Carbapenem
Aerobic gram-positive microorganisms: S. aureus (methicillin susceptible strains only), S. pyogenes, S. agalactiae
Aerobic gram-negative microorganisms: E. coli, H. influenzae, M. catarrhalis, K. pneumoniae
Anaerobic microorganisms: Bacteroides fragilis and other Bacteroides species, C. clostridioforme, Peptostreptococcus species (Table 1)
Cause rapid bacterial cell death by covalently binding to penicillin-binding proteins (PBPs) involved in the biosynthesis of mucopeptides in bacterial cell walls. Bactericidal effects result through inhibition of cellular growth and division and the loss of cell wall integrity, eventually causing cell wall lysis. The primary target is PBP 2.
Carbapenems produce time-dependent killing
Cmax: 155mcg/ml; Half-life: 3.8 hours; Volume of distribution: 8.2L; Table 2
Gastrointestinal: Nausea, diarrhea, abdominal pain, vomiting, constipation, GERD
Cardiovascular System: Edema, chest pain, tachycardia
Central Nervous System: Headache, altered mental status (confusion, disorientation, somnolence), seizures
Hematologic: Decreases in hemoglobin and hematocrit, decrease in platelet counts, eosinophilia
Genitourinary: Vaginitis
Renal: Renal insufficiency
Hepatic: Increased serum transaminases and alkaline phosphatase
Respiratory: Dyspnea, cough, pharyngitis, and “respiratory distress”
Dermatologic: Erythrema, pruritis, rash; extravasation at injection site, phlebitis, thrombophlebitis
Sterile lyophilized 1 g powder for intravenous infusion or for intramuscular injection
Acute pelvic infection: 1 g IV/IM daily for 3-10 days
Community-acquired pneumonia: 1 g IV/IM daily for 10-14 days
Intra-abdominal infections: 1 g IV/IM daily for 5-14 days
Skin/skin structure infections: 1 g IV/IM daily for 7-14 days
Urinary tract infection: 1 g IV/IM daily for 10-14 days
Pediatric dosing: 1 g IV/IM daily for pediatric patients aged 13 years and older or 15 mg/kg twice daily for pediatric patients aged 3 months to 12 years
Renal Failure: For the patients with creatinine clearance (CrCl) equal to or greater than 30 ml/min, no adjustment is necessary. In patients with CrCl < 30, give 500 mg every 24 hours.
Hepatic failures: Dosage adjustment is not required.
Contraindications: Prior anaphylactic reactions to beta-lactams, hypersensitivity to amide-type anesthetics
Precautions: Known or suspected CNS disorders including seizure history (increased risk for seizures)
Probenecid (moderate severity): Probenecid inhibits the renal excretion of ertapenem thereby increasing its plasma concentrations and prolonging its elimination half-life.
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivity, CBC w/differential, urinalysis, temperature, pulmonary function tests, improvement of clinical signs/symptoms of infection (eg, pulmonary function in pneumonia, pain in UTI)
Toxicity: CBC; Vital signs post-infusion in patients with risk factors for hypersensitivity (eg, history of allergies or sensitivity to cephalosporins) (signs of anaphylaxis); Neurologic evaluation in patients developing focal tremors, myoclonus, or seizures during therapy; Signs/symptoms of toxicity (eg, rash, GI disturbances, mental status changes, seizure activity, local complications (phlebitis)
Invanz/Merck in the following countries: Australia, United Kingdom, Singapore, New Zealand, Germany, Ireland, France, Austria, Sweden, Israel, Finland, and Belgium