What is Invanz (Ertapenem)?

From the Guidelines

Invanz (ertapenem) is a suitable option for the treatment of diabetic foot infections, particularly for moderate to severe infections, due to its broad-spectrum activity against gram-positive, gram-negative, and anaerobic bacteria 1.

Key Considerations

• The choice of antibiotic regimen should be based on the likely or proven causative pathogen(s) and their antibiotic susceptibilities, as well as the clinical severity of the infection, patient-related factors, and the presence of local protocols 1.
• Invanz is typically administered as a 1 gram intravenous or intramuscular injection once daily for 3-14 days, depending on the infection type, and works by inhibiting bacterial cell wall synthesis, causing bacterial cell death.
• Common side effects include diarrhea, nausea, headache, and injection site reactions, and patients with penicillin allergies may have cross-reactivity.

Treatment Guidelines

• The IDSA and IWGDF guidelines suggest that the treatment of diabetic foot infections should be based on the severity of the infection, with mild infections typically treated with oral agents and moderate to severe infections treated with parenteral agents 1.
• The guidelines also recommend that the choice of antibiotic regimen should be based on the likely or proven causative pathogen(s) and their antibiotic susceptibilities, as well as the clinical severity of the infection, patient-related factors, and the presence of local protocols.

Evidence Summary

• A systematic review of randomized controlled trials found that no antibiotic class or agent has been found to be superior to others for treating diabetic foot infections, except in two studies, one of which found tigecycline to be significantly worse than ertapenem, and another that found ertapenem to have a slightly lower clinical cure rate than piperacillin-tazobactam 1.
• The review also found that the use of carbapenems was identified as an independent predictor of need for major amputation, and use of vancomycin was an independent predictor of reinfection or death in one study, but that these antibiotics are often used in more severe or non-responsive cases, making it difficult to draw clear conclusions.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Invanz

• Invanz, also known as ertapenem, is a parenteral carbapenem antibiotic used to treat various bacterial infections 2, 3, 4.
• It has a broad spectrum of in vitro activity against Gram-negative and Gram-positive pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae, and anaerobic pathogens 2, 3.

Approved Indications

• Invanz is approved for use in adults and pediatric patients aged ≥3 months in the US, and in adults in the EU 2, 3.
• Approved indications include complicated intra-abdominal infection (cIAI), community-acquired pneumonia (CAP), acute pelvic infection, complicated skin and skin structure infection (cSSSI), and complicated urinary tract infection (cUTI) 2, 3, 4.

Efficacy and Safety

• Ertapenem has shown similar efficacy to comparator antibacterials, such as piperacillin/tazobactam and ceftriaxone, in various infections 2, 5.
• It has a convenient once-daily administration schedule and is generally well tolerated, with a similar safety profile to other antibiotics 2, 3, 5.
• Ertapenem is suitable for mild to moderately ill patients with community-acquired infections and for outpatient intravenous antibacterial therapy 4.

Specific Infections

• Ertapenem is effective in treating diabetic foot infections, with clinical and microbiological response rates similar to those of piperacillin/tazobactam 6.
• It is also effective in treating mixed anaerobic complicated intra-abdominal, complicated skin and skin structure, and acute pelvic infections, with cure rates similar to those of piperacillin-tazobactam 5.