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(Err-tah-PEN-em)
Invanz
Class: Anti-infective
Carbapenem

  Action Inhibits cell wall synthesis.

  Indications Treatment of moderate to severe complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, complicated urinary tract infections (UTIs) (including pyelonephritis), and acute pelvic infections (including postpartum endomyometritis, septic abortion, and postsurgical gynecologic infections) caused by susceptible microorganisms.

  Contraindications Hypersensitivity to any component of this product or to other drugs in the same class, patients who have demonstrated anaphylactic reactions to beta-lactams; because of the lidocaine diluent, patients with known sensitivity to local anesthetics of the amide type.

  Route/Dosage

Complicated Intra-Abdominal Infections

ADULTS: IV/IM 1 g/day for 5 to 14 days.

Complicated Skin and Skin Structure Infections

ADULTS: IV/IM 1 g/day for 7 to 14 days.

Community-Acquired Pneumonia or Complicated UTIs

ADULTS: IV/IM 1 g/day for 10 to 14 days.

Acute Pelvic Infections

ADULTS: IV/IM 1 g/day for 3 to 10 days.

Renal Insufficiency

ADULTS: IV/IM Ccr < 30 mL/min: 500 mg/day.

Hemodialysis

ADULTS: IV/IM 500 mg within 6 hr prior to hemodialysis and a supplemental dose of 150 mg following the hemodialysis session.

  Interactions

Probenecid: Inhibits renal excretion of ertapenem; coadministration is not recommended.

Do not mix or co-infuse with other medications; do not use diluents containing dextrose.

  Lab Test Interferences None well documented.

  Adverse Reactions CARDIOVASCULAR: Chest pain; hypertension; hypotension; tachycardia. CNS: Headache; altered mental status; anxiety; dizziness; insomnia; fatigue. DERMATOLOGIC: Erythema; extravasation; infused vein complication; phlebitis/thrombophlebitis; pruritus; rash. EENT: Pharyngitis. GI: Diarrhea; nausea; abdominal pain; acid regurgitation; constipation; oral candidiasis; vomiting. GU: Vaginitis; increased serum creatinine. HEMATOLOGIC: Increased eosinophils; decreased hematocrit, hemoglobin, and platelets. HEPATIC: Increased ALT, AST, and bilirubin. METABOLIC: Increased serum glucose and serum potassium; decreased serum potassium. RESPIRATORY: Cough; dyspnea; rales/rhonchi; respiratory distress. OTHER: Asthenia; edema/swelling; fever; leg pain.

  Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. CHILDREN: Safety and efficacy not established. Elderly: Because elderly are more likely to have decreased renal function, select dose with caution. CNS: Seizures and other CNS adverse effects may occur. Pseudomembranous Colitis: Consider possibility in patients with diarrhea. Hypersensitivity: Hypersensitivity reactions may occur; do not administer to patients who have demonstrated anaphylactic reactions to beta-lactams, carbapenams, or penicillin. Renal Insufficiency: Adjust dose accordingly. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible organisms.

PATIENT CARE CONSIDERATIONS

  Administration/Storage

  • For IV or IM administration only. Do not administer SC.
  • Administer prescribed dose once daily.
  • Administer reduced dose to patients with renal impairment.
  • For IV infusion, reconstitute with 10 mL of compatible diluent (Water for Injection, 0.9% Sodium Chloride Injection, or Bacteriostatic Water for Injection). Do not use diluents containing dextrose. Shake well to dissolve powder and immediately transfer contents of the reconstituted vial to 50 mL of 0.9% Sodium Chloride Injection. Infuse prescribed dose over 30 min. Complete infusion within 6 hr of reconstitution. Do not mix or co-infuse with other medications.
  • Do not administer if reconstituted solution is cloudy, discolored, or contains particulate matter.
  • For IM administration, reconstitute with 3.2 mL of 1% Lidocaine HCl Injection (without epinephrine). Shake vial thoroughly to form clear solution. Immediately withdraw contents of vial and administer by deep IM injection into large muscle mass. Do not administer IV. Use reconstituted IM solution within 1 hr after preparation.
  • Reconstituted solution may exhibit a pale yellow color, which is normal and does not affect potency.
  • If other drugs are being administered through same IV line, flush IV line before and after infusion of ertapenem with 0.9% Sodium Chloride Injection.
  • Store lyophilized powder < 77°F. Reconstituted solution for IV administration, diluted in 0.9% Sodium Chloride Injection, may be stored at room temperature and used within 6 hr or stored under refrigeration for 24 hr and used within 4 hr after removal from refrigeration. Protect from freezing. Use reconstituted solution for IM administration within 1 hr of preparation.

  Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies, especially to amide type local anesthetics, penicillin and beta-lactam antibiotics. Note history of renal impairment, seizures, or brain lesions.
  • Review results of culture and sensitivity testing as available.
  • Monitor for signs of infection, especially fever, and for positive response to antibiotic therapy.
  • Monitor patient for signs of anaphylaxis or severe allergic reaction. Discontinue therapy and immediately notify health care provider if noted. Be prepared to treat appropriately.
  • Monitor patient for GI, CNS, and general body side effects. Report to health care provider if noted and significant.
  • If seizure occurs, withhold drug, institute safety measures, and notify health care provider.
  • Withhold drug and notify health care provider if any of the following occurs: severe diarrhea; loose, foul-smelling stools; vaginal itching or discharge.
OVERDOSAGE: SIGNS & SYMPTOMS
  Nausea, diarrhea, dizziness

  Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug. Explain to patient that medication will be prepared and administered by a health care provider.
  • Review dosing schedule and prescribed length of therapy with patient. Advise patient that dose and duration of therapy are dependent on site and cause of infection and response to therapy.
  • Instruct patient to report the following to health care provider: itching; rash; hives; difficulty breathing; diarrhea; black furry tongue; loose, foul-smelling stools; vaginal itching or discharge.

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