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Canadian Journal of Infectious Diseases
Volume 9 (1998), Issue 4, Pages 215-228
Original Article

Imipenem and Meropenem: Comparison of In Vitro Activity, Pharmacokinetics, Clinical Trials and Adverse Effects

George G Zhanel,1 Andrew E Simor,3 Lavern Vercaigne,2 Lionell Mandell,4 and the Canadian Carbapenem Discussion Group

1Departments of Medicine and Microbiology, Health Sciences Centre and Faculties of Pharmacy and Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
2Department of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
3Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
4Department of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada

Received 11 June 1997; Accepted 11 November 1997

Copyright © 1998 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To compare and contrast imipenem and meropenem in terms of in vitro activity, pharmacokinetics, clinical efficacy and adverse effects.

DATA SELECTION: MEDLINE search from 1975 to 1997 and follow-up of references.

DATA EXTRACTION: Clinical trials comparing imipenem with meropenem, or either imipenem or meropenem with standard therapy in the treatment of serious infections were selected.

DATA SYNTHESIS: Imipenem, the first carbapenem, was first marketed in 1987; meropenem was introduced to the market in 1996. In general, imipenem is more active against Gram-positive cocci while meropenem is more active against Gram-negative bacilli. The agents display similar pharmacokinetics. Clinical studies in patients with serious infections (intra-abdominal infection, respiratory infection, septicemia, febrile neutropenia) report similar bacteriological and clinical cure rates with imipenem and meropenem. Meropenem is approved for the treatment of bacterial meningitis, whereas imipenem is not. Adverse effects are similar.

CONCLUSIONS: Current literature supports the use of imipenem at a dose of 500 mg every 6 h and meropenem at 1 g every 8 h for the treatment of severe infections. For the treatment of serious infections, imipenem (500 mg every 6 h or 2 g/day [$98/day]) is more economical than meropenem (1 g every 8 h or 3 g/day [$142/day]) based on acquisition cost.