From the Guidelines
Invanz (ertapenem) should be considered over Merrem (meropenem) for treating ESBL infections due to its once-daily dosing, narrower spectrum of activity, and potential to reduce selection pressure for resistance.
Key Considerations
- Ertapenem has a longer half-life, allowing for once-daily dosing (1g IV daily), which improves patient convenience and potentially reduces healthcare costs, as noted in the management of intra-abdominal infections 1.
- The narrower spectrum of activity of ertapenem, with less activity against Pseudomonas aeruginosa and Acinetobacter species, helps reduce selection pressure for resistance among these problematic pathogens while still effectively treating ESBL-producing organisms, a consideration emphasized in the context of managing infections caused by multidrug-resistant gram-negative bacteria 1.
- Both ertapenem and meropenem belong to the carbapenem class, sharing the same mechanism of action by binding to penicillin-binding proteins and disrupting bacterial cell wall synthesis, making them effective against beta-lactamase producing organisms, as discussed in the guidelines for the management of intra-abdominal infections 1.
Clinical Implications
- The choice between ertapenem and meropenem should consider the patient's specific infection, local resistance patterns, and the need for antimicrobial stewardship, as highlighted in the recommendations for the management of intra-abdominal infections 1.
- Ertapenem's once-daily dosing and narrower spectrum of activity make it an attractive option for ESBL infections, potentially reducing the risk of promoting resistance and preserving the efficacy of broader-spectrum carbapenems like meropenem for more severe infections, in line with the principles of antimicrobial stewardship 1.
- Clinicians should be aware of the pharmacokinetic properties of these antibiotics and adjust dosing regimens according to the patient's pathophysiological status, ensuring optimal exposure at the infection site, as recommended in the guidelines for managing intra-abdominal infections 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Rationale for Changing Merrem to Invanz for ESBL
- The decision to change from meropenem (Merrem) to ertapenem (Invanz) for the treatment of extended-spectrum beta-lactamase (ESBL)-producing infections is based on several factors, including the efficacy and safety profiles of these carbapenems 2, 3.
- Ertapenem has been shown to be effective in treating ESBL-producing Enterobacterales bacteremia, with some studies suggesting it may have a more favorable outcome compared to other carbapenems, although the difference may not always be statistically significant 2.
- The choice between ertapenem and meropenem may depend on the specific patient population and the severity of the infection, with ertapenem potentially being more suitable for less severely ill patients who are at risk of ESBL-EC bacteremia and unlikely to have infection due to Pseudomonas aeruginosa 2, 3.
- Clinical guidelines recommend the use of carbapenems, including ertapenem and meropenem, as preferred or alternative treatments for ESBL-producing Enterobacterales infections, depending on the specific circumstances and the susceptibility of the organism 4.
Considerations for Treatment of ESBL Infections
- The treatment of ESBL-producing infections requires careful consideration of the antimicrobial susceptibility pattern of the organism, as well as the severity of the infection and the patient's underlying health status 5, 6.
- Carbapenems, including ertapenem and meropenem, are generally effective against ESBL-producing Enterobacterales, but the choice of agent may depend on factors such as the presence of other resistant organisms, such as Pseudomonas aeruginosa, and the patient's renal function 2, 3.
- The emergence of ESBL-producing Gram-negative pathogens is a global public health concern, and the development of effective treatment strategies is critical to improving patient outcomes 6.