The recommendations for dosing the drug indicate the amount of imipeic to be administered. The calculation of the total daily dose should be based on the severity of the infection, kidney function and body weight of the patient. The introduction is divided into several methods.
The following doses are calculated for adult patients with a body weight of 70 kg and more and a CC of 70 ml / min / 1.73 m2 and more. For adult patients with SC less than 70 ml / min / 1.73 m2 and / or less body weight should be proportionately reduced dose.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.
Adult patients with mild infection and uncomplicated urinary tract infections - 250 mg 4 times a day (a total daily dose of 1 g), an average degree of severity - 500 mg 3 times a day or 1 g 2 times a day (total pulmonary dose 1.5 -2 g), severe severity and complicated urinary tract infection - 500 mg 4 times a day (total daily dose of 2 g), with an infection endangering the patient's life - 1 g 3-4 times a day (total daily dose of 3-4 g).
For the prevention of postoperative infections in adults - 1 g during the introductory anesthesia and 1 g - after 3 hours. In the case of surgical intervention with a high risk of infection (operation on the colon and rectum), 500 mg are additionally administered at 8 and 16 h after introductory anesthesia.
The maximum daily doses for I / O administration in adult patients (body weight ≥ 70 kg) with renal insufficiency, depending on the severity of infection and CC values (ml / min / 1.73 m2):
- for mild infection severity and CK 41-70 ml / min - 250 mg after 8 hours, CK 21-40 ml / min - 250 mg after 12 hours, KK 6-20 ml / min - 250 mg after 12 h;
- for infection of moderate severity and CK 41-70 ml / min - 250 mg after 6 hours, CK 21-40 ml / min - 250 mg after 8 hours, KK 6-20 ml / min - 250 mg after 12 h;
- In severe (high-sensitivity strains) and CC 41-70 ml / min - 500 mg every 8 hours, CC 21-40 ml / min - 250 mg after 6 hours, KK 6-20 ml / min - 250 mg after 12 hours;
- In severe cases (moderately sensitive strains, including Pseudomonas aeruginosa) and CC 41-70 ml / min - 500 mg every 6 hours, CC 21-40 ml / min - 500 mg after 8 hours, CC 6 -20 ml / min - 500 mg every 12 hours;
- In severe life-threatening infections, and CC 41-70 ml / min - 750 mg every 8 hours, CC 21-40 ml / min - 500 mg after 6 hours, KK 6-20 ml / min - 500 mg after 12 hours.
For adult patients with SC less than 70 ml / min / 1.73 m2 and / or body weight less than 70 kg is proportional to reduce the dose (calculation of doses of imipenem):
The maximum daily dose of 1,0 g
| Masss bodiesa | Creatinine clearance, ml / min / 1.73 m2 |
| ≥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 |
The maximum daily dose of 1.5 g
| Masss bodiesa | 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 |
The maximum daily dose 2,0 g
|
Masss bodiesa | Creatinine clearance, ml / min / 1.73 m2 |
| ≥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 h |
| 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 m g every 6 h | 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 |
The maximum daily dose 3,0 g
| Masss bodiesa | Creatinine clearance, ml / min / 1.73 m2 |
| ≥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 mg 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 |
The maximum daily dose 4,0 g
| Masss bodiesa | Creatinine clearance, ml / min / 1.73 m2 |
| ≥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 m g every 8 h | 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 |
For adults with SC less than 5 ml / min, the drug is given only if hemodialysis is performed no later than 48 hours later. In the treatment of adult patients with SC less than 5 ml / min / 1.73 m2, on hemodialysis, recommendations on the dosage regimen should be applied for patients with QC of 6-20 ml / min. The drug should be administered after hemodialysis and then at 12-hour intervals from the end of the procedure. For such patients, especially if they have diseases of the central nervous system, careful monitoring must be carried out. The use of the drug in adult patients on hemodialysis is recommended only in cases when the benefit of treatment exceeds the potential risk of seizures. Imenem and cilastatin are removed during hemodialysis, so the drug is administered after the procedure and thereafter with an interval of 12 hours.
At present, there is insufficient data on the dosing regimen for preoperative prophylaxis of adult patients with SC less than 70 ml / min / 1.73 m2.
Children with a body weight of 40 kg and more - the same dose as for 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.
Application in elderly patients
According to clinical studies, the efficacy and safety of imipenem + cilastatin in IV administration in elderly people over the age of 65 does not differ from those in younger patients.However, taking into account the reduced functions of the cardiovascular system, liver, kidneys, as well as the presence of concomitant diseases and concomitant medication, characteristic for this age group, care should be taken in choosing the dose, adhering to the lower limits of the recommended doses. It is advisable to monitor the excretory function of the kidneys. The state of the kidneys in elderly patients can not be fully determined only on the basis of measuring the level of residual blood nitrogen or creatinine. To determine the dosage of such patients, it is recommended to determine the clearance of creatinine.
Rules for the preparation of solutions.
To prepare the infusion solution, the following solvents are used: 0.9% sodium chloride solution, 5% dextrose solution, 10% dextrose solution, 5% dextrose solution and 0.9% sodium chloride solution.
The contents of the vial are previously dissolved in 10 ml of a suitable solvent. The resulting solution can not be used for administration!
After dilution, the solution is shaken well, after which it is transferred to a vial or container with the rest of the solvent (90 ml). The total volume of the solvent is 100 ml.For the complete transfer of the drug (remnants of the drug on the walls of the vial with a capacity of 20 ml), add 20 ml of the previously obtained solution to the vial, shake well and re-transfer to a vial or container with the solution already obtained. Only after this, the solution is ready for use.
The concentration of imipenem in the resulting solution is 5 mg / ml. Every 250-500 mg is administered intravenously drip for 20-30 minutes, and every 750 mg-1 g for 40-60 minutes. Patients who experience nausea during infusion should reduce the rate of administration of the drug.