Ertapenem Dosing for Contaminated Colon Surgery
For contaminated colon surgery, ertapenem should be administered at a dose of 1 g intravenously once daily. 1
Indications and Rationale
- Ertapenem 1 g once daily is specifically recommended for patients with inadequate/delayed source control or those at high risk of infection with community-acquired ESBL-producing Enterobacterales in intra-abdominal infections 1
- Ertapenem has demonstrated efficacy in intra-abdominal infections with a broad spectrum of activity against common aerobic and anaerobic pathogens encountered in contaminated colon surgery 2
- The 1 g once-daily dosing regimen provides adequate tissue penetration into colorectal tissue for up to 8.5 hours after administration 3
Administration Guidelines
- Administer ertapenem 1 g intravenously over 30 minutes 4
- For surgical prophylaxis, administer within 1 hour before the surgical incision 4, 5
- For treatment of established infection, continue therapy for 4 days in immunocompetent and non-critically ill patients if source control is adequate 1
- For immunocompromised or critically ill patients, extend therapy up to 7 days based on clinical condition and inflammatory markers 1
Special Considerations
For patients in septic shock, consider alternative carbapenems with more frequent dosing:
- Meropenem 1 g q6h by extended infusion or continuous infusion
- Doripenem 500 mg q8h by extended infusion or continuous infusion
- Imipenem/cilastatin 500 mg q6h by extended infusion 1
Single-dose ertapenem has shown improved compliance with surgical antibiotic prophylaxis guidelines compared to multiple-dose regimens 6
Pharmacokinetic Considerations
- Ertapenem has a plasma half-life of approximately 4 hours in healthy volunteers 2
- The drug achieves peak tissue concentrations of 6.4 ± 2.3 mg/kg in colorectal tissue 3
- For patients with body mass index ≥ 20 kg/m², consider more frequent dosing to ensure adequate tissue concentrations 7
Clinical Evidence
- Ertapenem has demonstrated equivalence to piperacillin/tazobactam in clinical trials for intra-abdominal infections 4, 2
- In a study evaluating ertapenem for prophylaxis of surgical site infections in elective colorectal surgery, the success rate was 70.5% compared to 57.2% for cefotetan 4
- A Chinese multicenter study showed that ertapenem was as effective as ceftriaxone/metronidazole for surgical site infection prophylaxis in elective colorectal surgery 5
Antimicrobial Stewardship Considerations
- While ertapenem provides excellent coverage against ESBL-producing Enterobacterales, it has limited activity against Pseudomonas aeruginosa, Acinetobacter species, and enterococci 2, 7
- Consider local antimicrobial resistance patterns when selecting ertapenem for contaminated colon surgery 2
- Monitor for development of resistance, although carbapenemases remain relatively rare after many years of carbapenem use 2