A beta-lactam and belongs to the subgroup of carbapenems.

Indications: abdominal infections; acute gynaecological infections; community-acquired pneumonia diabetic foot infections of the skin and soft-tissue; prophylaxis for colorectal surgery Complicated Urinary Tract Infections (Including Pyelonephritis) Acute Pelvic Infections Complicated Intra-abdominal Infections.

Cautions: Sensitivity to beta-lactam antibacterial (avoid if history of immediate hypersensitivity reaction, elderly, CNS disorders—risk of seizures; interactions: Hypersensitivity reactions The most important side-effect of the penicillin is hypersensitivity which causes rashes and anaphylaxis and can be fatal. Allergic reactions to penicillin occur in 1–10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy (e.g. asthma, eczema, hay fever) are at a higher risk of anaphylactic reactions to penicillin. Individuals with a history of anaphylaxis, urticaria, or rash immediately after penicillin administration are at risk of immediate hypersensitivity to penicillin; these individuals should not receive a penicillin. Patients who are allergic to one penicillin will be allergic to all because the hypersensitivity is related to the basic penicillin structure. As patients with a history of immediate hypersensitivity to penicillin may also react to the cephalosporin and other beta-lactam antibiotics, they should not receive these antibiotics; ztreonam may be less likely to cause hypersensitivity in penicillin-sensitive patients and can be used with caution. If a penicillin (or another beta-lactam antibiotic) is essential in an individual with immediate hypersensitivity to penicillin then specialist advice should be sought on hypersensitivity testing or using a beta- lactam antibiotic with a different structure to the penicillin that caused the hypersensitivity Individuals with a history of a minor rash (i.e. non- confluent, non-pruritic rash restricted to a small area of the body) or a rash that occurs more than 72 hours after penicillin administration are probably not allergic to penicillin and in these individuals a penicillin should not be withheld unnecessarily for serious infections; the possibility of an allergic reaction should, however, be borne in mind. Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.

Renal impairment Risk of seizures; max. 500 mg daily if eGFR less than 30 ml/minute/1.73 m2

Pregnancy: Manufacturer advises avoid unless potential benefit outweighs risk.

Breast-feeding: Present in milk—manufacturer advises avoid.

Note: Do not confuse with other medications or use dextrose diluent Prolonged use increases risk of super infections Use caution in renal impairment; adjust dose in moderate to severe renal dysfunction Carbapenem use may decrease serum levels of divalproex sodium or valproic acid.

Contra-indications: Hypersensitivity to ertapenem, beta- lactams, or other drugs in this class IM administration: Hypersensitivity to amide local anesthetics (eg, lidocaine) Side Effects: Diarrhoea, nausea, vomiting, headache, injection-site reactions, rash (also reported with eosinophilia and systemic symptoms), pruritus, raised platelet count; less commonly dry mouth, taste disturbances, dyspepsia, abdominal pain, anorexia, constipation, melaena, antibiotic-associated colitis, bradycardia, hypotension, chest pain, oedema, pharyngeal discomfort, dyspnea, dizziness, sleep disturbances, confusion, asthenia, seizures, raised glucose, petechiae; rarely dysphagia, cholecystitis, liver disorder (including jaundice), arrhythmia, increase in blood pressure, syncope, nasal congestion, cough, wheezing, anxiety, depression, agitation, tremor, pelvic peritonitis, renal impairment, muscle cramp, scleral disorder, blood disorders (including neutropenia, rombocytopenia, haemorrhage), hypoglycaemia, electrolyte disturbances; also reported hallucinations, dyskinesia.

Dose: Powder for injection1g/vial For adult: Community- Acquired Pneumonia 1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically Complicated Urinary Tract Infections (Including Pyelonephritis) 1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically Acute Pelvic Infections 1 g/day IV/IM for 3-10 days Complicated Intra- abdominal Infections 1 g/day IV/IM for 5-14 days Complicated Skin/Skin Structure Infections 1 g/day IV/IM for 7-14 days; may be continued up to 4 weeks for diabetic foot infections, depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis).

Dosing Modifications

Renal impairment CrCl >30 ml/min/1.73 m²: Dosage adjustment not necessary

CrCl <30 ml/min/1.73 m² and end-stage renal disease (ESRD): 500 mg/day IV

Dialysis: 500 mg/day IV; if given ≤6 hr before dialysis, supplemental dose of 150 mg afterward.

for pediatric:

Community-Acquired Pneumonia

<3 years: Safety and efficacy not established

3-12 years: 15 mg/kg IV/IM q12hr up to 14 days; not to exceed 1 g q12hr; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically.

>12 years: 1 g/day IV/IM up to 14 days; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically

Complicated Urinary Tract Infections (Including Pyelonephritis)

<3 years: Safety and efficacy not established

3-12 years: 15 mg/kg IV/IM q12hr up to 14 days; not to exceed 1 g q12hr; after ≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically.

>12 years: 1 g/day IV/IM up to 14 days; after

≥3 days of parenteral therapy, may be switched to appropriate PO regimen if patient improves clinically Acute Pelvic Infections <3 years: Safety and efficacy not established 3-12 years: 15 mg IV/IM q12hr for 3-10 days.

>12 years: 1 g/day IV/IM for 3-10 days.

Complicated Intra-abdominal Infections <3 years: Safety and efficacy not established 3-12 years: 15 mg IV/IM q12hr for 5-14 days.

>12 years: 1 g/day IV/IM for 5-14 days.

Complicated Skin/Skin Structure Infections <3 years: Safety and efficacy not established 3-12 years: 15 mg IV/IM q12hr for 7-14 days; may be continued up to 4 weeks for diabetic foot infections,

depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis)

>12 years: 1 g/day IV/IM for 7-14 days; may be continued up to 4 weeks for diabetic foot infections, depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis)