Other meanings of Imipenem
Antibiotic
Imipenem is a broad-spectrum carbapenem antibiotic, usually administered with cilastatin to protect it from renal breakdown. It is reserved primarily for serious bacterial infections caused by susceptible organisms, particularly when resistance limits narrower treatments.
Imipenem kills susceptible bacteria by disrupting peptidoglycan construction in the cell wall. As a carbapenem, it binds several penicillin-binding proteins and is relatively stable against many common β-lactamases, giving it activity against numerous Gram-positive, Gram-negative, and anaerobic bacteria.1
The drug is commonly paired with cilastatin because the kidney rapidly breaks down imipenem through dehydropeptidase I. Cilastatin inhibits that enzyme, increasing active imipenem exposure and reducing formation of a potentially nephrotoxic metabolite. The combination does not itself broaden antibacterial activity; its purpose is pharmacokinetic protection.
Imipenem–cilastatin is used for severe or complicated infections when the likely pathogens and local resistance patterns justify a carbapenem. Labeled and guideline-supported uses include complicated intra-abdominal and urinary infections, lower-respiratory infections, bloodstream infections, and serious skin, soft-tissue, bone, and joint infections.2
It is administered parenterally, with dosage selected according to infection severity, organism susceptibility, age, and kidney function. Imipenem is not a treatment for viral illness, and empiric therapy should be narrowed when culture and susceptibility results become available. Stewardship programs therefore reserve it for documented or strongly suspected infections in which less broad agents are unsuitable.
Seizures and other central-nervous-system effects are uncommon but clinically important risks, especially with excessive exposure, renal impairment, pre-existing neurologic disease, or infection involving the central nervous system. Dose adjustment is required when kidney function is reduced. Other adverse effects include nausea, diarrhea, rash, infusion-site reactions, and hypersensitivity in people with serious β-lactam allergy.
As with other broad-spectrum antibiotics, imipenem can disrupt normal intestinal flora and is associated with Clostridioides difficile infection.3 Resistance may arise through carbapenemases, altered porins combined with β-lactamases, or changes in target proteins. Metallo-β-lactamases are particularly significant because they can hydrolyze carbapenems and are not inhibited by many conventional β-lactamase inhibitors.
Imipenem was derived from thienamycin, a naturally occurring compound whose instability helped drive the development of a more usable semisynthetic carbapenem. Its introduction expanded treatment options for polymicrobial and resistant infections, but it also illustrated the trade-off between unusually broad coverage and ecological pressure favoring resistance.
Imipenem is not universally active against all difficult pathogens: it lacks reliable activity against methicillin-resistant Staphylococcus aureus, atypical bacteria, and many carbapenem-resistant Gram-negative organisms. The related combination imipenem–cilastatin–relebactam adds a β-lactamase inhibitor for selected resistant infections, but it does not overcome every resistance mechanism, particularly metallo-β-lactamases.4 Susceptibility testing and infection-site penetration therefore remain central to drug selection.
Clinical selection, dosing, and duration depend on the infection, microbiology results, renal function, and current local or national guidelines.
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