HWN Suggests

The Evil Side of Ertapenem

Carbapenems are frequently used in the inpatient setting. Carbapenems, including ertapenem, have been known to cause central nervous system toxicity in the form of hallucinations and seizures, even at appropriate dosing. Neurotoxicity is a rare side-effect of carbapenems. The prevalence of seizure activity secondary to carbapenems such as ertapenem is estimated to be less than 1%, while non-seizure neurotoxicity is even more rare. Few case reports have documented encephalopathy as a side-effect of carbapenems.

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Articles of Interest

A case series of confusional states and other neurotoxic effects caused by ertapenem

All beta-lactam antibiotics have been associated with diverse neurotoxic side effects, mainly seizures, encephalopathy or abnormal movements such as myoclonia, but the frequency of such effects varies according to the beta-lactam used. In this sense, imipenem tends to be more epileptogenic than meropenem or ertapenem, while myoclonia is common in patients exposed to cefepime.

Delirium and tremor associated with ertapenem treatment

Ertapenem is a broad-spectrum carbapenem antibiotic effective against gram positive and gram negative aerobic as well as anaerobic bacteria. Common adverse reactions (>5%) include nausea, headache, diarrhea, and local reactions related to infusion. Among the neurological and psychiatric adverse reactions, the incidence of seizures is 0.5%, while that of altered mental status such as agitation, disorientation, confusion, decreased mental acuity, somnolence and stupor ranges from 3.3 to 5.1%. Neurotoxicity other than seizures, associated with ertapenem is extremely rare.

Ertapenem (INVANZ): A New Once a Day Carbapenem

Like its big brother (Imipenem), ertapenem has a very broad spectrum of activity that includes all anaerobes and many aerobic gram-positive and gram-negative organisms. It has poor activity against P aeruginosa and Acinetobacter and lacks activity against Enterococcus faecium, S. epidermidis, B. Lepacia, S. maetophilia, and MRSA. Clinical studies submitted to the FDA showed that ertapenem was equivalent to piperacillin/ tazobactam for the treatment of complicated intra-abdominal infections, skin and skin structure infections, and acute pelvic infections. Ertapenem was also equivalent to ceftriaxone for the treatment of communityacquired pneumonia and complicated urinary tract infections.

Ertapenem-Induced Neurotoxicity: A Literature Review of Clinical Characteristics and Treatment Outcomes

Ertapenem is a 1-beta-methyl carbapenem that is stable to dehydropeptidases and binds better to penicillin-binding proteins (PBPs) and with bactericidal activity that acts by inhibition of the bacterial cell wall. Carbapenems possess greatest broad-spectrum activity against gram-positive and gram-negative aerobic and anaerobic bacteria. Ertapenem, however, lacks the coverage against Pseudomonas aeruginosa and Acinetobacter baumannii and thus exerts less selection pressure for resistance to these bacteria than do other carbapenems, which are usually used as treatments for community-acquired severe infectious diseases.

Meropenem vs Ertapenem

Unlike Meropenem that requires multiple doses per day due to its short half-life, Ertapenem only needs once-a-day dosing because of its longer half-life providing patients with more convenience. However, it may not cover all varieties of bacteria that Meropenem can combat - so choosing between these antibiotics should be based on infection type and patient's specific needs

Resources

Ertapenem

You should save it as a last resort. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ertapenem and other antibacterial drugs, Ertapenem should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

NPS MedicineWise

INVANZ contains the active ingredient Ertapenem. INVANZ is used to treat infections caused by bacteria (germs). These infections include: infections within the abdomen (stomach), pelvic infections, diabetic foot infections in patients without osteomyelitis