Abstract
Clinical pharmacology and clinical efficacy and safety of imipenem/cilastatin sodium (IPM/CS), a beta-lactam antibiotic with a carbapenem nucleus and a dehydropeptidase-I inhibitor, were investigated in newborns.
1. Peak serum concentrations of IPM/CS at a dose of 20mg/20 mg/kg were achieved at the end of 60-minute infusion. Maximum serum levels of IPM and CS were 44.2μg/ml and 70.0μg/ml, respectively, in neonates with ages 0-3 days. IPM and CS peak levels in premature infants with ages 0-3 days were 47.2μg/ml and 56.1μg/ml, respectively. IPM and CS peak levels in neonates 4 day-old or older were 35.0μg/ml and 41.5μg/ml, respectively, and in premature infants of similar ages were 45.7μg/ml and 65.3μg/ml, respectively.
2. Mean serum half-lives of IPM and CS in 0-3 day-old neonates were 1.6 hours and 3.1 hours, respectively, and the mean serum half-lives in premature infants were 2.1 hours and 4.6 hours, respectively.
In neonates 4 day-old or older, the mean serum half-lives of IPM and CS were 1.6 hours and 2.6 hours, respectively, and in premature infants they were 1.5 hours and 1.9 hours, respectively.
3. A dose response was evident between doses of 10mg/10mg/kg and 20mg/20mg/kg of IPM and CS.
4. Urinary recovery rates of IPM for the 0-to 6-hour post IPM/CS infusion period ranged between 27.2 and 46.6%. For CS, urinary recovery rates for the 0-to 6-hour post IPM/CS infusion period ranged between 25.3 and 100.8%.
5. Clinical efficacy was evaluated in 9 patients and 7 patients showed excellent or good responses.
6. Of 14 patients who received IPM/CS treatment, 1 patient showed hematuria, leukopenia and thrombocytopenia, and 3 patients showed eosinophilia. However, these adverse reactions improved after the completion of therapy.
7. IPM has excellent antimicrobial activity against aerobic and anaerobic Gram-positive and Gram-negative bacteria. In this study, coadministration of IPM and CS produced good clinical responses and no serious adverse reactions. It is hence concluded that IPM/CS sodium is very useful for the treatment of severe bacterial infections in neonates, especially in the presence of beta-lactamase resistant strains and in polymicrobial infections.
