Ertapenem

General

• Type: Carbapenems
• Dosage Forms: IM, IV
• Common Trade Names: Invanz
• As opposed to meropenam, ertapenem does not cover Pseudomonas aeruginosa

Adult Dosing

General

• 1g IM/IV daily x 5-14 days
• First Dose: 1g IM/IV x 1

Specific Indications

• 1g IM/IV daily for all
• Intrabdominal infections x 5-14 days
• Skin Infections = x 7-14 days
• Pneumonia, community aquired x 10-14 days
• UTI, complicated = x 10-14 days
• Gynecologic = x 3-10 days
• Prophylaxis, colorectal surgery = x 1 dose

Pediatric Dosing

General (3mo-12 years)

• 30mg/kg/day IM/IV divided BID x 5-14 days
• First Dose: 15mg/kg IM/IV x 1
• Max: 1 g/day
• For duration, see adult specific indication dosing

General (>13 Years)

See adult dosing

Special Populations

• Pregnancy Rating: B
• Lactation: Safety unknown
• Renal Dosing
  • Adult
    • CrCl <30: 500mg daily
    • Hemodyalisis: give 150mg supplement if maintenance dose <6h prior
  • Pediatric
    • CrCl <30: decrease dose 50%
    • Hemodyalisis: give 150mg supplement if maintenance dose <6h prior
• Hepatic Dosing (Adult & Pediatric)
  • No data

Contraindications

• Allergy to class/drug
• Hypersensitivity to amide anesthetics (IM only)

Cautions

• Hypersensitivity to Beta-Lactam
• Seizure history
• CNS disorder
• Renal impairment
• Recent antibiotic associated colitis

Adverse Reactions

Serious

• Hypersensitivity Reaction
• Anaphylaxis
• Neurotoxicity
• Seizures
• C. diff
• Superinfection
• Extravasation with tissue damage
• Hallucinations
• Hypertension
• Tachycardia
• Drug rash with eosinophilia

Common

• Diarrhea
• Infusion site reaction
• Nausea and Vomiting
• Transaminitis
• Headache
• Fever
• Altered Mental Status
• Constipation
• Abdominal Pain
• Edema
• Insomnia
• Thrombocytosis
• Dyspnea
• Rash
• Dizziness
• Puritis
• Hypotension
• Vaginitis

Pharmacology

• Half-life: 4h
• Metabolism: CYP450
• Excretion: Urine (80%)
• Mechanism of Action: Bactericidal

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	S
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	S
	C. jeikeium	R
	L. monocytogenes	I
Gram Negatives	N. gonorrhoeae	X2
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	X1
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	S
	Bacteroides fragilis	S
	Prevotella melaninogenica	S
	Clostridium difficile	X2
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics

References

• Epocrates

Authors

Ross Donaldson, Kevin Lu, Neil Young, Daniel Ostermayer