Adult outpatient parenteral antimicrobial therapy (OPAT) good practice prescribing guide
Ertapenem
Ertapenem is a carbapenem with a broad spectrum of activity against Gram-positive (excluding Enterococci sp) and Gram-negative bacteria (excluding Pseudomonas sp). It is licensed for intra-abdominal infections, community acquired pneumonia, acute gynaecological infections and diabetic foot infections.
This guide shares practical experience on the use of ertapenem in an OPAT setting. To create the guidance, we took an evidence based approach. We also used expert consensus and practical experience from across NHS Scotland.
This drug summary does not provide specific treatment guidelines. Individual patient treatment should take into account the core principles of antimicrobial stewardship. This includes selection of the appropriate antimicrobial for the shortest duration with oral therapy being preferred, whenever possible.
For information on Route and method of administration, Contraindications, Cautions and adverse effects and Drug interactions please refer to the following approved resources:
- British National Formulary (BNF), https://bnf.nice.org.uk/
- Summary of Product Characteristics (SPC), https://www.medicines.org.uk/emc/
- The Renal Drug Database, https://renaldrugdatabase.com
- NHS Injectable Medicines Guide (Medusa), https://www.medusaimg.nhs.uk/ or local IV Drug monographs
- Stockley’s Drug Interaction, https://www.medicinescomplete.com/
These resources also have more information on licensed indication, use in pregnancy and use in breast feeding. When using unlicensed medicines, and/or off-label doses or indications, follow local health board governance processes.
It is strongly recommended that OPAT services in Scotland adhere to the Key performance indicators for the management of patients in an outpatient parenteral antimicrobial therapy (OPAT) setting.
Ertapenem
1. Indication and dose
| Licensed indication(s) in the OPAT setting | Dose |
| Intra-abdominal infections | 1g once daily |
| Community acquired pneumonia | |
| Acute gynaecological infections | |
| Diabetic foot infections of the skin and soft tissue |
| Off-label indications in the OPAT setting | Dose |
| Multi-drug resistant urinary tract infections | 1g once daily |
| Bone and joint infections | |
| Deep seated Gram negative infection (sensitive to ertapenem) |
2. Dose adjustments and monitoring
2a. Renal impairment
Information on dosing and possible toxicity in acute/chronic severe renal impairment is limited and therefore the UK manufacturer does not recommend if CrCl is less than 30ml/min.
The following dose suggestions are unlicensed:
| Renal function (Creatinine Clearance CrCl) | Dosage adjustment |
| 30ml/min or less | 500mg once daily |
| Haemodialysis If receiving regular three times a week haemodialysis (eg Mon/Wed/Fri) |
1g three times a week at the end of dialysis session |
| Irregular haemodialysis or other renal replacement therapy | Seek advice from pharmacy |
2b. Other dosage adjustments
| Patient characteristic | Dosage advice |
| Hepatic impairment | No dose adjustment necessary |
| Obesity | No dose adjustment necessary |
3. Monitoring requirements
| Frequency | Recommended monitoring |
| Baseline | Urea and Electrolytes (U&Es), liver function tests (LFTs), C-reactive protein (CRP) and full blood count (FBC) |
|
Weekly monitoring |
U&Es, LFTs, CRP and FBC |
|
Therapeutic drug monitoring |
No therapeutic drug monitoring required |
| Follow up | Ensure follow up arranged with referring speciality and/or completed with an infection specialist |
For the use of other antibiotics in an OPAT setting please refer to the SAPG website
Scottish Antimicrobial Prescribing Group (SAPG) | January 2024 for review January 2027
Content updated: April 2024