ertapenem

Action and Spectrum

Mechanism of action 

ertapenem works by inhibiting the bacterial cell wall synthesis, which is essential for the structural integrity and survival of bacteria. By inhibiting the synthesis of the cell wall, ertapenem prevents the bacteria from growing and multiplying, leading to their death 

Spectrum 

ertapenem has a broad spectrum of activity and is effective against a wide range of gram-negative and gram-positive bacteria, including Enterobacter, Escherichia coli, Klebsiella, and Pseudomonas. It is also effective against anaerobic bacteria, which are bacteria that can survive in the absence of oxygen. However, ertapenem is ineffective against viruses or fungi and should not be used to treat infections caused by these organisms. 

Drug Interaction

Adverse Reaction

Frequency defined:  

>10% 

Diarrhea 

1-10% 

Nausea 

Infused vein complications 

Increased alkaline phosphatase 

Fever 

Vomiting 

Insomnia 

Drug rash with eosinophilia 

Vaginitis 

Phlebitis 

tachycardia 

eosinophilia 

erythema 

chest pain 

fatigue 

oral candidiasis 

elevated liver function tests 

headache 

increased platelet count 

altered mental status 

abdominal pain 

constipation 

swelling 

rash 

dizziness 

pruritis 

acid regurgitation 

hypotension 

hypertension 

dyspepsia 

anxiety 

Post-marketing reports 

Muscular weakness 

Nervous system disorders 

Altered mental status 

Hypersensitivity vasculitis 

Anaphylactoid reactions 

Black Box Warning

Contraindication / Caution

Contraindications 

• ertapenem is contraindicated in individuals who have known hypersensitivity (allergy) to ertapenem or other carbapenem antibiotics. 
• ertapenem should also be used with caution in individuals with a history of hypersensitivity reactions to other medications. They may be more likely to experience an allergic reaction to ertapenem. 
• ertapenem should not be used in individuals with severe kidney impairment, as it is eliminated from the body mainly through the kidneys. In these individuals, the dosage of ertapenem may need to be adjusted, or alternative treatment may be necessary. 

Caution 

• Allergic reactions: It may cause allergic reactions, including rash, hives, and difficulty breathing. If you experience these symptoms, stop taking ertapenem and seek medical attention immediately. 
• Renal impairment: It is eliminated from the body mainly through the kidneys, so it should be used with caution in individuals with kidney impairment. The dosage of ertapenem may need to be adjusted, or alternative treatment may be necessary for these individuals. 
• Pregnancy and breast-feeding: It should be used with caution in pregnant women and nursing mothers, as the safety of ertapenem during pregnancy and breastfeeding has not been established. It is important to discuss the potential risks and benefits of ertapenem with a healthcare provider before using it during pregnancy or while breastfeeding. 
• Antibiotic resistance: It is important to use ertapenem only when it is indicated and to complete the full course of treatment to prevent the development of antibiotic resistance. 
• Other medications: It may interact with certain medications, so you must inform your healthcare provider about all the medications you are taking before starting treatment with ertapenem. 
• Proper dosing: It is essential to follow the dosing instructions provided by your healthcare provider and not to take more or less of the medication than prescribed. Taking too much or too little of the medication may reduce its effectiveness or increase the risk of side effects. 

Pregnancy / Lactation

Pregnancy consideration: Insufficient data available 

Lactation: Excretion of the drug in human breast milk is known 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology 

ertapenem (trade name Invanz) is a broad-spectrum injectable antibiotic used to treat various bacterial infections, including urinary tract infections, skin infections, and infections of the abdomen, pelvis, and lower respiratory tract. It belongs to a class of antibiotics called carbapenems, which are known for their effectiveness against a wide range of bacteria, including many that are resistant to other types of antibiotics.  

Pharmacodynamics 

It is a broad-spectrum injectable antibiotic used to treat a variety of bacterial infections. It belongs to a class of antibiotics called carbapenems, which are known for their effectiveness against a wide range of bacteria, including many that are resistant to other types of antibiotics. 

Pharmacokinetics 

• Absorption: It is absorbed well by intramuscular (IM) injection, with a bioavailability of 90%. This means that 90% of the medication reaches the bloodstream after it is injected. The peak plasma time, or the time it takes for the medication to reach its highest concentration in the blood, is 2.3 hours after IM injection. 
• Distribution: It is widely distributed in the body and is highly protein bound, meaning that it binds to proteins in the blood. The extent of protein binding depends on the concentration of the medication in the blood: at concentrations of 300 mcg/mL or higher, 85% of ertapenem is protein bound, while at concentrations of less than 100 mcg/mL, 95% is protein bound. The volume of distribution (Vd), which measures how widely the medication is distributed in the body, is 0.2 L/kg in children 3 months to 12 years old, 0.16 L/kg in adolescents 13 to 17 years old, and 0.12 L/kg in adults. 
• Metabolism: It is hydrolyzed, or broken down, into an inactive metabolite in the body. 
• Elimination: It is eliminated from the body mainly through the kidneys, with 80% of the medication excreted in the urine as an unchanged drug and metabolite and 10% excreted in the feces. The half-life of ertapenem, or the time it takes for the concentration of the medication in the body to be reduced by half, is 2.5 hours in children three months to 12 years old, and 4 hours in individuals over 12 years old 

Adminstartion

Administration 

• IV incompatibilities: ertapenem should not be mixed with other medications or diluted with dextrose solutions. 
• IV preparation: ertapenem should be reconstituted by mixing the contents of a 1 g vial with 10 mL of sterile water for injection (SWI), normal saline (NS), or bacteriostatic water for injection (BWI). The solution should be shaken and transferred to a 50 mL NS bag for infusion. 
• IV administration: ertapenem should be infused over 30 minutes. 
• IM preparation: ertapenem can also be given by intramuscular (IM) injection, but it must be reconstituted with 3.2 mL of 1% lidocaine injection (without epinephrine). The solution should be shaken well and used within 1 hour after preparation. 
• IM administration: the IM preparation of ertapenem should be injected deep into a large muscle mass, such as the gluteal muscle or the lateral part of the thigh. It is essential to ensure the patient does not have an allergy to lidocaine or other amide anesthetics before administering the IM preparation. The IM preparation should not be given intravenously. 
• Storage: before reconstitution, ertapenem should be stored at a temperature below 25°C (77°F). The reconstituted IV solution can be stored at room temperature for up to 6 hours or in the refrigerator for up to 24 hours. If the reconstituted IV solution is refrigerated, it should be used within 4 hours after removal from the refrigerator. ertapenem should not be frozen. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ertapenem 

Pronounced: [ er-ta-PEN-em ] 

Why do we use ertapenem? 

ertapenem is a broad-spectrum injectable antibiotic used to treat a variety of bacterial infections, including: 

• Urinary tract infections: ertapenem is used to treat urinary tract infections, including bladder and kidney infections. 
• Skin infections: ertapenem is used to treat infections of the skin and soft tissues, including abscesses and wounds. 
• Abdominal and pelvic infections: ertapenem is used to treat infections of the abdomen and pelvis, including infections of the appendix, colon, and rectum. 
• Lower respiratory tract infections: ertapenem is used to treat lower respiratory tract infections, including pneumonia and bronchitis