Letters to the Editor

Indian Pediatrics 2002; 39:703

Imipenem

We read with interest the recent article on the subject(1) and want following points to be clarified: (i) Author has mentioned that half life of imipenem is 1 hr. According to our understanding, drug with such a half life can not have adequate serum levels at 6 or 8 hrs. When imipenem is combined with cilastatin, half life of drug is increased to 8 hours which has not been mentioned in the text(2). (ii) Author has mentioned that some of the nosocomial isolates of pseudomonas aeruginosa are resistant to imipenem. Whereas P.aeruginosa is a common isolate in nosocomial infections and approximately 20 percent of which are resistant(3). (iii) One of the side effects mentioned as neutropenia, then how the drug can be used in febrile neutropenic cancer patients. (iv) The most frequent adverse effect of imipenem reported is candida albicans super infection. This may require antimycotic therapy(2). It has not been mentioned anywhere in the text. Some authors are against the use of imipenem in CNS infections since cilastatin prevents its penetration into CSF(2). Author has not mentioned any personal experience about the drug. Cost and availablity has also not been mentioned.

Limitations to its use are relatively low blood levels, short serum half life, central nervous system side effects and high cost(3).

References

1. Salaria M. Imipenem. Indian Pediatr 2001; 38: 1370-1373.

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

3. Archer GL, Polk RE. Treatment and prophylaxis of bacterial infections. In: Harrison’s Principles of Internal Medicine. 15th edn. Eds. Braunwald E, Fauci AS, Kasper Dl, Hauser SL, Longo Dl, Jameson JL, New York, McGraw Hill Publications 2001; pp 867-882.