Ertapenem


Generic Medicine Info
Indications and Dosage
Intravenous
Prophylaxis of surgical infections
Adult: 1 g as a single dose, to be given 1 hr before the surgery.

Parenteral
Community-acquired pneumonia, Intra-abdominal infections, Skin and skin structure infections, Urinary tract infections
Adult: 1 g once daily IM (for up to 7 days) or IV infusion over 30 min (for up to 14 days).
Child: 3 mth to 13 yr 15 mg/kg bid. Max: 1 g/day.
Renal Impairment
Patient undergoing haemodialysis: 500 mg/day; if daily dose given w/in 6 hr prior to haemodialysis, supplemental dose of 150 mg should be administered following the dialysis period.
CrCl Dosage
≤30 and ESRD 500 mg/day.
Reconstitution
IV: Dilute powd for inj in 10 mL of sterile water for inj, NaCl 0.9% inj or bacteriostatic water for inj then reconstituted soln should be further diluted w/ 50 mL NaCl 0.9%. IM: Reconstitute w/ 3.2 mL of lidocaine 1% inj (w/o epinephrine).
Incompatibility
Ertapenem Na should not be diluted or reconstituted w/ dextrose-containing soln or admixed w/ other medications. Y-site: Anidulafungin, caspofungin.
Contraindications
Hypersensitivity to ertapenem, other carbapenems; history of anaphylactic reaction to β-lactams (e.g. penicillins, cephalosporins). Known hypersensitivity to local anaesth of the amide type due to use of lidocaine as diluent in IM use.
Special Precautions
Patient w/ known or suspected CNS disorders (e.g. brain lesions, history of seizures). Renal impairment. Pregnancy and lactation.
Adverse Reactions
Drug rash w/ eosinophilia and systemic symptoms (DRESS), pruritus, diarrhoea, nausea, vomiting, infused vein complication, phlebitis or thrombophlebitis, headache, muscular weakness, gait disturbance, abnormal coordination, vaginitis; elevations in ALT, AST, alkaline phosphatase and platelet count. Dry mouth, taste disturbances, dyspepsia, abdominal pain, anorexia, constipation, melaena, bradycardia, hypotension, chest pain, oedema, pharyngeal discomfort, dyspnoea, dizziness, sleep disturbances, confusion, asthenia, seizures, raised glucose, petechiae.
Potentially Fatal: Hypersensitivity reactions (e.g. anaphylaxis), Clostridium difficile-associated colitis.
IM/IV/Parenteral: B
Monitoring Parameters
Periodic renal, hepatic and haematopoietic assessment during prolonged therapy. Monitor signs of hypersensitivity reactions, neurologic status.
Drug Interactions
May decrease plasma levels of valproic acid thus, increasing the risk of seizures. Increased plasma concentrations w/ probenecid.
Action
Description: Ertapenem is a synthetic carbapenem β-lactam antibiotic which inhibits bacterial cell wall synthesis binding to 1 or more penicillin-binding proteins (PBPs). It is active against gm+ve and gm-ve aerobic and anaerobic bacteria and stable against hydrolysis by dehydropeptidase 1 (DHP 1).
Pharmacokinetics:
Absorption: Almost completely absorbed following IM admin. Bioavailability: Approx 90% (IM). Time to peak plasma concentration: Approx 2.3 hr (IM).
Distribution: Distributed into breast milk. Volume of distribution: Approx 0.2 L/kg (3 mth to 12 yr); approx 0.16 L/kg (13-17 yr); approx 0.12 L/kg (adult). Plasma protein binding: >90% (mainly albumin).
Metabolism: Partially metabolised via hydrolysis of its β-lactam ring by DHP 1 to an open-ringed metabolite.
Excretion: Via urine (approx 80% as unchanged drug and metabolite); faeces (approx 10%). Plasma half-life: 2.5 hr (infants and childn 3 mth to 12 yr); approx 4 hr (adult).
Chemical Structure

Chemical Structure Image
Ertapenem

Source: National Center for Biotechnology Information. PubChem Database. Ertapenem, CID=150610, https://pubchem.ncbi.nlm.nih.gov/compound/Ertapenem (accessed on Jan. 22, 2020)

Storage
Reconstituted soln: Store at 25°C (for 6 hr) or refrigerate between 2-8°C (for 24 hr). Do not freeze.
MIMS Class
References
Anon. Ertapenem. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 28/04/2014.

Buckingham R (ed). Ertapenem sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com/. Accessed 28/04/2014.

Invanz For Injection. U.S. FDA. https://www.fda.gov/. Accessed 28/04/2014.

Joint Formulary Committee. Ertapenem. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com/. Accessed 28/04/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Ertapenem sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com/. Accessed 28/04/2014.

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