months, the drug is used for the same indications as in adult patients.
Data on the efficacy and safety of the drug for intravenous administration in children up to 3 months and with impaired renal function (serum creatinine more than 2 mg / dl) is not enough.
Children with a body weight of 40 kg and more - appoint the same dose as adults.
Children older than 3 months and weighing less than 40 kg - 15 mg / kg 4 times a day; the maximum daily dose is 2 g.
Preparation of a solution for intravenous infusion
Imipenem + Cilastatin for intravenous infusions should not be mixed or added to other antibiotics.
The drug dosage form for intravenous infusions has a chemical incompatibility with lactic acid (lactate) and should not be prepared on the basis of solvents containing it. However, intravenously, the drug can be administered via the same infusion system as the lactate-containing solution.
The following solvents are used to prepare the infusion solution: 0.9% sodium chloride solution, 5% aqueous dextrose solution, 10% aqueous dextrose solution, 5% dextrose solution and 0.9% sodium chloride solution, 5% dextrose solution and 0.45% sodium chloride solution, 5% dextrose solution and 0.225% sodium chloride solution, 5% dextrose solution and 0.15% potassium chloride solution, mannitol 5% and 10%. In a ratio of 100 ml of solvent and 500 mg of imipenem. The concentration of imipenem in the resulting solution is 5 mg / ml.
Table 2 presents data on the use of a solution of the preparation prepared on the basis of a number of infusion solutions and stored at room temperature or in a refrigerator.
Table 2.
| Solvent | Term stability of the drug |
| Room temperature (25 ° C) | Cooling (4 ° C) |
| 0.9% solution of sodium chloride | 4 hours | 24 h |
| 5% aqueous dextrose solution | 4 hours | 24 h |
| 10% aqueous solution of dextrose | 4 hours | 24 h |
| 5% dextrose solution and 0.9% sodium chloride solution | 4 hours | 24 h |
| 5% dextrose solution and 0.45% sodium chloride solution | 4 hours | 24 h |
| 5% dextrose solution and 0.225% sodium chloride solution | 4 hours | 24 h |
| 5% dextrose solution and 0.15% potassium chloride solution | 4 hours | 24 h |
| Mannitol 5% and 10% | 4 hours | 24 h |
Vials with a capacity of 20 ml and 30 ml
When using the drug in vials of 20 ml or 30 ml capacity, the contents of the vial are previously dissolved in 10 ml of a suitable solvent.
The resulting solution can not be used for administration!
The solution is shaken well, then transferred to a vial or container with the rest of the solvent (90 ml). The total volume of the solvent is 100 ml. For complete transfer of the drug: 20 ml of the previously obtained solution are added to the vial, shaken well and transferred back to the vial or container with the solution already obtained. Only after this, the solution is ready for use.