Inhaling imipenem

[GrahamDean]

Hi. I'm in club med for a B. Cepacia that is sensitive to imipenem/cilastatin. I'm rather scared as I've read it's a pretty tough guy to get rid of. Anyone heard of doing inhaled imipenem/cilastatin? The idea is to do it for a few months after I leave the hospital, maybe it will help (a bit like taking tobi for Pseudo). The docs here say that you shouldn't inhale it, but don't say why.

 

[triples15]

Hi Graham, sorry to hear that you are having problems!

I feel like I can't be of much help, but I wanted to mention that I do know of one person that has recently started inhaled Meropenum, and has had an increase in FEV1 and feels some general overall improvement. I know that Mero and Imipenum are not the same, but they are similar. Neither are ones that you hear of nebbed very often, so I thought I'd mention it.

When I mentioned trying inhaled Meropenum to my doc he didn't seem super keen on it. He said it is something we could try down the road if/when we had to. I was asking about it as an option because I can't tolerate Tobi (bronchospasms) and am allergic to Colistin. So I thought it would be nice to have another inhaled antibiotic in my arsenal.

In my opinion, I'd say give it a whirl if your doc will prescribe it! If you have nasty side effects, or it's not helping at all you can stop.

Anyway, hope that helps at all!

Take Care,

Autumn 33 w/cf

 

[Patti Rowland]

Hi,
My daughter cultured positive for b cepacia years ago and I was terrified. However, she inhales colistin/cayston together one month and tobi podhaler the next month and it has never shown up in a culture again. Its been at least 7 years. She is doing very well and the doctors said if it is still there and just hasn't shown up again ~ her body is "keeping it at bay." I hope this happens to you as well ~ that it won't be of any great consequence.

 

[occupyjapan]

The problem you'll run into with nebbed antibiotics is that there's only two that are approved (Tobi and Cayston) and only a few more that have extensive data for off-label use (Colistin, Fortaz, Gentamicin, to a much lesser degree Meropenem); the rest are a total shot in the dark as to 1) if they're safe, 2) if they work and 3) what the dosage should be assuming 1 and 2 are okay. You'd literally be nebulizing IV antibiotics, not a specially prepared nebulized version and this can be a HUGE difference. IV aztreonam is extremely toxic if inhaled, but Cayston is formulated in such a way that it's safe. There are currently trials on a nebulized preparation of Levofloxacin, but IV Levofloxacin is preserved in sugar which wouldn't be too great to inhale. Nebulized amikacin can be harsher than Tobi, but Arikace seems to be much tolerable to trial patients. Sometimes, the benefits outweigh the risks. Some people have problems with nebulized colistin but IV colistin will fry your brain and kidneys.

Meropenem is the closest antibiotic to what you're wanting to do, and some people have nebulized that and with good results, but the additional hurdle you'll run into with Imipenem is that it has to be mixed with cilastatin to prevent your body from breaking down the Imipenem before it has a chance to work and who knows what that'll do in your lungs? This is the only article I can find about nebulized Imipenem and while it seems to suggest it's okay, it's a bit worrying that I can only find the one. http://www.jccjournal.org/article/S0883-9441(07)00153-0/fulltext

 

[brad.johns]

There is a guy on facebook (memejohn) who has used what you are talking about and has had good results. I believe he is on this board as well. He goes by JohnO I believe here.

 

[triples15]

There is a guy on facebook (memejohn) who has used what you are talking about and has had good results. I believe he is on this board as well. He goes by JohnO I believe here.

Yep, that's who I was talking about too. He's inhaling Meropenum..

 

[GrahamDean]

Hi. Many thanks for your answers, especially to "occupyjapan" for the article that made very interesting reading. Acording to the hospital, inhaled meropenem is actually something that they already do in certain cases. However the bacteria I have is parcially resistent to meropenem, and sensitive do imipenem, but there is no protocol for inhaling imipenem.