Imipenem is the first of the carbapenems – a new class of β-lactam antibiotics. It is combined with cilastatin, a non-antibiotic enzyme inhibitor which prevents the breakdown of imipenem to nephrotoxic metabolites. The combination (Primaxin – MSD) is available only for intravenous use. Imipenem has an unusually wide spectrum of activity covering most Gram-positive and Gram-negative bacteria including cephalosporin-resistant strains and anaerobes. Empirical use as the sole antibiotic in severe infections and as definitive treatment of unusually resistant bacteria is tempting.
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