From the Guidelines
For pneumonia, meropenem is generally preferred over ertapenem, especially for severe or hospital-acquired pneumonia, due to its broader coverage against Pseudomonas aeruginosa and other resistant gram-negative pathogens. Meropenem (1g IV every 8 hours) offers this broader coverage that ertapenem lacks 1. Ertapenem (1g IV once daily) can be appropriate for community-acquired pneumonia when Pseudomonas is not a concern, and its once-daily dosing may improve compliance and reduce healthcare costs. When selecting between these carbapenems, consider the likely pathogens based on the pneumonia type (community vs. hospital-acquired), local resistance patterns, and patient factors such as recent antibiotic exposure.
Key Considerations
- Meropenem penetrates lung tissue well and has demonstrated efficacy in severe respiratory infections 1.
- For patients with renal impairment, both medications require dose adjustment.
- If Pseudomonas is suspected or confirmed, meropenem is the necessary choice, while ertapenem may be sufficient and more convenient for less severe community-acquired pneumonia without risk factors for resistant pathogens.
Recommendations
- For severe or hospital-acquired pneumonia, use meropenem (1g IV every 8 hours) as the preferred carbapenem option due to its broader coverage against resistant gram-negative pathogens, including Pseudomonas aeruginosa 1.
- For community-acquired pneumonia without risk factors for resistant pathogens, ertapenem (1g IV once daily) may be considered for its convenience and potential to reduce healthcare costs, but always consider local resistance patterns and patient-specific factors 1.
From the Research
Ertapenem vs Meropenem for Pneumonia
- There are no direct comparisons between ertapenem and meropenem for pneumonia in the provided studies.
- However, the studies provide information on the efficacy and safety of meropenem in treating various types of pneumonia, including hospital-acquired pneumonia, ventilator-associated pneumonia, and community-acquired pneumonia 2, 3, 4, 5, 6.
- Meropenem has been shown to be effective in treating pneumonia caused by Gram-negative bacteria, including Pseudomonas aeruginosa, and has been compared to other antibiotics such as cefepime and cefiderocol 3, 4, 5, 6.
- The studies suggest that meropenem is a suitable option for the treatment of pneumonia, including nosocomial pneumonia, and has a favorable safety profile 2, 3, 4, 5, 6.
- However, the emergence of antimicrobial resistance during meropenem treatment is a concern, and strategies such as regimen intensification and combination therapy may be necessary to mitigate this risk 4.
Meropenem Efficacy and Safety
- Meropenem has been shown to be effective in treating various types of pneumonia, including hospital-acquired pneumonia, ventilator-associated pneumonia, and community-acquired pneumonia 2, 3, 4, 5, 6.
- The drug has a broad spectrum of activity against Gram-positive and Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae 2.
- Meropenem has been compared to other antibiotics, including cefepime and cefiderocol, and has been shown to be non-inferior in terms of efficacy and safety 5, 6.
- The safety profile of meropenem is favorable, with the most common adverse events being urinary tract infection and hypokalaemia 6.
Resistance and Treatment Strategies
- The emergence of antimicrobial resistance during meropenem treatment is a concern, and strategies such as regimen intensification and combination therapy may be necessary to mitigate this risk 4.
- A study using a rabbit lung infection model found that increasing meropenem monotherapy demonstrated a dose-response effect to bacterial kill and an inverted U relationship with emergent resistance 4.
- The addition of amikacin to meropenem suppressed the emergence of resistance, and a network of porin loss, efflux upregulation, and increased expression of AmpC was identified as the mechanism of this emergent resistance 4.