What is the intravenous (IV) dose of Ertapenem?

From the Guidelines

The standard intravenous (IV) dose of ertapenem is 1 gram once daily, as recommended by the most recent guidelines 1. This dose is suitable for adults with normal renal function. For patients with renal impairment (creatinine clearance ≤30 mL/min), the dose should be reduced to 500 mg once daily. Ertapenem requires reconstitution with appropriate diluent before administration, typically with 10 mL of sterile water or normal saline for the initial reconstitution, followed by further dilution in 50-100 mL of normal saline for IV infusion. The duration of therapy depends on the type and severity of infection being treated, typically ranging from 3 to 14 days. Some key points to consider when using ertapenem include:

• It is a broad-spectrum carbapenem antibiotic effective against many gram-positive, gram-negative, and anaerobic bacteria.
• It is suitable for complicated intra-abdominal infections, complicated skin infections, community-acquired pneumonia, complicated urinary tract infections, and acute pelvic infections.
• It has the advantage of once-daily dosing due to its extended half-life compared to other carbapenems.
• However, it lacks activity against Pseudomonas aeruginosa and Acinetobacter species.
• Due to antimicrobial stewardship considerations, its use should be limited if alternatives are available 1. It is preferred to meropenem/imipenem due to its single administration and reserve of other carbapenems for severe infections 1. For ESCR-E treatment, ESCMID guidelines recommend carbapenems as the preferred regimen for severe infections; for BSIs without septic shock, ertapenem may be preferred to imipenem or meropenem (conditional recommendation, moderate certainty of evidence) 1.

From the FDA Drug Label

The concentration of ertapenem in breast milk from 5 lactating women with pelvic infections (5 to 14 days postpartum) measured at random time points daily for 5 consecutive days following the last 1 g dose of intravenous therapy (3 to 10 days of therapy) showed low levels. Average plasma concentrations (mcg/mL) of ertapenem following a single 30-minute infusion of a 1 g intravenous (IV) dose and administration of a single 1 g intramuscular (IM) dose in healthy young adults are presented in Table 8.

The recommended IV dose of ertapenem is 1 g.

From the Research

Ertapenem IV Dose

• The recommended dose of ertapenem is 1g administered intravenously once daily 2, 3.
• Studies have shown that the pharmacokinetics of ertapenem in critically ill patients are different from those in healthy volunteers, with enhanced volume of distribution and clearance, resulting in lower maximum plasma concentrations and area under the concentration-time curve 2, 3.
• The free-drug concentrations of ertapenem in critically ill patients may not exceed the minimum inhibitory concentration for an adequate period, suggesting that a shortening of the dosage interval or continuous infusion may be necessary to ensure optimal free concentrations 2, 3.
• A study comparing the pharmacokinetics of intramuscular and intravenous administration of ertapenem found that the relative bioavailability of the 1g intramuscular dose was 92% 4.
• The pharmacokinetics of ertapenem are not directly compared to meropenem in the provided studies, but a study on meropenem pharmacokinetics in critically ill patients with sepsis found that fluid overload can alter meropenem pharmacokinetics and affect the achievement of pharmacokinetic/pharmacodynamic targets 5.
• Ertapenem has been shown to be effective and safe for the treatment of various community-acquired infections, including complicated intra-abdominal infection, acute pelvic infection, and community-acquired pneumonia 6.