Imipenem

(For additional information see "Imipenem and cilastatin: Pediatric drug information") Dosage based on imipenem content: Non-CNS infections: IV: Infants ≥3 months, Children, and Adolescents: 15 to 25 mg/kg every 6 hours Maximum dosage: 4,000 mg/day Burkholderia pseudomallei (melioidosis) (off-label use): IV: Initial: 20 mg/kg every 8 hours for at least 10 days (White 2003) or 25 mg/kg (up to 1 g) every 6 hours for at least 10 days (Currie 2003); continue parenteral therapy until clinical improvement, then switch to oral therapy if tolerated and/or appropriate. Additional data may be necessary to further define the role of imipenem/cilastatin in this condition. Cystic fibrosis exacerbations: IV: Infants, Children, and Adolescents: Up to 100 mg/kg/day divided every 6 hours (Strandvik 1988; Zobell 2012); maximum dose: 4 g daily has been used (Zobell 2012). Note: Efficacy in exacerbations may be limited due to rapid development of resistance (Zobell 2012).

Refer to adult dosing.

Adults: US labeling (estimation of renal function for the purpose of dosing adjustment should be done using the Cockcroft-Gault formula): Usual dosing regimen of 500 mg every 6 hours: CrCl ≥90 mL/minute: No dosage adjustment necessary. CrCl ≥60 to CrCl ≥30 to CrCl ≥15 to CrCl Usual dosing regimen of 1,000 mg every 8 hours: CrCl ≥90 mL/minute: No dosage adjustment necessary. CrCl ≥60 to CrCl ≥30 to CrCl ≥15 to CrCl Usual dosing regimen of 1,000 mg every 6 hours: CrCl ≥90 mL/minute: No dosage adjustment necessary. CrCl ≥60 to CrCl ≥30 to CrCl ≥15 to CrCl Canadian labeling: Reduced IV dosage regimen based on creatinine clearance (mL/minute/1.73 m2) and body weight ≥70 kg (Note: The manufacturer labeling recommends further proportionate dose reductions for patients Mild renal impairment (CrCl 31 to 70 mL/minute/1.73 m2): Fully susceptible organisms: Maximum dosage: 500 mg every 8 hours Less susceptible organisms (primarily some Pseudomonas strains): Maximum dosage: 500 mg every 6 hours Moderate renal impairment (CrCl 21 to 30 mL/minute/1.73 m2): Fully susceptible organisms: Maximum dosage: 500 mg every 12 hours Less susceptible organisms (primarily some Pseudomonas strains): Maximum dosage: 500 mg every 8 hours Severe renal impairment (CrCl 0 to 20 mL/minute/1.73 m2): Fully susceptible organisms: Maximum dosage: 250 mg every 12 hours Less susceptible organisms (primarily some Pseudomonas strains): Maximum dosage: 500 mg every 12 hours Note: Patients with CrCl 6 to 20 mL/minute/1.73 m2 should receive 250 mg every 12 hours or 3.5 mg/kg (whichever is lower) every 12 hours for most pathogens; seizure risk may increase with higher dosing. End-stage renal disease (ESRD) on intermittent hemodialysis (IHD): Use the dosing recommendation (for US labeling) for patients with a CrCl ≥15 to or 250 to 500 mg every 12 hours (Heintz 2009). Note: Dosing dependent on the assumption of 3 times/week, complete IHD sessions. Continuous renal replacement therapy (CRRT) (Heintz 2009; Trotman 2005): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment: CVVH: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 8 hours CVVHD: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 6 to 8 hours CVVHDF: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 6 hours Note: Data suggest that 500 mg every 8 to 12 hours may provide sufficient time above MIC to cover organisms with MIC values ≤2 mg/L; however, a higher dose of 500 mg every 6 hours is recommended for resistant organisms (pa

There are no dosage adjustments provided in the manufacturer's labeling.