What is the recommended dose of Ertapenem (generic name) for Intravenous (IV) infusion?

Ertapenem IV Dosing Recommendations

The standard adult dose of ertapenem for IV infusion is 1 gram once daily. 1, 2

Adult Dosing

Standard Dosing

• Adults: 1 gram IV once daily 1, 3
• Duration: Typically 5-14 days depending on the infection type 3
• Administration: Infuse over 30 minutes after reconstitution 1

Special Populations

• Renal Impairment:
  • CrCl ≤30 mL/min: Reduce to 500 mg once daily 1
  • Hemodialysis patients: 500 mg daily, but caution is advised due to risk of CNS toxicity 4
• Hepatic Impairment: No dosage adjustment required 1
• Elderly: No dosage adjustment required based on age alone, but consider renal function 1

Pediatric Dosing

• Children 3 months to 12 years: 15 mg/kg IV every 12 hours (not to exceed 1 g/day) 1, 3
• Children 13 years and older: 1 gram IV once daily (adult dose) 1, 3
• Not recommended for infants under 3 months of age 1

Administration Guidelines

1. Reconstitute with appropriate diluent
2. Transfer to 50 mL 0.9% Sodium Chloride Injection
3. Infuse over 30 minutes 1
4. Chemical stability: Limited stability at room temperature (6 hours) or refrigerated (24 hours, then 4 hours at room temperature) 1

Clinical Applications

Ertapenem is particularly useful for:

• Complicated intra-abdominal infections 3, 5
• Community-acquired pneumonia 3
• Complicated urinary tract infections 1
• Skin and soft tissue infections 1
• Acute pelvic infections 1
• Aspiration pneumonia (due to anaerobic coverage) 3
• Infections with suspected ESBL-producing organisms 2

Important Considerations

• Loading Dose: A loading dose identical to the standard dose should be administered before starting maintenance dosing 3
• Outpatient Therapy: Ertapenem's once-daily dosing makes it convenient for outpatient parenteral antimicrobial therapy 3, 2
• Antimicrobial Spectrum: Not active against Pseudomonas aeruginosa, Acinetobacter species, MRSA, or enterococci 2
• Stability Issues: Carbapenems have limited stability (ertapenem: 6-12 hours depending on concentration) at 25°C, which may affect administration scheduling 3

Potential Adverse Effects

• Monitor for CNS toxicity (seizures, hallucinations, cognitive dysfunction), especially in hemodialysis patients 4
• Other common adverse effects include diarrhea, nausea, headache, and infusion site reactions 1

Clinical Pearls

• Ertapenem has been shown to be effective as monotherapy, eliminating the need for combination therapy in many cases 5
• The subcutaneous route may be an alternative to IV administration in certain situations, particularly for outpatient therapy 6
• For severe infections or higher MICs, twice-daily dosing may be considered to optimize PK/PD target attainment 6

By following these dosing recommendations, you can optimize the efficacy of ertapenem while minimizing the risk of adverse effects.