Ertapenem
lINDICATIONS AND DOSE
Abdominal infections|Acute gynaecological infections|
Community-acquired pneumonia
▶BY INTRAVENOUS INFUSION
▶Child 3 months–12 years: 15 mg/kg every 12 hours;
maximum 1 g per day
▶Child 13–17 years: 1 g once daily
Diabetic foot infections of the skin and soft-tissue
▶BY INTRAVENOUS INFUSION
▶Child 13–17 years: 1 g once dailylCAUTIONSCNS disorders—risk of seizures
lINTERACTIONS→Appendix 1 : carbapenems
lSIDE-EFFECTS
▶Common or very commonDiarrhoea
▶UncommonFaeces discoloured.headache.hotflush.
hypertension.melaena.skin reactions
▶Frequency not knownAggression.hallucination.
psychiatric disorder
lALLERGY AND CROSS-SENSITIVITYAvoid if history of
immediate hypersensitivityreaction to beta-lactam
antibacterials.
Use with caution in patients with sensitivity to beta-
lactam antibacterials.
lPREGNANCYManufacturer advises avoid unless potential
benefit outweighs risk.
lBREAST FEEDINGPresent in milk—manufacturer advises
avoid.
lRENAL IMPAIRMENTUse with caution (risk of seizures);
avoid if estimated glomerularfiltration rate less than
30 mL/minute/ 1. 73 m
2
.
lDIRECTIONS FOR ADMINISTRATIONForintravenous infusion
(Invanz®), give intermittentlyinSodium chloride 0. 9 %.
Reconstitute 1 g with 10 mL Water for injectionsorSodium
chloride 0. 9 %; dilute requisite dose in infusionfluid to a
final concentration not exceeding 20 mg/mL; give over
30 minutes; incompatible with glucose solutions.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
ELECTROLYTES:May contain Sodium
▶Invanz(Merck Sharp & Dohme Ltd)
Ertapenem (as Ertapenem sodium) 1 gramInvanz 1 g powder for
solution for infusion vials| 1 vialP£ 31. 65
Imipenem with cilastatin
lINDICATIONS AND DOSE
Aerobic and anaerobic Gram-positive and Gram-negative
infections (not indicated for CNS infections)|Hospital-
acquired septicaemia
▶BY INTRAVENOUS INFUSION
▶Neonate up to 7 days: 20 mg/kg every 12 hours.▶Neonate 7 days to 20 days: 20 mg/kg every 8 hours.▶Neonate 21 days to 28 days: 20 mg/kg every 6 hours.▶Child 1–2 months: 20 mg/kg every 6 hours
▶Child 3 months–17 years: 15 mg/kg every 6 hours (max.
per dose 500 mg)Infection caused byPseudomonasor other less sensitive
organisms|Empirical treatment of infection in febrile
patients with neutropenia|Life-threatening infection
▶BY INTRAVENOUS INFUSION
▶Child 3 months–17 years: 25 mg/kg every 6 hours (max.
per dose 1 g)
Cystic fibrosis
▶BY INTRAVENOUS INFUSION
▶Child: 25 mg/kg every 6 hours (max. per dose 1 g)
DOSE EQUIVALENCE AND CONVERSION
▶Dose expressed in terms of imipenem.lUNLICENSED USENot licensed for use in children under
1 year; not licensed for use in children with renal
impairment.
lCAUTIONSCNS disorders.epilepsy
lINTERACTIONS→Appendix 1 : carbapenems
lSIDE-EFFECTS
▶Common or very commonDiarrhoea.eosinophilia.nausea.
skin reactions.thrombophlebitis.vomiting
▶UncommonBone marrow disorders.confusion.dizziness.
drowsiness.hallucination.hypotension.leucopenia.
movement disorders.psychiatric disorder.seizure.
thrombocytopenia.thrombocytosis
▶Rare or very rareAgranulocytosis.anaphylactic reaction.
angioedema.chest discomfort.colitis haemorrhagic.
cyanosis.dyspnoea.encephalopathy.flushing.focal
tremor.gastrointestinal discomfort.haemolytic anaemia.
headache.hearing impairment.hepatic disorders.
hyperhidrosis.hyperventilation.increased risk of
infection.myasthenia gravis aggravated.oral disorders.
palpitations.paraesthesia.polyarthralgia.polyuria.
pseudomembranous enterocolitis.renal impairment.
severe cutaneous adverse reactions (SCARs).spinal pain.
tachycardia.taste altered.urine discolouration.vertigo
▶Frequency not knownAgitation
lALLERGY AND CROSS-SENSITIVITYAvoid if history of
immediate hypersensitivityreaction to beta-lactam
antibacterials.
Use with caution in patients with sensitivity to beta-
lactam antibacterials.
lPREGNANCYManufacturer advises avoid unless potential
benefit outweighs risk (toxicity inanimalstudies).
lBREAST FEEDINGPresent in milk but unlikely to be
absorbed.
lRENAL IMPAIRMENT
Dose adjustmentsReduce dose if estimated glomerular
filtration rate less than 70 mL/minute/ 1. 73 m^2 , risk of CNS
side-effects.
lEFFECT ON LABORATORY TESTSPositive Coombs’test.
lDIRECTIONS FOR ADMINISTRATIONForintravenous infusion
dilute to a concentration of 5 mg (as imipenem)/mL in
Sodium chloride 0. 9 %; give up to 500 mg (as imipenem)
over 20 – 30 minutes, give dose greater than 500 mg (as
imipenem) over 40 – 60 minutes.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
ELECTROLYTES:May contain Sodium
▶Imipenem with cilastatin (Non-proprietary)
Cilastatin (as Cilastatin sodium) 500 mg, Imipenem (as Imipenem
monohydrate) 500 mgImipenem 500 mg / Cilastatin 500 mg powder
for solution for infusion vials| 1 vialP£ 12. 00 (Hospital only)|
5 vialP£ 60. 00 (Hospital only)
▶Primaxin I.V.(Merck Sharp & Dohme Ltd)
Cilastatin (as Cilastatin sodium) 500 mg, Imipenem (as Imipenem
monohydrate) 500 mgPrimaxin IV 500 mg powder for solution for
infusion vials| 1 vialP£ 12. 00BNFC 2018 – 2019 Bacterial infection 315
Infection5