Lizasoaín M, Noriega A R
Unidad de Enfermedades Infecciosas, Hospital 12 de Octubre, Madrid.
Enferm Infecc Microbiol Clin. 1997 Sep;15 Suppl 1:73-7.
The purpose of this article is to review the safety and tolerance of two carbapenems (imipenem/cilastatin and meropenem) in order to establish their possible use in different clinical settings. The tolerance and safety profile of both carbapemens in intravenous and intramuscular formulation is good. With imipenem/cilastatin, nausea and vomiting can constitute a practical problem requiring prolonged times of perfusion and high dilutions. The possibility of administering meropenem in intravenous infusion or bolus injection with lower volumes of fluid, without increasing the incidence of these adverse reactions, may have practical advantages in special situations. The possible neurotoxicity of the imipenem/cilastatin presents limitations of the use in high risk circumstances such as meningitis, previous alterations of CNS, renal insufficiency and concomitant administration of other drugs with neurotoxic profiles and when high doses of administration are needed. The meropenem, by the contrary, can be used in patients with infections of the CNS and other risk factors, at high doses, without increased risk of seizures.
本文旨在回顾两种碳青霉烯类药物（亚胺培南/西司他丁和美罗培南）的安全性和耐受性，以确定它们在不同临床环境中的可能用途。两种碳青霉烯类药物静脉和肌肉注射剂型的耐受性和安全性良好。使用亚胺培南/西司他丁时，恶心和呕吐可能成为一个实际问题，需要延长输注时间并进行高倍稀释。在不增加这些不良反应发生率的情况下，美罗培南可以采用较低液体量进行静脉输注或推注给药，这在特殊情况下可能具有实际优势。亚胺培南/西司他丁可能存在的神经毒性限制了其在脑膜炎、既往中枢神经系统病变、肾功能不全以及同时使用其他具有神经毒性的药物等高危情况下的应用，以及在需要高剂量给药时的应用。相反，美罗培南可用于患有中枢神经系统感染和其他危险因素的患者，高剂量使用时癫痫发作风险不会增加。
