Be Alert for Seizures with Imipenem Use



Be Alert for Seizures with Imipenem Use


Anthony D. Slonim MD, DRPH



Imipenem, meropenem, and ertapenem are members of the class of antibacterial agents named carbapenems. Carbapenems are one of four types of beta-lactam antibiotics. The other three are the penicillins, cephalosporins, and monobactams. Imipenem shares many of the other characteristics of these beta-lactam antibacterials: a bactericidal mechanism of action; renal excretion; and a broad spectrum of activity that covers many Gram-positive and Gram-negative aerobic organisms. In the case of imipenem and many of the penicillins, activity also includes anaerobes. Imipenem, in its commercial formulation, is complexed with cilastin to reduce its renal metabolism.


Watch Out For

Carbapenems have a number of adverse effects that can be classified by the affected system. Carbapenems can cause hypersensitivity reactions. These reactions will often present as skin rashes, urticaria, or even Stevens-Johnson syndrome in severe cases. Gastrointestinal side effects include nausea, vomiting, and abnormal liver-function tests and transaminases. From a bone-marrow perspective, marrow suppression and a positive Coombs test can result. Renal dysfunction can result from imipenem use and all beta-lactam antibacterial agents (including imipenem) require dosage adjustment in the setting of renal insufficiency and failure because of their renal excretion. Neurologically, imipenem can cause myoclonus and seizures. Seizures are a fairly common complication and result from a lowering of the seizure threshold in susceptible patients. Fortunately, this complication is not nearly as common with the use of meropenem. Seizures also occur in the setting of new-onset renal dysfunction if the carbapenem dose is not adjusted.

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Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Be Alert for Seizures with Imipenem Use

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