Ertapenem

Welcome to Dwaey, specifically on Ertapenem page.
This medicine contains important and useful components, as it consists of
Ertapenem is available in the market in concentration.

Generic Name of Ertapenem - Learn More

Ertapenem

Ertapenem Precaution - What You Need to Know

Ertapenem is a broad-spectrum intravenous and intramuscular carbapenem antibiotic used to treat a variety of bacterial infections. Caution is necessary in patients with a history of hypersensitivity to beta-lactam antibiotics, such as penicillins or cephalosporins, as cross-reactivity may occur, leading to allergic reactions ranging from mild rashes to anaphylaxis. Prior to initiation, a thorough allergy history should be assessed to rule out severe reactions. Additionally, patients with a history of seizures or those with central nervous system disorders should be monitored closely, as carbapenems, including ertapenem, may lower the seizure threshold and increase the risk of seizures.

Patients with renal impairment require dosage adjustments based on their glomerular filtration rate (GFR). In such cases, monitoring of renal function is necessary, and the dosage should be reduced to avoid drug accumulation, which could lead to toxicity. Ertapenem should be used with caution in pregnant women, as there is limited data on its safety in pregnancy. It should only be used during pregnancy if the benefits outweigh the risks. Similarly, it should be avoided in breastfeeding mothers unless absolutely necessary, as it is excreted into breast milk.

Patients with gastrointestinal disease, especially those with a history of colitis, should be closely monitored due to the risk of developing Clostridium difficile-associated diarrhea. The drug should be discontinued immediately if such an infection is suspected.

Ertapenem Indication - Uses and Benefits

Ertapenem is indicated for the treatment of moderate to severe infections caused by susceptible organisms. These infections include intra-abdominal infections (such as complicated appendicitis and peritonitis), urinary tract infections, skin and soft tissue infections, community-acquired pneumonia, pelvic infections, and as part of the treatment regimen for diabetic foot infections. Ertapenem is also approved for the prevention of surgical infections in certain high-risk patients undergoing elective colorectal surgery.

Ertapenem is preferred in the treatment of infections caused by Gram-negative and Gram-positive organisms, including extended-spectrum beta-lactamase (ESBL)-producing bacteria, and certain anaerobes. It is not effective against methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, or Acinetobacter species, which limits its scope in certain severe infections.

Off-label uses include the treatment of infections in immunocompromised patients and in complicated infections where multidrug-resistant organisms may be present. However, it is important to confirm the specific bacterial strain’s susceptibility to ertapenem to ensure its efficacy.

Ertapenem Contraindications - Important Warnings

Ertapenem is contraindicated in patients with known hypersensitivity to carbapenems, including ertapenem itself, or other beta-lactam antibiotics, due to the risk of severe allergic reactions, including anaphylaxis. Additionally, it should not be used in patients who have had a history of significant allergic reactions to other beta-lactam antibiotics, such as cephalosporins or penicillins, as cross-reactivity may occur.

Ertapenem is also contraindicated in patients with a history of seizures, as carbapenems have been associated with a lowered seizure threshold, particularly in patients with central nervous system disorders or those predisposed to seizures. For these individuals, alternative antibiotics with a safer profile for seizure-prone patients should be considered.

In pregnant women, ertapenem should only be used if the potential benefit outweighs the potential risks, as there is limited evidence on its safety during pregnancy. It is also contraindicated in breastfeeding women unless the benefits outweigh the risks, as the drug may be excreted into breast milk, and its effects on the nursing infant are unknown.

Ertapenem Side Effects - What to Expect

Ertapenem is generally well tolerated, but like all antibiotics, it carries the potential for side effects. Common side effects include gastrointestinal disturbances such as nausea, vomiting, and diarrhea. Diarrhea, in particular, can be a sign of Clostridium difficile infection, a potentially life-threatening complication, and should be investigated immediately if suspected.

Skin reactions, including rash and pruritus, are also frequent. These reactions are generally mild, but in some cases, they can escalate to more serious conditions such as Stevens-Johnson syndrome or toxic epidermal necrolysis. In the event of severe skin reactions, ertapenem should be discontinued.

Less commonly, ertapenem can cause hematologic abnormalities such as thrombocytopenia or leukopenia. Monitoring of blood counts is recommended, especially during prolonged therapy. Other severe but rare side effects include hepatotoxicity (elevated liver enzymes) and renal dysfunction, which can occur more frequently in patients with pre-existing kidney conditions.

