Antimicrobials

Active against:

• Most Gram-positive organisms including Staphylococci (methicillin-sensitive strains), Streptococci
• Most Gram-negative organisms (including extended spectrum beta-lactamase (ESBL) producers): E.coli, K. pneumoniae, P. mirabilis, Enterobacter, Serratia, Citrobacter, H. influenzae
• Anaerobes (including Bacteroides fragilis)

Not Active against:

• Gram positives organisms: Methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus spp, Listeria
• Gram negative organisms: Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia

Appropriate Uses:

• Treatment of serious Gram-negative or polymicrobial infections (e.g. urosepsis, intra-abdominal infections, complicated skin and soft tissue infections, such as diabetic foot ulcer) where coverage against Pseudomonas aeruginosa, Acinetobacter or Enterococcus is NOT necessary AND organisms are suspected or documented to be multi-drug resistant (e.g. ESBLs, AmpC chromosomal resistant)

Inappropriate Uses:

• Treatment of infections suspected or confirmed to be due to Pseudomonas aeruginosa, Acinetobacter spp. or Enterococcus spp.
• Meningitis and other CNS infections
• Treatment of infective endocarditis
• Treatment of infections caused by meropenem-resistant organisms
• Treatment of infections caused by organisms susceptible to a narrower spectrum antimicrobial agent which is less costly and would be equally safe and effective

• The potential for cross-reactivity exists among penicillins, cephalosporins and ertapenem. Refer to Guidelines on Penicillin Allergy.
• Seizures have occurred rarely (much lower risk than with imipenem); risk factors include renal insufficiency or CNS disorders (e.g. brain lesions, history of seizures)
• Limited data to support ertapenem’s use for the treatment of osteomyelitis. In addition, high level of protein binding (>90%) may limit ertapenem’s bone penetration. If treating osteomyelitis, consider an alternative antimicrobial regimen.

• Hypersensitivity: drug fever, skin rash, urticaria, anaphylaxis
• Hematologic: positive Coombs test, rarely thrombocytopenia, leukopenia
• Hepatic/Renal: transient rise in AST/ALT and urea nitrogen (no clinical evidence of renal toxicity)
• Gastrointestinal: nausea, vomiting, diarrhea, oral candidiasis, rarely pseudomembranous colitis
• CNS: seizures at high doses, particularly in patients with compromised renal function or CNS disorders

• Usual dosage: 1 g IV Q24H
• Renal Insufficiency: see Table below