Successful use of higher-than-recommended dosage of imipenem in Pseudomonas aeruginosa endocarditis.

Abstract

OBJECTIVE:

To report a case of Pseudomonas aeruginosa endocarditis that was successfully treated with high-dose imipenem/cilastatin and to discuss dosage modification based on individual pharmacokinetic parameters.

DATA SOURCES:

Clinical studies, review articles, and relevant laboratory and pharmacokinetic information.

CASE SUMMARY:

A 27-year-old man with right-sided P. aeruginosa endocarditis was successfully treated with long-term imipenem/cilastatin and tobramycin. The imipenem dose required to achieve therapeutic serum concentrations and cidal activity was 6 g/d. The manufacturer's recommended maximum dose is 4.0 g/d or 50 mg/kg/d. Because of the patient's large apparent volume of distribution, low serum imipenem concentrations, and lack of serum cidal activity, the clinical decision was made to increase the dose to 6 g/d or 54 mg/kg/d. Treatment was tolerated for seven weeks without any adverse effects. The patient remains free of symptoms 24 months after the diagnosis.

CONCLUSIONS:

Careful and discriminate use of larger-than-recommended doses of imipenem may be indicated in certain clinical situations. Dosage may need to be adjusted to body size in order to obtain optimal serum concentrations and activity.

• Authors: J H King, E J Kailath, D B Hrdy
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 26 Issue 5 Pg. 639-41 (May 1992) ISSN: 1060-0280 [Print] United States
• PMID: 1591421 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Drug Combinations
• Cilastatin
• Imipenem
• Cilastatin, Imipenem Drug Combination
• Tobramycin

Topics

• Adult
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Cilastatin (administration & dosage, therapeutic use)
• Cilastatin, Imipenem Drug Combination
• Drug Combinations
• Drug Therapy, Combination (administration & dosage, therapeutic use)
• Endocarditis, Bacterial (drug therapy)
• Humans
• Imipenem (administration & dosage, therapeutic use)
• Male
• Pseudomonas Infections (drug therapy)
• Risk Factors
• Tobramycin (administration & dosage, therapeutic use)