Pharmacokinetic and clinical evaluation of serious infections in premature and newborn infants under therapy with imipenem/cilastatin

• Published in: Infection 1999, Vol.27 (4-5), p.299-304
• Main Authors: Böswald, M, Döbig, C, Kändler, C, Krüger, C, Scharf, J, Soergel, F, Zink, S, Guggenbichler, J P
• Format: Article
• Language: English
• Subjects: Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Cilastatin - pharmacology; Cilastatin - therapeutic use; Dose-Response Relationship, Drug; Female; Humans; Imipenem - pharmacology; Imipenem - therapeutic use; Infant, Newborn; Infant, Premature, Diseases - drug therapy; Infant, Premature, Diseases - mortality; Infusions, Intravenous; Intensive Care Units, Neonatal; Male; Prognosis; Protease Inhibitors - pharmacology; Protease Inhibitors - therapeutic use; Retrospective Studies; Severity of Illness Index; Survival Rate; Thienamycins - pharmacology; Thienamycins - therapeutic use
• ISSN: 0300-8126

Efficacy and pharmacokinetic parameters of imipenem/cilastatin (I/C) were investigated in a retrospective evaluation in 104 premature and newborn infants. Patients enrolled in this investigation constituted a particularly high risk group with extreme prematurity, perinatal asphyxia and amnion infection as well as various malformations. In 15 of the 104 infants serum concentrations were measured for drug monitoring and determination of optimal total daily dosage. A total daily dose of 50 mg/kg birth weight for premature and newborn infants divided into two doses led to imipenem peak concentrations of 17.7 mg/l +/- 9.2 mg/l (range: 1.95-38.05) and trough levels were 2.35 mg/l +/-1.02 (range 2.34-10.88) in premature infants. Imipenem peak concentrations of 20.6 +/- 10.8 (range 3.94-32.3) and trough levels of 0.43 +/- 0.17 (range 0.16-0.94) were measured in newborns. The half-life of elimination was 3.3 h and 1.86 h, respectively. Six of the 104 treated patients died, five of them of causes unrelated to infection. Seizures occurred in 8.9% of patients during therapy with I/C compared with 5.8% of a large survey of premature and newborn infants in our intensive care unit (ICU). However, the severity of illness of these two groups cannot be compared. I/C can be expected to constitute effective therapy in premature and newborn infants with serious nosocomial infections even after failure of other broad spectrum antibiotics.