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Ertapenem

Intravenous
Intramuscular
Class
Antibiotics
Subclass
Carbapenems
Substance name
Ertapenem sodium
Brand names
Invanz®
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Treatment
Community-acquired pneumonia
•
1 g IV q24h for 10 to 14 days
Diabetic foot ulcer in patients without osteomyelitis
•
1 g IV q24h for 7 to 14 days
Gynecologic and pelvic infections in females • Postpartum endomyometritis, septic abortion, post-surgical gynecologic infections
•
1 g IV q24h for 14 days
Intra-abdominal infections • Complicated
•
1 g IV q24h for 5-14 days
Pyelonephritis
•
1 g IV q24h for 10 to 14 days
SSTIs • Complicated
•
1 g IV q24h for 7 to 14 days
Acute diverticulitis • Inpatient, mild-to-moderate • Off-label
•
1 g IV q24h
Native vertebral osteomyelitis • Off-label
•
1 g IV q24h for 6 weeks
Prevention
Prevention of surgical site infection, during elective colorectal surgery
•
1 g IV × 1 1 hour before surger
Other off-label uses
•
Treatment of catheter-associated infections
•
Treatment of peritoneal dialysis-associated peritonitis
•
Treatment of prosthetic joint infection
Indications for use
Labeled indications
Adults
•
Treatment of community-acquired pneumonia
•
Treatment of diabetic foot ulcer in patients without osteomyelitis
•
Treatment of gynecologic and pelvic infections in females (postpartum endomyometritis, septic abortion, post-surgical gynecologic infections)
•
Treatment of intra-abdominal infections (complicated)
•
Treatment of pyelonephritis
•
Treatment of SSTIs (complicated)
•
Treatment of UTIs
•
Prevention of surgical site infection, in patients undergoing elective colorectal surgery
Off-label indications
Adults
•
Treatment of acute diverticulitis (inpatient, mild-to-moderate)
•
Treatment of catheter-associated infections
•
Treatment of native vertebral osteomyelitis
•
Treatment of peritoneal dialysis-associated peritonitis
•
Treatment of prosthetic joint infection
Safety risks
Contraindications
Hypersensitivity to ertapenem sodium or any of its components or to β-lactams
Warnings and precautions
C. difficile infection
•
Maintain a high level of suspicion, as ertapenem sodium has been associated with an increased risk of C. difficile-associated diarrhea.
Decreased serum valproate levels
•
Use caution in patients receiving valproic acid or divalproex sodium.
Seizure
•
Use caution in patients with brain lesions or brain tumor, a history of seizure disorder, or other neurological disease.
Superinfection
•
Maintain a high level of suspicion, as prolonged use of ertapenem sodium injection may result in overgrowth of nonsusceptible organisms.
Specific populations
Renal impairment
CrCl 30-50 mL/min
•
Use acceptable. No dose adjustment required.
CrCl 10-30 mL/min
•
Reduce dose by 0-50%. Maximal dose of 50% of the dose, or 1 g 3 times a week. Not recommended by UK manufacturer due to lack of data in GFR<30 mL/min but a dose of 50% is recommended in US data sheet.
CrCl < 10 mL/min
•
Reduce dose by 50%. Maximal dose of 50% of the dose, or 1 g 3 times a week. Not recommended by UK manufacturer due to lack of data in GFR<30 mL/min but a dose of 50% is recommended in US data sheet.
Renal replacement therapy
Continuous renal replacement
•
Dose as in eGFR 10-30 mL/min/1.73 m². Reduce dose by 0-50%.
Intermittent hemodialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Reduce dose by 50%.
Peritoneal dialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Reduce dose by 50%.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Diarrhea, vomiting
Common 1-10%
•
Anemia, hypotension, ↑ liver enzymes, abdominal pain, confusion, constipation, cough, dizziness, dyspnea, fever, headache, injection site reactions, insomnia, itching, nausea, seizure, skin rash, somnolence, vaginitis
Uncommon < 1%
•
AF, acute pancreatitis, angioedema, bradycardia, candidiasis, cardiac arrest, cholelithiasis, ↓ serum potassium, depression, esophagitis, gastritis, gastrointestinal bleeding, gout, heart failure, hemorrhoids, hyperhidrosis, hypertension, ileus, ↑ BUN, ↑ blood glucose, ↑ serum TBIL, ↑ serum potassium, ↑ serum sodium, jaundice, oral ulcers, pulmonary embolism, pharyngitis, phlebitis, pleural effusion, pseudomembranous colitis, pyloric stenosis, arthralgia, asthenia, chest pain, chills, dry mouth, dysgeusia, dyspepsia, dysphagia, dysuria, fatigue, flank pain, flatulence, hematuria, hemoptysis, hiccups, hypoesthesia, loss of appetite, low urine output, malaise, muscle cramps, nosebleed, rhinorrhea, skin flushing, syncope, urinary frequency, urinary retention, vertigo, weight loss, sinus tachycardia, skin erythema, stomatitis, stroke, tremor, urticaria, VT, wheezing, wound dehiscence
Unknown frequency
•
Acute generalized exanthematous pustulosis, DRESS syndrome, delirium, dyskinesia, encephalopathy, myoclonus, hallucinations, tooth abnormalities, vasculitis
Interactions
Drug(s)
Check Interactions
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