science

Imipenem/cilastatin/relebactam

Imipenem/cilastatin/relebactam is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Imipenem/cilastatin/relebactam rather than just read about it. In short: Imipenem/cilastatin/relebactam, sold under the brand name Recarbrio(Merck), is a fixed-dose combination medication used as an antibiotic. In 2019, it was approved for use in the United States for the treatment of complicated urinary tract and complicated intra-abdominal infections.

Key takeaways

Imipenem/cilastatin/relebactam belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Imipenem/cilastatin/relebactam to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Imipenem/cilastatin/relebactam from memory before moving on to harder problems.

Reference excerpt

Imipenem/cilastatin/relebactam, sold under the brand name Recarbrio(Merck), is a fixed-dose combination medication used as an antibiotic. In 2019, it was approved for use in the United States for the treatment of complicated urinary tract and complicated intra-abdominal infections. It is administered via intravenous injection. The most common adverse reactions include nausea, diarrhea, headache, fever and increased liver enzymes. The most common adverse reactions observed in people treated for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) include increased aspartate/alanine aminotransferases (increased liver enzymes), anemia, diarrhea, hypokalemia (low potassium), and hyponatremia (low sodium).

Antimicrobial activity Imipenem/cilastatin/relebactam has improved activity against P. aeruginosa with decreased porins expression and/or overproducing β-lactamases of the category "AmpC", thanks to relebactam AmpC inhibition. Imipenem/cilastatin/relebactam maintains a limited activity against blaOXA-48-expressing carbapenem-resistant Enterobacterales, and has no activity against metallo-β-lactamase-producing isolates. Relebactam has no activity against OXA class D β-lactamases of A. baumannii. For susceptibility testing purposes, the concentration of relebactam is fixed at 4 mg/L. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) provided a susceptibility clinical breakpoint of ≤2 mg/L for Enterobacterales, P. aeruginosa, and Acinetobacter spp., while The Clinical & Laboratory Standards Institute (CLSI) provided a susceptibility clinical breakpoint of ≤1 mg/L for Enterobacterales and ≤2 mg/L for P. aeruginosa.

Pharmacokinetic properties Imipenem/cilastatin/relabactam is an hydrophilic compound. The distribution of imipenem/relebactam is prevalent in the interstitial spaces. Protein binding is 20% for imipenem, 20% for cilastatin and 22% for relebactam; volume of distribution is 24.3 L for imipenem and cilastatin and 19 L for relebactam. The two drugs achieve relatively high concentrations in the respiratory system: the exposure in epithelial lining fluid, relative to that of unbound concentrations in plasma, is 55% for imipenem and 54% for relebactam. Both imipenem and relebactam have renal clearance and a half-life of approximately 1 h. Dose adjustment should be performed in renal impairment.

Medical uses In the United States imipenem/cilastatin/relebactam is indicated for the treatment of people with complicated urinary tract infections and complicated intra-abdominal infections who have limited or no alternative treatment options. It is also indicated to treat HABP/VABP in adults 18 years of age and older. In the European Union it is indicated for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options.

History The application for imipenem/cilastatin/relebactam was granted Qualified Infectious Disease Product (QIDP), fast track, and priority review designations by the U.S. Food and Drug Administration (FDA). The FDA granted the approval of Recarbrio to Merck & Co., Inc. The determination of efficacy of imipenem/cilastatin/relebactam was supported in part by the findings of the efficacy and safety of imipenem-cilastatin for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI). The contribution of relebactam to imipenem/cilastatin/relebactam was assessed based on data from in vitro studies and animal models of infection. The safety of imipenem/cilastatin/relebactam, administered via injection, was studied in two trials (Trial 1/NCT01505634, Trial 2/NCT01506271), one each for cUTI and cIAI. The cUTI trial included 298 adult participants with 99 treated with the proposed dose of imipenem/cilastatin/relebactam. The cIAI trial included 347 participants with 117 treated with the proposed dose of imipenem/cilastatin/relebactam. Trial 1 enrolled adult participants hospitalized with cUTI. Trial 2 enrolled adult participants hospitalized with cIAI that required surgery or drainage. In both trials, participants were assigned to either imipenem/cilastatin with varying doses of relebactam or imipenem/cilastatin with placebo intravenously, every 6 hours for 4 to 14 days. Neither the participants nor the investigators knew which treatment was being given until after the trial was completed. The trials were conducted in Europe, South America, the United States, Asia Pacific, Africa, and Mexico. It was approved for use in the European Union in February 2020. In June 2020, imipenem/cilastatin/relebactam was approved for the indication to treat hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in adults 18 years of age and older. The safety and efficacy of imipenem/cilastatin/relebactam for the treatment of HABP/VABP were evaluated in a randomized, controlled clinical trial of 535 hospitalized adults with HABP/VABP due to Gram-negative bacteria (a type of bacteria) in which 266 participants were treated with imipenem/cilastatin/relebactam and 269 participants were treated with piperacillin-tazobactam, another antibacterial drug. Overall, 16% of participants who received imipenem/cilastatin/relebactam and 21% of participants who received piperacillin-tazobactam died through day 28 of the study.

Worked examples

Example 1 — a first encounter with Imipenem/cilastatin/relebactam

Start with the simplest possible case. Write down what Imipenem/cilastatin/relebactam claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Imipenem/cilastatin/relebactam before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Imipenem/cilastatin/relebactam ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Imipenem/cilastatin/relebactam

In research: Imipenem/cilastatin/relebactam appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Imipenem/cilastatin/relebactam in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Imipenem/cilastatin/relebactam is common in secondary-school and first-year university syllabi. It links to neighbouring topics Beta-lactamase inhibitors, Carbapenem antibiotics, Combination antibiotics, so understanding it makes those chapters shorter.
In everyday life: Look for Imipenem/cilastatin/relebactam outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Imipenem/cilastatin/relebactam in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Imipenem/cilastatin/relebactam means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Imipenem/cilastatin/relebactam out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Imipenem/cilastatin/relebactam in simple terms?

Why does Imipenem/cilastatin/relebactam matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Imipenem/cilastatin/relebactam?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Imipenem/cilastatin/relebactam.