Duration of Ertapenem IV Therapy
For most infections, ertapenem should be administered for 5-14 days depending on the infection type, with typical durations of 5-7 days for intra-abdominal infections, 7-14 days for skin/soft tissue infections, and 10-14 days for pneumonia and complicated urinary tract infections. 1
Standard Treatment Durations by Infection Type
Intra-Abdominal Infections
- 5-14 days total duration for complicated intra-abdominal infections 1
- 3-day regimens are effective for localized, mild-to-moderate community-acquired peritonitis requiring surgical intervention 2, 3
- For patients with adequate source control who are immunocompetent and non-critically ill, 4 days of therapy is sufficient 4
- Immunocompromised or critically ill patients may require up to 7 days based on clinical condition and inflammatory markers 4
Complicated Urinary Tract Infections and Pyelonephritis
- 10-14 days total duration is recommended 1
- Median parenteral therapy duration is 4 days (range 2-14 days), with switch to oral therapy after ≥3 days if clinically improved 5, 6
- 5-7 days total duration is appropriate for uncomplicated cases 7
- Total treatment course (parenteral plus oral) typically averages 13-14 days 5, 6
Skin and Soft Tissue Infections
- 7-14 days for complicated skin and skin structure infections, including diabetic foot infections 1
- For hidradenitis suppurativa as rescue therapy, 6 weeks of daily ertapenem (1g IV) is recommended 8
Pneumonia
- 10-14 days total duration, with possible switch to oral therapy after ≥3 days of parenteral treatment once clinical improvement is demonstrated 1
- 5-7 days may be sufficient for patients who are afebrile for 48 hours and achieve clinical stability 7, 8
- For ICU-level pneumonia, 7 days as part of β-lactam-based combination therapy 8
Acute Pelvic Infections
- 3-10 days for postpartum endomyometritis, septic abortion, and post-surgical gynecologic infections 1
Bone and Joint Infections
- 6 weeks for vertebral osteomyelitis caused by Enterobacteriaceae 8
Dosing Specifications
Standard Adult Dosing
- 1 gram IV once daily for patients ≥13 years of age 1
- Infuse over 30 minutes 1
- Maximum duration for IV administration is 14 days 1
Pediatric Dosing (3 months to 12 years)
- 15 mg/kg twice daily (not to exceed 1g/day) 1
Renal Impairment
- No adjustment needed if creatinine clearance >30 mL/min/1.73 m² 1
- 500 mg daily for severe renal impairment (CrCl ≤30 mL/min/1.73 m²) 1
- Supplementary 150 mg dose if administered within 6 hours prior to hemodialysis 1
Critical Clinical Considerations
When NOT to Use Ertapenem
- Avoid in septic shock: Once-daily dosing is inadequate for critically ill patients in septic shock; use meropenem, doripenem, or imipenem/cilastatin with more frequent dosing instead 4, 8
- Lacks activity against Pseudomonas aeruginosa and Enterococcus species, unlike other carbapenems 9
Antimicrobial Stewardship
- Preferred over broader carbapenems (imipenem, meropenem) for ESBL-producing E. coli bacteremia without septic shock to preserve broader-spectrum agents 8
- For non-severe ESBL infections, consider alternatives like piperacillin/tazobactam or trimethoprim-sulfamethoxazole if susceptibility confirmed 8
Switching to Oral Therapy
- Patients can switch to appropriate oral agents after ≥3 days of parenteral therapy once clinical improvement is demonstrated 1, 5
- Ciprofloxacin is the most commonly used oral switch agent 5