What is the treatment for Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) Urinary Tract Infection (UTI) in children using Ertapenem?

From the Guidelines

Ertapenem is an effective treatment for Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) Urinary Tract Infection (UTI) in children, administered at a dose of 15 mg/kg twice daily (not to exceed 1 g/day) for children 3 months to 12 years, and 1 g/day for children 13 years and older, as recommended by the guidelines 1.

Treatment Considerations

When treating ESBL-producing E. coli UTIs in children with Ertapenem, it is essential to consider the following:

• The dosage is based on normal renal and hepatic function, and the dose in mg/kg should be based on total body weight 1.
• Ertapenem must be administered intravenously or intramuscularly, often requiring hospitalization initially, though some patients may transition to outpatient parenteral antibiotic therapy.
• The typical treatment duration is 7-14 days, depending on infection severity.
• Before starting treatment, urine culture with antimicrobial susceptibility testing should be performed to confirm the diagnosis and ensure appropriate antibiotic selection 1.
• While treating, adequate hydration should be maintained, and follow-up urine cultures may be necessary to confirm infection clearance.

Alternative Antibiotics

Alternative antibiotics like meropenem or imipenem may be considered based on susceptibility testing, and oral options such as fosfomycin or nitrofurantoin might be appropriate for uncomplicated lower UTIs if the organism shows susceptibility.

Key Points

• Ertapenem is a carbapenem antibiotic that remains stable against ESBL-producing organisms 1.
• The guidelines recommend maximizing β-Lactam antibiotic dosages if undrained intra-abdominal abscesses may be present 1.
• Antibiotic serum concentrations and renal function should be monitored, especially when using antibiotics like gentamicin or tobramycin 1.

From the FDA Drug Label

1. 4 Complicated Urinary Tract Infections Including Pyelonephritis Ertapenem for Injection is indicated for the treatment of adult patients and pediatric patients (3 months of age and older) with complicated urinary tract infections including pyelonephritis due to Escherichia coli, including cases with concurrent bacteremia, or Klebsiella pneumoniae.

The treatment for Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) Urinary Tract Infection (UTI) in children using Ertapenem is not directly addressed in the FDA drug label. However, Ertapenem is indicated for the treatment of complicated urinary tract infections, including pyelonephritis, due to Escherichia coli.

• The dose of Ertapenem for Injection in patients 3 months to 12 years of age is 15 mg/kg twice daily (not to exceed 1 g/day) 2.
• It is essential to note that the FDA drug label does not explicitly mention the effectiveness of Ertapenem against ESBL-producing E. coli.
• When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy 2.

From the Research

Treatment Options for ESBL E. coli UTI in Children using Ertapenem

• Ertapenem is a carbapenem antibiotic that can be used to treat Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) Urinary Tract Infections (UTIs) in children 3, 4.
• However, the use of carbapenems, including ertapenem, should be limited to severe or complicated infections, and alternative treatment options should be considered for uncomplicated UTIs 4.
• Other treatment options for ESBL E. coli UTIs in children include:
  • Oral antibiotics such as nitrofurantoin, fosfomycin, and pivmecillinam, which have been shown to be effective against ESBL-producing E. coli 5, 6.
  • Combination therapy with oral cephalosporins and amoxicillin/clavulanate, which has been shown to be effective in some studies 6.
• A study comparing fosfomycin tromethanol and carbapenems (including meropenem and imipenem/cilastatin) for the treatment of ESBL-producing E. coli-related complicated lower urinary tract infections found similar clinical and microbiological success rates between the two groups 7.
• The choice of treatment should be based on the severity of the infection, the susceptibility of the organism, and the patient's clinical condition, as well as local resistance patterns and treatment guidelines 3, 4.

Ertapenem Specifics

• Ertapenem is a once-daily carbapenem antibiotic that has been shown to be effective against ESBL-producing E. coli 3, 4.
• It is typically used for the treatment of complicated intra-abdominal infections, complicated skin and skin structure infections, and community-acquired pneumonia, as well as for the treatment of UTIs caused by ESBL-producing organisms 3, 4.
• The use of ertapenem should be reserved for severe or complicated infections, and alternative treatment options should be considered for uncomplicated UTIs 4.

Considerations for Children

• The treatment of ESBL E. coli UTIs in children should be guided by local resistance patterns and treatment guidelines, as well as the severity of the infection and the patient's clinical condition 3, 4.
• The use of carbapenems, including ertapenem, should be limited to severe or complicated infections, and alternative treatment options should be considered for uncomplicated UTIs 4.