Efficacy of imipenem/cilastatin in endocarditis

Gordon Dickinson, Kassandra Rodriguez, Sergio Arcey, Albert Alea, Richard Greenman

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Imipenem, a potent new beta-lactam antibiotic, which is bactericidal against most pathogenic bacteria, and cilastatin, a dehydropeptidase inhibitor combined with imipenem to prevent the metabolism of imipenem in the kidney, were evaluated in the treatment of bacterial endocarditis. Seventeen patients, including 14 who used intravenous drugs, were treated with imipenem/cilastatin in a dose of 500 mg each infused over 30 minutes every six hours. The mean duration of treatment was 29 days with a range of 21 to 56 days. Causative bacteria were Staphylococcus aureus in 10 patients, S. aureus plus group B Streptococcus in one, viridans group Streptococcus in two, Neisseria subflava, Eikenella corrodens, and group G Streptococcus in one patient, and Staphylococcus epidermidis, Hemophilus aphrophilus, and Enterobacter aerogenes in one patient each. The minimal bactericidal concentration of imipenem against 16 of 18 isolates tested was 0.04 μg/ml, 1 μg/ml against H. aphrophilus, and 0.4 μg/ml against E. aerogenes. The site of infection was the right side of the heart in 11 patients, the left side in five, and both sides in one. The mean number of days to defervescence was 9.7. All patients were cured, and none required cardiac surgery. Adverse effects were few and interrupted treatment occurred in only one patient who had acute dyspnea during an infusion on Day 26 of therapy. Imipenem/cilastatin appears to be a relatively safe and highly effective treatment of staphylococcal endocarditis in intravenous drug users; too few patients with endocarditis caused by other bacteria were treated to allow a firm statement about efficacy in non-staphylococcal endocarditis.

Original languageEnglish
Pages (from-to)117-121
Number of pages5
JournalThe American Journal of Medicine
Volume78
Issue number6 SUPPL. 1
DOIs
StatePublished - Jun 7 1985

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Endocarditis
Imipenem
Aggregatibacter aphrophilus
Enterobacter aerogenes
Bacteria
Staphylococcus aureus
Eikenella corrodens
Cilastatin
Viridans Streptococci
Neisseria
Therapeutics
Bacterial Endocarditis
Streptococcus agalactiae
Staphylococcus epidermidis
imipenem drug combination cilastatin
beta-Lactams
Drug Users
Streptococcus
Dyspnea
Thoracic Surgery

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Efficacy of imipenem/cilastatin in endocarditis. / Dickinson, Gordon; Rodriguez, Kassandra; Arcey, Sergio; Alea, Albert; Greenman, Richard.

In: The American Journal of Medicine, Vol. 78, No. 6 SUPPL. 1, 07.06.1985, p. 117-121.

Research output: Contribution to journalArticle

Dickinson, G, Rodriguez, K, Arcey, S, Alea, A & Greenman, R 1985, 'Efficacy of imipenem/cilastatin in endocarditis', The American Journal of Medicine, vol. 78, no. 6 SUPPL. 1, pp. 117-121. https://doi.org/10.1016/0002-9343(85)90113-5
Dickinson, Gordon ; Rodriguez, Kassandra ; Arcey, Sergio ; Alea, Albert ; Greenman, Richard. / Efficacy of imipenem/cilastatin in endocarditis. In: The American Journal of Medicine. 1985 ; Vol. 78, No. 6 SUPPL. 1. pp. 117-121.
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