What is the recommended dose and treatment duration of ertapenem (a carbapenem antibiotic) for urinary tract infections (UTIs) with impaired renal function?

From the Guidelines

For patients with urinary tract infections (UTIs) and impaired renal function, ertapenem dosing should be adjusted to 500 mg once daily for those with creatinine clearance less than 30 mL/min/1.73m². The treatment duration for UTIs can vary based on the syndrome and antimicrobial class used, but for β-lactams like ertapenem, a duration of 7 days is recommended for adult pyelonephritis 1. Key considerations for ertapenem use in UTIs include:

• Dose adjustment for renal impairment to prevent accumulation and potential toxicity
• Effectiveness against ESBL-producing organisms, which are often resistant to other antibiotics
• Monitoring for side effects, particularly in patients with severe renal impairment or CNS disorders
• Importance of adequate hydration to help clear the infection and reduce kidney stress
• Concentration of ertapenem in urine, which enhances its effectiveness for urinary tract infections Given the lack of specific guidance on ertapenem dosing for UTIs in the provided evidence, clinical judgment and consideration of the patient's renal function and infection severity are crucial for determining the optimal dose and treatment duration 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosing considerations should be made in adults with advanced or end-stage renal impairment and those on hemodialysis. (2.4,2. 5) Treatment regimen: Adults and pediatric patients 13 years of age and older. The dosage should be 1 gram once a day intravenously or intramuscularly. (2.2) Renal Impairment: Dose adjustment is necessary, if creatinine clearance is ≤30 mL/min/1.

The recommended dose of ertapenem for urinary tract infections (UTIs) in adults with normal renal function is 1 gram once a day intravenously or intramuscularly. However, for adults with impaired renal function, specifically those with creatinine clearance ≤30 mL/min/1, dose adjustment is necessary. The exact dose adjustment for impaired renal function is not specified in the provided drug label text, but it is indicated that considerations should be made for adults with advanced or end-stage renal impairment and those on hemodialysis 2.

From the Research

Ertapenem Dosing for UTI

• The recommended dose and treatment duration of ertapenem for urinary tract infections (UTIs) can vary depending on the severity of the infection and the patient's renal function.
• According to the studies, ertapenem is effective in treating UTIs caused by extended-spectrum β-lactamase (ESBL)-producing bacteria, with a mean duration of treatment ranging from 7-14 days 3, 4.
• For adults with complicated UTIs, the recommended dose of ertapenem is 1g once daily, with a median duration of parenteral therapy of 4 days and a total therapy duration of 13 days 5.
• In patients with impaired renal function, the efficacy of ertapenem may be affected, with a prolonged time to negative urine cultures (>3 days) in those with decreased renal function and alkaline urinary pH 6.
• Ertapenem can be administered intravenously or subcutaneously, with a retrospective study showing that subcutaneous injections were effective in treating UTIs caused by ESBL-producing enterobacteriaceae 7.

Treatment Duration and Renal Function

• The treatment duration of ertapenem for UTIs can vary depending on the severity of the infection and the patient's renal function.
• Studies have shown that ertapenem is effective in treating UTIs caused by ESBL-producing bacteria, with a mean duration of treatment ranging from 7-14 days 3, 4.
• In patients with impaired renal function, the dose of ertapenem may need to be adjusted, with a recommended dose of 500mg once daily for patients with creatinine clearance (CrCl) of 30-50 mL/min 6.
• The efficacy of ertapenem in patients with impaired renal function may be affected, with a prolonged time to negative urine cultures (>3 days) in those with decreased renal function and alkaline urinary pH 6.

Efficacy and Safety

• Ertapenem has been shown to be effective in treating UTIs caused by ESBL-producing bacteria, with a high cure rate and minimal adverse effects 3, 4, 5.
• The safety and efficacy of ertapenem in patients with impaired renal function have been evaluated, with studies showing that ertapenem is well-tolerated and effective in this population 6, 7.
• However, the efficacy of ertapenem may be affected by the presence of renal insufficiency and alkaline urinary pH, with a prolonged time to negative urine cultures (>3 days) in these patients 6.