Ertapenem Dosing in CKD Stage 3b Patients
For patients with CKD stage 3b (eGFR 30-44 mL/min/1.73m²), the recommended dose of ertapenem is 1 gram once daily, with no dose adjustment required since this falls within the creatinine clearance >30 mL/min/1.73m² category. 1
Dosing Guidelines Based on Renal Function
- For patients with creatinine clearance >30 mL/min/1.73m², the standard dose of 1 gram once daily is recommended 1
- For patients with severe renal impairment (creatinine clearance ≤30 mL/min/1.73m²) and end-stage renal disease (creatinine clearance ≤10 mL/min/1.73m²), the dose should be reduced to 500 mg daily 1
- For hemodialysis patients receiving the 500 mg daily dose, a supplementary dose of 150 mg is recommended if ertapenem is administered within 6 hours prior to hemodialysis 1
Administration Considerations
- Ertapenem should be infused intravenously over a period of 30 minutes 1
- Intramuscular administration may be used as an alternative to intravenous administration in appropriate cases 1
- When administered intravenously, ertapenem must be reconstituted and then diluted prior to administration 1
Safety Considerations in CKD
- Ertapenem has been associated with central nervous system (CNS) toxicity in patients with advanced kidney disease, particularly those on hemodialysis 2, 3
- Symptoms of CNS toxicity may include seizures, hallucinations, and cognitive dysfunction 2
- These adverse effects typically resolve within days after discontinuation of the medication 2
Special Considerations for More Advanced CKD
- For patients progressing to more severe renal impairment (CKD stage 4-5), close monitoring for signs of CNS toxicity is warranted 3
- In hemodialysis patients, some studies suggest that the recommended 500 mg daily dose may still be excessive, particularly in patients with smaller body size 2
- Alternative dosing strategies such as thrice weekly administration after hemodialysis sessions have been studied and may maintain adequate plasma concentrations while reducing toxicity risk 4
Monitoring Recommendations
- Monitor for signs of CNS toxicity including confusion, hallucinations, myoclonic jerks, and seizures, especially in patients with worsening renal function 2, 3
- Consider more frequent clinical assessment during the first few days of therapy to detect early signs of adverse effects 3
- If CNS symptoms develop, consider discontinuation of ertapenem and switching to an alternative antimicrobial agent 2
Pharmacokinetic Considerations
- Ertapenem is primarily eliminated by the kidneys, with approximately 30% cleared during a hemodialysis session 2
- The elimination half-life is prolonged in patients with renal impairment 5
- In patients with complicated urinary tract infections, high urinary concentrations of ertapenem can be achieved, which may be beneficial for treating urinary tract pathogens 5