Seizures are a potential severe side effect, particularly in patients with central nervous system disorders or in those with a history of seizures. If seizures occur, ertapenem should be discontinued, and appropriate management should be initiated.

Ertapenem Pregnancy Category ID - Safety Information

2

Ertapenem Mode of Action - How It Works

Ertapenem exerts its antibacterial effect by inhibiting bacterial cell wall synthesis. It binds to penicillin-binding proteins (PBPs) in the bacterial cell membrane, which are responsible for cross-linking the peptidoglycan layer of the cell wall. By inhibiting this process, ertapenem weakens the cell wall, leading to bacterial cell lysis and death.

Ertapenem has a broad spectrum of activity against both Gram-positive and Gram-negative bacteria, including many that produce beta-lactamase enzymes. Its stability against beta-lactamase production allows it to be effective against many resistant strains of bacteria. However, it does not have activity against methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, or certain other multi-drug resistant organisms.

Ertapenem is bactericidal, meaning it kills bacteria rather than merely inhibiting their growth. This property makes it effective in treating severe infections and conditions requiring rapid bacterial eradication.

Ertapenem Drug Interactions - What to Avoid

Ertapenem has several potential drug-drug interactions that should be considered to ensure safety and efficacy. The most significant interactions involve drugs that alter renal function or that affect the metabolism of ertapenem. For instance, drugs that impair renal clearance (such as diuretics or nephrotoxic drugs) may increase ertapenem levels, raising the risk of toxicity. Conversely, drugs that enhance renal clearance, like certain antibiotics (e.g., rifampin), may reduce its efficacy.

Concurrent use of ertapenem with probenecid, which inhibits renal secretion, may lead to increased blood levels of ertapenem and thus increase the risk of side effects, including seizures. Therefore, the combination should be avoided or used with extreme caution.

Ertapenem can also interact with other antibiotics, especially other beta-lactam antibiotics or aminoglycosides, which may have additive effects on bacterial killing, but also increase the risk of nephrotoxicity. Caution is advised when using ertapenem in combination with other antimicrobial agents, and close monitoring of renal function is required.

Anticoagulants, such as warfarin, may have their effects potentiated when taken with ertapenem, possibly increasing the risk of bleeding. INR (International Normalized Ratio) should be closely monitored, and dose adjustments of anticoagulants might be necessary.

Ertapenem Adult Dose - Recommended Dosage

The typical adult dose of ertapenem for most infections is 1 gram administered intravenously (IV) or intramuscularly once daily. For severe infections or complicated intra-abdominal infections, a loading dose of 1 gram may be given initially, followed by the same daily dose. In patients with impaired renal function, the dose may need to be adjusted based on the patient’s creatinine clearance.

The duration of treatment varies depending on the infection, but it is generally between 5 to 14 days. For surgical prophylaxis, ertapenem is usually administered as a single dose of 1 gram before surgery.

In cases of complicated infections, such as diabetic foot infections or intra-abdominal infections, the treatment duration may be extended, and the patient should be monitored for resolution of symptoms and infection markers (e.g., fever, white blood cell count).

Ertapenem Child Dose - Dosage for Children

Ertapenem is not typically used in children under 3 months of age due to a lack of safety data. For children 3 months and older, the dose of ertapenem is usually 15 mg/kg (up to 1 gram) once daily, administered either intravenously or intramuscularly. This dosage may be adjusted in children with renal impairment, based on their creatinine clearance.

For children with complicated intra-abdominal infections or soft tissue infections, longer durations of therapy may be required, generally between 7 to 14 days depending on clinical response. Close monitoring for side effects, particularly gastrointestinal symptoms and blood counts, is important during therapy in the pediatric population.

Ertapenem Renal Dose - Dosage for Kidney Conditions

In patients with renal impairment, the dose of ertapenem should be adjusted to avoid drug accumulation and potential toxicity. The dose adjustment is based on the patient's creatinine clearance (CrCl):

- For CrCl > 30 mL/min: 1 gram IV or IM once daily.
- For CrCl 10-30 mL/min: 500 mg IV or IM once daily.
- For CrCl <10 mL/min: 500 mg IV or IM every 48 hours.

Patients undergoing hemodialysis may receive the standard 1-gram dose post-dialysis. It's essential to monitor renal function regularly in patients with renal impairment, as they may require further dose adjustments.