Ertapenem Dosing in Renal Impairment
For patients with severe renal impairment (creatinine clearance ≤30 mL/min/1.73 m²), reduce ertapenem to 500 mg once daily; if administered within 6 hours before hemodialysis, give a supplementary 150 mg dose after the dialysis session. 1
Standard Dosing for Normal Renal Function
- Adults and patients ≥13 years: 1 gram IV or IM once daily 1
- Pediatric patients 3 months to 12 years: 15 mg/kg twice daily (maximum 1 g/day) 1
- The standard 1 gram daily dose is supported by the Infectious Diseases Society of America for patients with creatinine clearance >30 mL/min/1.73 m² 2
Renal Impairment Dosing Algorithm
Step 1: Calculate creatinine clearance using the Cockcroft-Gault equation if only serum creatinine is available 1:
- Males: (weight in kg) × (140 - age) / [(72) × serum creatinine (mg/100 mL)]
- Females: 0.85 × (value calculated for males) 1
Step 2: Apply dose adjustment based on renal function:
- CrCl >30 mL/min/1.73 m²: No adjustment needed; use standard 1 gram daily 1
- CrCl ≤30 mL/min/1.73 m² (severe impairment): Reduce to 500 mg once daily 2, 1
- End-stage renal disease (CrCl ≤10 mL/min/1.73 m²): 500 mg once daily 1
Hemodialysis Considerations
Critical timing consideration: The relationship between ertapenem administration and hemodialysis timing determines supplementation needs 1:
- If ertapenem given within 6 hours before hemodialysis: Administer supplementary 150 mg dose following the dialysis session 2, 1
- If ertapenem given ≥6 hours before hemodialysis: No supplementary dose needed 1
This supplementation is necessary because hemodialysis removes a significant portion of the drug when administered shortly before the session 2.
Administration Guidelines
- IV infusion: Infuse over 30 minutes 1
- IM injection: May be used as alternative for up to 7 days (IV can be used up to 14 days) 1
- Do NOT mix or co-infuse with other medications 1
- Do NOT use diluents containing dextrose 1
Treatment Duration by Indication
The Infectious Diseases Society of America and other societies recommend the following durations 2, 1:
- Complicated UTI/pyelonephritis: 10-14 days 2, 1
- Complicated intra-abdominal infections: 5-14 days 1
- Complicated skin/skin structure infections: 7-14 days 1
- Community-acquired pneumonia: 10-14 days 1
- Acute pelvic infections: 3-10 days 1
Special Populations
Pediatric patients with renal impairment: No dosing data available; use with caution 1
Hepatic impairment: No dose adjustment recommendations can be made due to insufficient data 1
Peritoneal dialysis or hemofiltration: No data available for dosing guidance 1
Common Pitfalls to Avoid
- Failing to give post-dialysis supplementation when ertapenem is administered within 6 hours of hemodialysis leads to subtherapeutic levels 2, 1
- Using dextrose-containing diluents is contraindicated and may affect drug stability 1
- Administering reconstituted IM solution intravenously is inappropriate and potentially dangerous 1
- Assuming dose adjustments are needed for mild-moderate renal impairment (CrCl >30 mL/min) is incorrect; full dose should be maintained 1