Antimicrobials
Ertapenem

Ertapenem

Restricted

Medium
N/A
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status No

Special Authority None

PharmaCare Coverage None

Outpatient Cost 1g powder for soln/inj - $53.50-68.03/vial

Targeted therapy of ESBL infections and other resistant gram negative infections.

Empiric therapy when broad spectrum of carbapenems is desired without the need for anti-pseudomonal activity.

Restrictions Status: Yes (inj)

Restricted to outpatient use only:

1) Empiric therapy: Severe Gram-negative or polymicrobial infections with risk factors for resistance, or when other antibiotics are contraindicated due to allergy or intolerance

OR

2) Directed therapy: Gram-negative or polymicrobial infection resistant to other antibiotics (e.g. ceftriaxone, fluoroquinolones, cotrimoxazole), or when other antibiotics are contraindicated due to allergy, intolerance or unavoidable logistical circumstances

Note: Pharmacists are NOT required to enforce compliance with new provincial ‘indication based’ restrictions at the time of order verification.

For additional assistance in optimizing this order, contact an Antimicrobial Stewardship pharmacist, medical microbiologist on call or an ID physician.

Acute liver injury (mainly with IV)

  • usually mild and self-limiting
  • involves cholestatic hepatitis and elevations in ALT, AST and alkaline phosphatase
  • liver failure is rare

Neutropenia (mainly with IV)

  • associated with immune-mediated destruction of polymorphonuclear leukocytes
  • sx: abrupt onset of fever, rash, and eosinophilia

Thrombocytopenia (mainly with IV)

  • acute immune-mediated
  • usually platelet count normalizes within 2 weeks after discontinuation

Allergic interstitial nephritis (mainly with IV)

  • sx: acute and often severe renal failure, with active urinary sediment (hematuria, proteinuria, and pyuria) but no red cell casts
  • usually signs of hypersensitivity are present (fever, peripheral eosinophilia, eosinophiluria and rash)
  • several cases of cross-sensitivity between beta-lactam antibiotics

Pulmonary infiltrate with eosinophilia (PIE) syndrome (mainly with IV)

  • sx: abrupt onset of fever, chills, dyspnea, pulmonary infiltrates and peripheral eosinophilia

CNS toxicity (mainly with IV)

  • sx: seizures, encephalopathy
  • seizure risk lower than other carbapenems

Allergic reaction (PO and IV)

  • IgE-mediated
  • sx: pruritus, flushing, urticaria, angioedema, wheezing, laryngeal edema, hypotension, and/or anaphylaxis
  • sx usually appear within 4 hrs of administration but may begin within mins

Serum sickness (PO and IV)

  • late allergic reaction
  • sx: fever, rash, adenopathy, arthritis and glomerulonephritis
  • associated with circulating immune complexes

Rash (PO and IV)

  • includes morbilliform rash, erythema multiforme, SJS, exfoliative dermatitis, toxic epidermal necrolysis and vasculitis
  • sx: photosensitivity, skin lesions, mucosal membrane ulceration, erythema, scaling, palpable purpura and/or positive Nikolsky's sign

Note: EBV-related rash - not an allergy

  • morbilliform rash, occurring 48 hrs to weeks after initial amoxicillin exposure in patients with Epstein Barr Virus, does not appear to be a true drug allergy

Antimicrobial class: Carbapenem

Pregnancy category: B

Average serum half life: 4.0 hr

Urine penetration: Therapeutic

Lung penetration: Therapeutic

Biliary penetration: Moderate