Ertapenem Dosage

Usual Adult Dose for Intraabdominal Infection

Complicated: 1 gram IV or IM once daily for 5 to 14 days

Usual Adult Dose for Pelvic Infections

1 gram IV or IM once daily for 3 to 10 days

Usual Adult Dose for Pneumonia

Community-acquired: 1 gram IV or IM once daily
The recommended total duration of antibiotic treatment is 10 to 14 days, which includes a possible conversion to oral therapy after at least 3 days of parenteral therapy and once clinical improvement occurs.

Usual Adult Dose for Pyelonephritis

1 gram IV or IM once daily
The recommended total duration of antibiotic treatment is 10 to 14 days, which includes a possible conversion to oral therapy after at least 3 days of parenteral therapy and once clinical improvement occurs.

Usual Adult Dose for Skin or Soft Tissue Infection

Complicated: 1 gram IV or IM once daily for 7 to 14 days
The recommended total duration of antibiotic treatment for diabetic foot infections without osteomyelitis is up to 28 days, which includes a possible conversion to oral therapy.

Usual Adult Dose for Urinary Tract Infection

Complicated: 1 gram IV or IM once daily
The recommended total duration of antibiotic treatment is 10 to 14 days, which includes a possible conversion to oral therapy after at least 3 days of parenteral therapy and once clinical improvement occurs.

Usual Adult Dose for Infection Prophylaxis

Prophylaxis of surgical site infection following elective colorectal surgery: 1 gram IV one time, one hour prior to surgical incision

Usual Pediatric Dose for Intraabdominal Infection

Complicated infection:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 5 to 14 days

Usual Pediatric Dose for Pelvic Infections

3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 3 to 10 days

Usual Pediatric Dose for Pneumonia

Community-acquired:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 10 to 14 days

Usual Pediatric Dose for Pyelonephritis

3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or more: 1 gram IV or IM once daily

Duration: 10 to 14 days

Usual Pediatric Dose for Skin or Soft Tissue Infection

Complicated:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 7 to 14 days

Usual Pediatric Dose for Urinary Tract Infection

Complicated:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or more: 1 gram IV or IM once daily

Duration: 10 to 14 days

Renal Dose Adjustments

CrCl 30 mL/min or less:
Adult: 500 mg IV once daily
Pediatric: Data not available

Renal function should be monitored, especially in elderly patients.

Liver Dose Adjustments

No adjustment recommended

Precautions

Intramuscular administration is contraindicated in patients with amide anesthetic hypersensitivity.

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following ertapenem therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Ertapenem has been associated with seizures and other CNS side effects such as confusion, most commonly in patients with CNS disorders such as brain lesions, history of seizures, bacterial meningitis, or renal impairment. Recommended dosages should not be exceeded, especially in patients with risk factors. Neurologic evaluation, anticonvulsant therapy, and ertapenem dosage adjustment or discontinuation are recommended for patients who experience tremors, myoclonus or seizures.

Periodic renal, hepatic and hematopoietic monitoring is recommend during prolonged therapy.

Efficacy and safety have not been established in patients less than 3 months of age. Ertapenem is not recommended in the treatment of meningitis in pediatric patients due to insufficient CSF penetration.

Dialysis

For hemodialysis patients, the recommended dose is 500 mg IV once daily, given at least 6 hours before hemodialysis. If administered within 6 hours before hemodialysis, a supplementary dose of 150 mg is recommended after the hemodialysis session.

There are no data regarding peritoneal dialysis or hemofiltration.

Other Comments

Intravenous ertapenem doses should be infused over 30 minutes.

Alternatively, ertapenem may be given by intramuscular injection for up to 7 days, where appropriate. The intravenous route is preferred for severe or life-threatening infections and for patients with reduced resistance (i.e., malnutrition, trauma, surgery, heart failure, malignancy, or shock).