From the Guidelines
Ertapenem is a broad-spectrum carbapenem antibiotic effective against many gram-positive, gram-negative, and anaerobic bacteria, providing excellent coverage against most Enterobacteriaceae, anaerobes, and many gram-positive organisms, but is less active against Pseudomonas aeruginosa, Acinetobacter species, and Enterococcus species. It maintains activity against many multi-drug resistant organisms due to its stability against most beta-lactamases 1. Ertapenem is typically administered as a once-daily 1g intravenous or intramuscular dose, making it convenient for outpatient parenteral antibiotic therapy 1. This antibiotic is particularly useful for complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, complicated urinary tract infections, and acute pelvic infections where Pseudomonas coverage is not required 1. Some key points to consider when using ertapenem include:
- Its once-daily dosing and spectrum make it an excellent option for treating serious community-acquired infections while avoiding unnecessary Pseudomonas coverage 1.
- The use of ertapenem should be limited to preserve the activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
- Ertapenem is not recommended for use in patients with hospital-acquired infections unless they have a known history of colonization or infection by extended-spectrum beta-lactamase-producing Enterobacteriaceae or ceftazidime-resistant P. aeruginosa, and severe sepsis or septic shock 1. The choice of empiric antibiotic regimens in patients with intra-abdominal infections should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1. In general, ertapenem is a valuable option for the treatment of complicated intra-abdominal infections, but its use should be guided by local resistance patterns and the specific clinical scenario 1.
From the FDA Drug Label
Ertapenem for injection is a penem antibacterial indicated in adult patients and pediatric patients (3 months of age and older) for the treatment of the following moderate to severe infections caused by susceptible bacteria: Complicated intra-abdominal infections. (1. 1) Complicated skin and skin structure infections, including diabetic foot infections without osteomyelitis. (1.2) Community-acquired pneumonia. (1.3) Complicated urinary tract infections including pyelonephritis. (1.4) Acute pelvic infections including postpartum endomyometritis, septic abortion and post-surgical gynecologic infections. (1. 5)
The coverage of ertapenem includes:
- Complicated intra-abdominal infections
- Complicated skin and skin structure infections, including diabetic foot infections without osteomyelitis
- Community-acquired pneumonia
- Complicated urinary tract infections, including pyelonephritis
- Acute pelvic infections, including postpartum endomyometritis, septic abortion, and post-surgical gynecologic infections 2
From the Research
Ertapenem Coverage
Ertapenem is a carbapenem antibiotic with a broad spectrum of activity against various bacteria, including:
- Gram-positive bacteria, such as Streptococcus pneumoniae and methicillin-susceptible Staphylococcus aureus 3, 4, 5
- Gram-negative bacteria, including Enterobacteriaceae, such as Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis 3, 4, 5, 6
- Anaerobic bacteria, including Bacteroides fragilis and Clostridium species 3, 4, 5, 6
Restrictions on Coverage
However, ertapenem has restricted activity against certain nosocomial pathogens, including:
- Pseudomonas aeruginosa 3, 7
- Acinetobacter species 3, 7
- Methicillin-resistant Staphylococcus aureus (MRSA) 3, 4
- Enterococci 3, 7
Clinical Uses
Ertapenem is suitable for the treatment of various infections, including: