ertapenem
ertapenem
Pharmacologic class: Carbapenem
Therapeutic class: Anti-infective
Pregnancy risk category B
Action
Inhibits cell-wall synthesis in bacteria, causing cell death
Availability
Powder for infusion (lyophilized): 1 g/vial
Indications and dosages
➣ Community-acquired pneumonia; skin infections; complicated genitourinary (GU) infections; complicated intra-abdominal infections; acute pelvic infections
Adults and children older than age 13: 1 g I.M. or I.V. daily. Length of treatment varies with type of infection: community-acquired pneumonia, 10 to 14 days; skin and skin structures, 7 to 14 days; GU, 10 to 14 days; intra-abdominal, 5 to 14 days; acute pelvic, 3 to 10 days.
Children age 3 months to 12 years: 15 mg/kg twice daily (not to exceed 1 g/day). May be given by I.V. infusion for up to 14 days or I.M. injection for up to 7 days.
➣ Prophylaxis of surgical site infection in elective colorectal surgery
Adults: 1 g I.V. as single dose given 1 hour before surgical incision
Dosage adjustment
• Renal impairment
Contraindications
• Hypersensitivity to drug, its components, other carbapenems, or beta-lactams
• I.M. injection in patients allergic to lidocaine or other amide local anesthetics
Precautions
Use cautiously in:
• seizure disorder
• pregnant or breastfeeding patients
• children (not recommended in infants younger than age 3 months).
Administration
• Reconstitute for I.V. use by adding to vial 10 ml of sterile or bacteriostatic water or normal saline for injection. Don't use diluents containing dextrose.
• Further dilute reconstituted drug in 50 ml of normal saline solution; infuse over 30 minutes. Don't mix or infuse with other drugs.
• Reconstitute for I.M. use by adding 3.2 ml of 1% lidocaine to vial and shaking well.
• Inject I.M. dose deep into large muscle mass, such as gluteus maximus or lateral thigh.
Adverse reactions
CNS: headache, dizziness, asthenia, fatigue, insomnia, altered mental status, anxiety, seizures
CV: hypotension, hypertension, chest pain, phlebitis, thrombophlebitis, arrhythmias, heart failure
EENT: pharyngitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastroesophageal reflux disease, pseudomembranous colitis
GU: vaginitis
Hepatic: hepatotoxicity
Respiratory: crackles, cough, dyspnea, wheezing, respiratory distress
Skin: rash, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis
Other: fever, pain, induration, and inflammation at I.V. site; edema; hypersensitivity reactions including anaphylaxis
Interactions
Drug-drug. Probenecid: increased blood level and half-life of ertapenem
Patient monitoring
See Monitor vital signs, ECG, and cardiovascular status closely. Stay alert for arrhythmias, edema, respiratory distress, and other signs and symptoms of heart failure.
See Assess neurologic status, and watch for signs of impending seizure.
See Monitor bowel pattern, and stay alert for signs and symptoms of pseudomembranous colitis.
• Inspect injection site for evidence of thrombophlebitis and induration.
See Watch for indications of erythema multiforme (sore throat, rash, cough, iris lesions, mouth sores, fever). Report early signs before condition progresses to Stevens-Johnson syndrome, and stay alert for other hypersensitivity reactions (including anaphylaxis).
Patient teaching
• Tell patient to notify nurse right away if drug causes pain or swelling at injection site.
• Inform patient that drug can be toxic to many organ systems. Tell him to promptly report significant adverse reactions.
• Tell female patient to inform prescriber of pregnancy or breastfeeding before taking drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.
ertapenem
(er-ta-pen-em) ertapenem,INVanz
(trade name)Classification
Therapeutic: anti infectivesPharmacologic: carbapenems
Indications
- complicated intra-abdominal infections,
- complicated skin and skin structure infections,
- community acquired pneumonia,
- complicated urinary tract infections (including pyelonephritis),
- acute pelvic infections including postpartum endomyometritis, septic abortion, and postsurgical gynecologic infections.
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IM | rapid | 2 hr | 24 hr |
| IV | rapid | end of infusion | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
- headache
Gastrointestinal
- pseudomembranous colitis (life-threatening)
- diarrhea
- nausea
- vomiting
Genitourinary
- vaginitis
Local
- phlebitis at IV site
- pain at IM site
Miscellaneous
- hypersensitivity reaction including anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
Probenecid ↓ excretion and ↑ blood levels.May ↓ serum valproate levels (↑ risk of seizures).Route/Dosage
Renal Impairment
Intramuscular Intravenous (Adults) CCr ≤30 mL/min/1.73m2—500 mg once daily.Availability
Nursing implications
Nursing assessment
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
- Obtain a history before initiating therapy to determine previous use of and reactions to penicillins, cephalosporins, or carbapenems. Persons with a negative history of penicillin sensitivity may still have an allergic response.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Have epinephrine, an antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Lab Test Considerations: May cause ↑ AST, ALT, serum alkaline phosphatase levels.
- May cause ↑ platelet and eosinophil counts.
Potential Nursing Diagnoses
Risk for infection (Indications, Side Effects)Implementation
- Do not confuse Invanz with Avinza.
- Intramuscular: Reconstitute 1-g vial with 3.2 mL of 1% lidocaine without epinephrine. Shake well to form solution. Immediately withdraw contents and inject deep into large muscle mass. Use reconstituted solution within 1 hr.
Intravenous Administration
- pH: 7.5.
- Intermittent Infusion: Diluent: Reconstitute 1-g vial with 10 mL of sterile water for injection or 0.9% NaCl and shake well. Further dilute in 50 mL of 0.9% NaCl. Administer within 6 hr of reconstitution.
- Rate: Infuse over 30 min.
- Y-Site Compatibility: acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, argatroban, arsenic trioxide, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, chloramphenicol, ciprofloxacin, cisatracurium, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, daptomycin, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, docetaxel, dolasetron, dopamine, doxacurium, doxycycline, enalaprilat, ephedrine, epinephrine, eptifibatide, erythromycin, esmolol, etoposide phosphate, famotidine, fenoldopam, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methyldopate, methylprednisolone sodium succinate, metoclopramide, metronidazole, milrinone, mitomycin, morphine, moxifloxacin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phentolamine, phenylephrine, potassium acetate, potassium chloride, potassium phosphates, procainamide, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiotepa, tigecycline, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: alemtuzumab, allopurinol, amiodarone, amphotericin B colloidal, anidulafungin, caspofungin, dantrolene, daunorubicin hydrochloride, diazepam, dobutamine, doxorubicin hydrochloride, droperidol, epirubicin, hydralazine, hydroxyzine, idarubicin, midazolam, mitoxantrone, nicardipine, ondansetron, pentamidine, phenytoin, prochlorperazine, promethazine, quinupristin/dalfopristin, thiopental, topotecan, verapamil
Patient/Family Teaching
- Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy.
- Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Consult health care professional before treating with antidiarrheals.
Evaluation/Desired Outcomes
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
ertapenem
A carbapenem broad-spectrum antibiotic active against both Gram positive and Gram negative bacteria. It is used mainyl to treat intra-abdominal and pelvic infections, and has the advantage over others in its class of allowing once-daily dosage. The drug has been found especially appropriate in the management of foot infection in diabetes. A brand name is Invanz.- zanjan
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