Invanz (Ertapenem)

Ertapenem is a carbapenem antibiotic used to treat serious bacterial infections affecting various organ systems.

• Complicated intra‑abdominal infections: provides broad‑spectrum coverage against Gram‑negative, Gram‑positive and anaerobic bacteria, facilitating infection resolution.
• Complicated urinary tract infections: eradicates susceptible uropathogens, including resistant strains, to achieve clinical cure.
• Community‑acquired pneumonia: achieves bacterial clearance in lower respiratory tract infections caused by susceptible organisms.
• Skin and soft tissue infections: resolves infections caused by susceptible Gram‑positive and anaerobic bacteria.

• Ertapenem inhibits bacterial cell wall synthesis by binding with high affinity to penicillin‑binding proteins (PBPs) of susceptible microorganisms. This binding blocks the transpeptidation step required for peptidoglycan cross‑linking, weakening the cell wall and leading to bacterial lysis. The molecule is stable against most β‑lactamases, granting it broad‑spectrum activity against Gram‑negative, Gram‑positive and anaerobic bacteria. Consequently, it exerts rapid bactericidal effects in susceptible pathogens.

Ertapenem may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea
• Diarrhea
• Headache
• Infusion site phlebitis
• Rash
• Elevated liver enzymes

Serious or Rare Side Effects

• Anaphylaxis or severe allergic reactions
• Clostridioides difficile‑associated diarrhea
• Seizures, especially in patients with renal impairment
• Acute renal failure
• Thrombocytopenia or severe neutropenia
• Hepatotoxicity with jaundice

When using Ertapenem, several precautionary measures should be considered to ensure safe administration.

• Assess renal function: dose adjustment may be required in patients with impaired renal clearance.
• Monitor for hypersensitivity: discontinue if signs of allergic reaction such as rash, itching or anaphylaxis appear.
• Observe for Clostridioides difficile infection: watch for persistent diarrhea and colitis during or after therapy.
• Use caution in patients with seizure disorders: ertapenem may lower the seizure threshold.
• Avoid concomitant use with valproic acid: ertapenem can reduce serum valproate concentrations, increasing seizure risk.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Ertapenem can interact with other medicines, influencing efficacy or safety.

Major Interactions (Avoid)

• Valproic acid: ertapenem accelerates valproate metabolism, potentially decreasing seizure control.
• Live vaccines: concurrent use may diminish vaccine efficacy and increase infection risk.

Moderate Interactions (Monitor Closely)

• Warfarin: ertapenem may potentiate anticoagulant effect, requiring INR monitoring.
• Other antibiotics (e.g., aminoglycosides): combined nephrotoxic potential may increase renal impairment risk.
• Diuretics: may affect renal clearance of ertapenem, necessitating dose review.
• Oral contraceptives: possible reduction in hormonal efficacy, advise additional contraceptive measures.