ertapenem

ertapenem,

an antiinfective agent to treat adults with moderate to severe infections, complicated skin and skin structure infections, and complicated urinary tract infections.

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ertapenem

Invanz

Pharmacologic class: Carbapenem

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Inhibits cell-wall synthesis in bacteria, causing cell death

Availability

Powder for infusion (lyophilized): 1 g/vial

⊘Indications and dosages

➣ Community-acquired pneumonia; skin infections; complicated genitourinary (GU) infections; complicated intra-abdominal infections; acute pelvic infections

Adults and children older than age 13: 1 g I.M. or I.V. daily. Length of treatment varies with type of infection: community-acquired pneumonia, 10 to 14 days; skin and skin structures, 7 to 14 days; GU, 10 to 14 days; intra-abdominal, 5 to 14 days; acute pelvic, 3 to 10 days.

Children age 3 months to 12 years: 15 mg/kg twice daily (not to exceed 1 g/day). May be given by I.V. infusion for up to 14 days or I.M. injection for up to 7 days.

➣ Prophylaxis of surgical site infection in elective colorectal surgery

Adults: 1 g I.V. as single dose given 1 hour before surgical incision

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug, its components, other carbapenems, or beta-lactams
• I.M. injection in patients allergic to lidocaine or other amide local anesthetics

Precautions

Use cautiously in:
• seizure disorder
• pregnant or breastfeeding patients
• Children (not recommended in infants younger than age 3 months).

Administration

• Reconstitute for I.V. use by adding to vial 10 ml of sterile or bacteriostatic water or normal saline for injection. Don't use diluents containing dextrose.
• Further dilute reconstituted drug in 50 ml of normal saline solution; infuse over 30 minutes. Don't mix or infuse with other drugs.
• Reconstitute for I.M. use by adding 3.2 ml of 1% lidocaine to vial and shaking well.
• Inject I.M. dose deep into large muscle mass, such as gluteus maximus or lateral thigh.

Route	Onset	Peak	Duration
I.V.	Rapid	30 min	Unknown
I.M.	10 min	2.3 hr	Unknown

Adverse reactions

CNS: headache, dizziness, asthenia, fatigue, insomnia, altered mental status, anxiety, seizures

CV: hypotension, hypertension, chest pain, phlebitis, thrombophlebitis, arrhythmias, heart failure

EENT: pharyngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastroesophageal reflux disease, pseudomembranous colitis

GU: vaginitis

Hepatic: hepatotoxicity

Respiratory: crackles, cough, dyspnea, wheezing, respiratory distress

Skin: rash, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis

Other: fever, pain, induration, and inflammation at I.V. site; edema; hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Probenecid: increased blood level and half-life of ertapenem

Patient monitoring

☞ Monitor vital signs, ECG, and cardiovascular status closely. Stay alert for arrhythmias, edema, respiratory distress, and other signs and symptoms of heart failure.
☞ Assess neurologic status, and watch for signs of impending seizure.
☞ Monitor bowel pattern, and stay alert for signs and symptoms of pseudomembranous colitis.
• Inspect injection site for evidence of thrombophlebitis and induration.
☞ Watch for indications of erythema multiforme (sore throat, rash, cough, iris lesions, mouth sores, fever). Report early signs before condition progresses to Stevens-Johnson syndrome, and stay alert for other hypersensitivity reactions (including anaphylaxis).

Patient teaching

• Tell patient to notify nurse right away if drug causes pain or swelling at injection site.
• Inform patient that drug can be toxic to many organ systems. Tell him to promptly report significant adverse reactions.
• Tell female patient to inform prescriber of pregnancy or breastfeeding before taking drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.