From the Guidelines
Ertapenem is a suitable option for treating sepsis and UTI with gram-negative rods, particularly for patients without septic shock, as it provides broad coverage against most Enterobacteriaceae. The standard adult dose is 1 gram intravenously once daily for 7-14 days, depending on clinical response 1. Ertapenem's once-daily dosing and broad spectrum of activity against gram-negative pathogens, anaerobes, and some gram-positive organisms make it a useful choice. However, it lacks activity against Pseudomonas aeruginosa and Acinetobacter species, so if these pathogens are suspected or identified, an alternative carbapenem like meropenem or imipenem would be more appropriate 1. Some studies suggest that ertapenem may be used instead of imipenem or meropenem for patients with BSI due to 3GCephRE without septic shock, with moderate certainty of evidence 1. Key considerations include:
- Monitoring the patient's clinical response, including fever resolution, hemodynamic stability, and improvement in urinary symptoms to assess treatment efficacy.
- Adjusting the dose for patients with renal impairment (CrCl ≤30 mL/min) to 500 mg daily.
- Narrowing therapy to the most appropriate antibiotic once culture and sensitivity results are available. It's also important to note that for patients with cUTI in the absence of septic shock, intravenous fosfomycin is a recommended option with high certainty of evidence, but ertapenem remains a viable alternative 1.
From the FDA Drug Label
- 4 Complicated Urinary Tract Infections Including Pyelonephritis Ertapenem for injection is indicated for the treatment of adult patients and pediatric patients (3 months of age and older) with complicated urinary tract infections including pyelonephritis due to Escherichia coli, including cases with concurrent bacteremia, or Klebsiella pneumoniae.
Ertapenem may be effective for a patient with sepsis and a UTI with gram-negative rods on culture, specifically Escherichia coli or Klebsiella pneumoniae, as it is indicated for the treatment of complicated urinary tract infections, including pyelonephritis, due to these pathogens 2.
From the Research
Ertapenem for Sepsis and UTI with Gram-Negative Rods
- Ertapenem is a carbapenem antibiotic, which is effective against a wide range of Gram-negative bacteria, including those that produce extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases 3.
- For the treatment of urinary tract infections (UTIs) caused by Gram-negative rods, carbapenems, including ertapenem, are considered a treatment option, especially for complicated UTIs or those caused by multidrug-resistant organisms 3, 4.
- In the context of sepsis, ertapenem can be used as part of the empirical therapy prior to the identification of the causative organism, given its broad-spectrum activity against Gram-negative pathogens 5.
- The management of septic shock due to Gram-negative bacteria involves early diagnosis, rapid initiation of appropriate antimicrobial therapy, and supportive care to manage organ dysfunction 4, 6.
- Achieving optimal antibiotic dosages is crucial in the treatment of severe sepsis and septic shock, as pharmacokinetics can be altered in critically ill patients, potentially leading to inadequate drug concentrations 7.
Considerations for Ertapenem Use
- Ertapenem has a broad spectrum of activity and is suitable for the treatment of serious bacterial infections, including those caused by Gram-negative rods 5.
- However, the use of carbapenems like ertapenem should be guided by antimicrobial stewardship principles to minimize the risk of resistance development and to ensure that the most appropriate therapy is selected based on susceptibility patterns 3, 4.
- In cases where ertapenem is used for UTIs or sepsis caused by Gram-negative rods, monitoring for clinical response and adjusting therapy based on culture and susceptibility results is essential 3, 5.