Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Feb 2007
ReviewErtapenem: the new carbapenem 5 years after first FDA licensing for clinical practice.
Ertapenem, a parenteral broad-spectrum 1-beta-methyl-carbapenem, was licensed 5 years ago for clinical practice in the US and Europe. The substance has a good in vitro activity against many common aerobic and anaerobic Gram-positive and -negative bacteria. Its in vitro activity against Enterobacteriaceae carrying plasmid- or chromosomal-mediated beta-lactamases, including AmpC- and extended-spectrum beta-lactamases, is especially clinically significant. ⋯ International guidelines recommend the initial empirical use of ertapenem for intra-abdominal infections, skin and skin-structure infections, acute pelvic infections, complicated urinary tract infections and pneumonia (both community-acquired and 'early-onset' nosocomial) in a dose of 1.0 g administered once daily. However, recent results from pharmacokinetic/pharmacodynamic modelling studies in critically ill patients with ventilator-associated pneumonia and adipose volunteers with a body mass index of > or = 20 kg/m(2) showed that the standard dose of 1.0 g/day may not provide adequate free, protein-unbound drug concentrations in plasma and organ tissues. Therefore, a shortening of the dosage interval or continuous infusion of ertapenem should be considered to ensure optimal free concentrations in these particular populations.