Ertapenem
Mechanism :
The bactericidal activity of ertapenem results from the inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin binding proteins (PBPs). In Escherichia coli, it has strong affinity toward PBPs 1a, 1b, 2, 3, 4 and 5 with preference for PBPs 2 and 3. Ertapenem is stable against hydrolysis by a variety of beta-lactamases, including penicillinases, and cephalosporinases and extended spectrum beta-lactamases. Ertapenem is hydrolysed by metallo-beta-lactamases.
Indication :
- Complicated skin and soft tissue infections
- Complicated intra-abdominal infections
- Complicated pneumonia
- Complicated urinary tract infections
Contraindications :
Hypersensitivity to ertapenem, beta-lactams, or other drugs in this class.
Dosing :
Under 3 months:
Safety and efficacy not established.
3 months-12 years:
15 mg/kg either IV/IM twice daily for 14 days; Max: 1 g twice daily.
>12 years:
1 g/day IV/IM for 14 days.
Adverse Effect :
Hypersensitivity to ertapenem, beta-lactams, or other drugs in this class.
Diarrhea, elevated liver function tests, pruritus, tachycardia, constipation, insomnia, increased alkaline phosphatase, dyspepsia, altered mental status, fever, abdominal pain, vomiting, edema, drug rash with eosinophilia, DRESS syndrome, hypotension, headache, chest pain, increased platelet count, acid regurgitation, fatigue.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 30-50 | Dose as in normal renal function |
| 10-30 | Use 50–100% of dose |
| <10 | Use 50% of dose, or 1 g 3 times a week. |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<10 mL/ min |
| HD | Dialysed. Dose as in GFR<10 mL/ min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Dialysed. Dose as in GFR=10– 30 mL/min |
Hepatic Dose :
No dosage adjustments are recommended.