Reply

Indian Pediatrics 2002; 39:703-704

Imipenem

Thanks for reading the article with interest and giving the opportunities to provide further clarifications:

(i) As imipenem is degraded by the enzyme renal dehydropeptidase present in the proximal renal tubules, addition of cilastatin prolongs the half life of the drug by inhibiting this degradation.

(ii) Resistance of P.aeruginosa to imipenem is well mentioned in the text. It is so important that even initially susceptible P.aeruginosa can develop resistance to imipenem. Therefore few authors have recommended addition of amikacin to imipenem, when treating P.aeruginosa infections(1,2).

(iii) Transient depression of white blood cell counts have been noted with imipenem in similar frequency as compared with other B.lactam drugs(3). This dose not become contra-indication for using this drug in febrile neutropenic patients;

(iv) Super infections with candida albicans has been well mentioned in the text;

(v) Many authors have used imipenem for meningitis and it does penetrate into the cerebrospinal fluid of children with inflammed meninges(4,5);

(vi) Since imipenem is not available in the routine market, it is difficult to mention cost and to study and analyse our experience of using this drug.

References

1. Cornaglia G, Mazzariol A, Hauretti L, Rossolini GM, Fontana R. Hospital outbreak of carbapenem resistant Pseudomonas aeruginosa producing VIM-1, a Novel Transferable Metallo-B-Lactamase. Clinic Inf Dis 2000; 31: 1119-1125.

2. Oral R, Akisu M, Kutursay N, Vardar F, Tansug N. Neonatal Klebsiella pneumonia sepsis and Imipenem - cilastatin. Indian J Pediatr 1998; 65: 121-129.

3. Alpert G, Dagan R, Connor E, Campos JM, Bloh M, Powell KR et al. Imipenem/Cilastatin for the treatment of infections in hospitalized children. Am J Dis Child 1985; 139: 1153-1156.

4. Klugman KP, Dagan R. Carbapenem treatment of meningitis. Scand J Infect Dis Suppl 1995; 96: 45-48.

5. Haimi Cohen Y, Amir J, Weinstock A, Varsano I. The use of imipenem-cilastatin in neontal meningitis caused by citrobacter diversus. Acta Pediatr 1993; 82: 530-553.