Two decades of imipenem therapy

Abstract

Imipenem, the first carbapenem discovered, was developed more than two decades ago in response to an unmet need for a highly potent, broad-spectrum antimicrobial agent with a strong safety profile. It has since been used to treat more than 26 million patients. In an era where antibiotic use has driven antibiotic resistance, choosing appropriate initial therapy for serious infection is critical. Appropriate antibiotic regimens must cover all likely pathogens, be administered promptly at the correct dosage and dosing interval, be well tolerated and prevent the emergence of resistance. While imipenem was initially reserved for use in intractable, serious infections, the benefits of early aggressive therapy are now known, making imipenem a core agent in de-escalation therapy due to proven efficacy and safety for indications such as nosocomial pneumonia, intra-abdominal infection, sepsis and febrile neutropenia. De-escalation therapy with an agent such as imipenem minimizes resistance development by initiating aggressive initial treatment and then tailoring therapy based on patient response and culture results, switching to a less expensive, narrower spectrum antibiotic regimen or shortening the duration of therapy. Imipenem has maintained sustained clinical efficacy, tolerability and in vitro activity against important bacterial pathogens for two decades. We review the factors that continue to make imipenem as appropriate an agent for de-escalation therapy now as it was 20 years ago.

Stenotrophomonas maltophilia Bacteraemia: Analysis of 33 Episodes Occurred in the ICU at the University Hospital in Sousse, Tunisia

“…In the present study, we found a high frequency in IMP prescription prior to SMB, which is consistent with previous reports, in which between 25% and 43% of patients received this antibiotic [5] [11] [23] [35]. The use of carbapenems has also been established as the primary risk factor for S. maltophilia infections [31] [39]. Prior therapy with IMP was 10 times more frequent amongst cases of S. maltophilia than in matched controls in a previous case-control study conducted at the University of Texas [12].…”

Imipenem-associated encephalopathy: alert to physicians

“…The article from Norrby 4 discusses the prevalence of seizures caused by imipenem to be 0.2%, while Rodloff et al 1 refers to the prevalence of seizures to be 1.4%. All these articles present seizures as the most common neurologic adverse event caused by imipenem.…”

“…Imipenem, one of the first antibiotics of the carbapenem class, was developed more than 2 decades ago and has been utilized for multi-resistant bacterial infections in more than 26 million patients 1 . It also has been a life-saving drug, as some bacteria are frequently resistant to other broadspectrum antibiotics.…”

Transcriptional organization of ThnI-regulated thienamycin biosynthetic genes in Streptomyces cattleya

“…3 Thienamycin, the first carbapenem described, 4 is considered one of the most potent, most broad spectrum of all natural antibiotics known so far and has an important clinical role in the treatment of severe nosocomial infectious diseases. 5 The gene cluster for thienamycin biosynthesis (thn) has been cloned from the producer S. cattleya NRRL 8057, 6 opening up the possibility to study its regulation. We recently showed that ThnI, an LysR-type pathway-specific transcriptional activator, constitutes a key factor in controlling thienamycin biosynthesis.…”