From the Guidelines
Ertapenem is not the first choice for Proteus mirabilis infections, but it may be used as an alternative in certain cases, as recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.
Key Points to Consider
- The ESCMID guidelines suggest using a carbapenem (imipenem or meropenem) as targeted therapy for patients with bloodstream infections (BSI) and severe infections due to third-generation cephalosporin-resistant Enterobacterales (3GCephRE) 1.
- Ertapenem may be used instead of imipenem or meropenem for patients with BSI due to 3GCephRE without septic shock, but this is a conditional recommendation based on moderate-level evidence 1.
- For patients with low-risk, non-severe infections due to 3GCephRE, the guidelines suggest using piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones, considering antibiotic stewardship 1.
Clinical Considerations
- Ertapenem is a carbapenem antibiotic that provides broad coverage against many gram-negative bacteria, including Proteus mirabilis.
- The typical adult dose of ertapenem is 1 gram given once daily, either intravenously or intramuscularly, for 3-14 days depending on the severity and type of infection.
- Dose adjustment is necessary for patients with renal impairment (creatinine clearance ≤30 mL/min).
Evidence-Based Decision
Based on the ESCMID guidelines, the use of ertapenem for Proteus mirabilis infections should be considered on a case-by-case basis, taking into account the severity of the infection, the patient's renal function, and the susceptibility pattern of the isolate 1.
From the FDA Drug Label
Ertapenem for injection is indicated for the treatment of adult patients and pediatric patients (3 months of age and older) with complicated skin and skin structure infections, including diabetic foot infections without osteomyelitis due to Staphylococcus aureus (methicillin susceptible isolates only), Streptococcus agalactiae, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Bacteroides fragilis, Peptostreptococcus species, Porphyromonas asaccharolytica, or Prevotella bivia.
Ertapenem is effective against Proteus mirabilis. It is indicated for the treatment of complicated skin and skin structure infections, including those caused by Proteus mirabilis 2.
From the Research
Ertapenem and Proteus Mirabilis
- Ertapenem is a carbapenem antibacterial with in vitro activity against many Gram-negative and Gram-positive aerobic and anaerobic bacteria 3, 4, 5.
- The studies do not specifically mention the effectiveness of ertapenem against Proteus mirabilis, but they do mention its activity against Enterobacteriaceae, which includes Proteus mirabilis 3, 4, 5.
- One study mentions that ertapenem has a narrower spectrum of antimicrobial activity compared to older carbapenems and lacks reliable activity against Pseudomonas and Enterococcus, but it does not specifically mention Proteus mirabilis 6.
- Another study discusses the increasing resistance of Proteus mirabilis to third-generation cephalosporins, but it does not mention ertapenem as a treatment option 7.
Treatment of Infections
- Ertapenem is approved for the treatment of complicated intra-abdominal infections, community-acquired pneumonia, and acute pelvic infection, among other indications 3, 4, 5.
- It has been shown to be effective in the treatment of various infections, including those caused by Enterobacteriaceae and anaerobic bacteria 3, 4, 5.
- However, its effectiveness against Proteus mirabilis specifically is not well-documented in the provided studies.