Ertapenem

Criteria & Principles

Pseudomonas spp., Enterococcus spp. and Acinetobacter spp. are all inherently resistant to ertapenem.
Patients with albumin < 2.5 gm/dL and/or elevated MICs (intermediate susceptibility) are at increased risk for suboptimal antibiotic concentrations; consider alternate therapy
Ertapenem may be administered via IV push over 3-5 minutes for adult patients

Usual Dose & Administration

Usual Adult Dose - IV or IM

1 g IV once daily

Adjustment of Dose & Administration

Indication-Specific Adjustment

Prophylaxis (colorectal surgery): 1gm IV X 1 dose within 60 minutes of surgery (no postoperative doses required)

Renal Adjustment

> 30mL/min
- No adjustment recommended
<= 30mL/min or hemodialysis
- 500mg IV or IM once daily
- 1 gm IV post-HD 3x/week (preferred for outpatient)*

*Confirm with dialysis center agent is available.

Patients with albumin < 2.5 gm/dL and/or elevated MICs (intermediate susceptibility) are at increased risk for suboptimal antibiotic concentrations; consider alternate therapy

Restricted Use

ID Approval is required for the use of ertapenem for patients hospitalized at Duke University Medical Center. See restriction page for additional information

References:

Push Administration

Wiskirchen D, Housman S, Quintiliani R, et al. Comparative pharmacokinetics, pharmacodynamics, and tolerability of ertapenem 1 gram/day administered as a rapid 5-minute infusion versus the standard 30-minute infusion in healthy adult volunteers. Pharmacotherapy. 2013;33(3):266-274.
Butterfield-Cowper J, Burgner K. Effects of I.V. push administration on β-lactam pharmacodynamics. Am J Health-Syst Pharm. 2017;74(9):e170-e175.

Hypoalbuminemia

Brink, A J et al. “Pharmacokinetics of once-daily dosing of ertapenem in critically ill patients with severe sepsis.” International journal of antimicrobial agents vol. 33,5 (2009): 432-6. doi:10.1016/j.ijantimicag.2008.10.005
Zusman, O et al. “Association between hypoalbuminemia and mortality among subjects treated with ertapenem versus other carbapenems: prospective cohort study.” Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases vol. 21,1 (2015): 54-8. doi:10.1016/j.cmi.2014.08.003

General Notes

Up-to-date cost information, click here
IV antimicrobials outpatient (OPAT) dosing, click here
Obesity dosing weight recommendations here
Helpful drug-drug interaction check website here
When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.