Inem (Imipenem + Cilastatin) 500 mg powder for solution, 5 vials: profile, composition and research

Reference page for Inem (Imipenem + Cilastatin) 500 mg powder for solution, 5 vials. Active substance: Имипенем + Циластатин / Imipenem + Cilastatin.

Key facts

What imipenem and cilastatin are

Imipenem with cilastatin is a two-component medicine given intravenously. Imipenem belongs to the carbapenems, a reserve group of antibacterials, while cilastatin is not an antibiotic at all and serves only to keep imipenem active in the body for longer.

The medicine is supplied as a sterile powder in vials, from which a solution for infusion is prepared. Each vial is intended for a single administration, so a pack holds five vials.

This combination is used in hospital care, when an infection is severe enough to need intravenous treatment. It is a prescription medicine and the decision to use it rests with a physician.

How the combination works

Imipenem blocks the bacterial cell wall

Imipenem binds to penicillin-binding proteins in the bacterial cell and interferes with the building of its outer wall. Without that supporting wall the bacterium cannot divide and dies. The spectrum covers many aerobic and anaerobic organisms.

Cilastatin shields imipenem

The human kidney contains an enzyme, dehydropeptidase-I, that breaks imipenem down quickly. Cilastatin blocks that enzyme and so keeps imipenem in its active form for longer, without any antibacterial action of its own.

Why the two are combined

On its own imipenem would leave the body too quickly to reach the needed concentration at the site of infection. Cilastatin does not widen the spectrum, but it markedly increases the share of imipenem available to act on the bacteria.

Approved uses

The product information lists severe bacterial infections of several organs and systems: the lower airways, heart, bladder, skin, kidneys, bones and joints, blood, and the abdominal and pelvic organs.

Use is also specified in patients with a low white-cell count and fever that is presumed to be caused by a bacterial infection. In such cases early empirical treatment matters.

The medicine does not act on viruses, so it is of no use in colds or flu. Prescribing, dose selection and the duration of administration belong to a physician, who also monitors tolerability and blood counts.

What the research shows

Imipenem is among the most extensively studied carbapenems. Review articles describe its broad spectrum and its place in severe hospital infections, and comparative trials use it as a reference point when evaluating new antibacterial agents.

The main theme of recent publications is resistance. Some organisms produce carbapenemase enzymes that break imipenem down, so effectiveness is judged from culture results and susceptibility testing.

The research does not offer one universal recommendation. Evidence on some rare pathogens is limited, and the choice of regimen remains a clinical decision.

Published research

Primary sources, verified against PubMed:

• Imipenem/cilastatin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy., PubMed 3552595 (Drugs, 1987).
• Comparative review of the carbapenems., PubMed 17488146 (Drugs, 2007).
• Carbapenems: past, present, and future., PubMed 21859938 (Antimicrobial agents and chemotherapy, 2011).
• Cefiderocol versus imipenem-cilastatin for the treatment of complicated urinary tract infections caused by Gram-negative uropathogens: a phase 2, randomised, double-blind, non-inferiority trial., PubMed 30509675 (The Lancet. Infectious diseases, 2018).

Listed for reference. Publication of a study is not a claim about this particular product.

Precautions

• This is a prescription medicine. Prescribing and monitoring are possible only under medical supervision.
• It is given intravenously, usually in hospital. The solution is prepared immediately before the infusion.
• Digestive reactions are possible: nausea, vomiting, diarrhoea. Redness, swelling and soreness can occur at the infusion site.
• Allergic reactions, including severe ones, have been described. Rash, facial swelling or difficulty breathing call for immediate medical help.
• Kidney and liver function and blood counts are monitored during treatment. The dose is adjusted in renal impairment.
• Seizures are possible, particularly in patients with central nervous system disease. Tell the doctor about every other medicine you take because of interaction risks.

Frequently asked