ertapenem: clinical use

Prescribing considerations

• Confirm that the infection and likely organism fit the licensed indications and ertapenem spectrum; obtain cultures and review susceptibility whenever possible.
• Use within antimicrobial-stewardship controls because ertapenem is a UK Reserve antibiotic.
• Ertapenem does not provide reliable activity against Pseudomonas aeruginosa, Acinetobacter species, enterococci or methicillin-resistant staphylococci.
• Experience in severe infection is limited. Efficacy has not been established for diabetic foot infection with concurrent osteomyelitis or pneumonia caused by penicillin-resistant Streptococcus pneumoniae.
• Safety and efficacy are not established below three months of age.

Contraindications and cautions

• Hypersensitivity to ertapenem or an excipient
• Hypersensitivity to another carbapenem
• Previous severe hypersensitivity, such as anaphylaxis or a severe skin reaction, to another beta-lactam antibiotic
• The selected product should not be used in severe renal impairment or haemodialysis because evidence is inadequate

Monitoring

• Assess renal function, particularly in older people and anyone at risk of accumulation.
• Monitor for seizures, myoclonus, confusion, altered consciousness or other features of encephalopathy.
• Monitor for hypersensitivity, antibiotic-associated diarrhoea and superinfection.
• Review the intravenous-line site and relevant blood tests, including blood count and liver and renal markers.

Clinical pharmacology

Ertapenem is a highly protein-bound carbapenem that inhibits bacterial cell-wall synthesis through penicillin-binding proteins. It is largely recovered through the kidneys, undergoes limited hepatic metabolism and is unlikely to cause clinically important CYP-mediated interactions.

Formulation and product differences

• The selected product is a powder for concentrate for intravenous infusion and must be reconstituted and diluted before use.
• Use sodium chloride infusion fluid as specified; dextrose-containing fluids must not be used for reconstitution or administration.
• The vial is for single use and the product contains sodium.

Solution for infusion

Route: Intravenous

Strengths: 1 g