JAC Advance Access published online on August 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg375
© 2003 by The British Society for Antimicrobial Chemotherapy
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Review
1 Antibiotic Resistance
Monitoring & Reference Laboratory, Central Public Health
Laboratory, 61 Colindale Avenue,
London NW9 5HT
* Corresponding author. E-mail: david.livermore{at}hpa.org.uk.
Ertapenem is a carbapenem that shares the activity
of imipenem and meropenem against most species, but is less active
against non-fermenters. Activity is retained against most strains
with AmpC and extended-spectrum
Keywords: carbapenems, Properties and potential of ertapenem
2 Department
of Medical Microbiology, Barts and the London,
Queen Mary's School of Medicine and Dentistry, Turner Street,
London E1 2AD
3 Department of Clinical Microbiology,
University College London Hospital, London WC1E 6DB, UK
-lactamases,
although resistance can arise if these enzymes are combined with
extreme impermeability. Resistance can also be caused by IMP, VIM,
KPC and NMC carbapenemases, but again, co-requires impermeability.
Although the spread of carbapenemases in the future is a concern,
they are currently very rare. Given as a 1 g intravenous (iv) infusion
once daily, ertapenem has a plasma half-life of 
4
h in healthy volunteers, and a Cmax of
155 mg/L and 13 mg/L for total and free drug, respectively. Excretion is
largely renal, divided equally between native drug and an open-ring
derivative. Trials show equivalence to piperacillin/tazobactam or
ceftriaxone in (a) intra-abdominal infections, (b) community-acquired
pneumonia, (c) acute pelvic infections, (d) skin and skin structure
infections and (e) complicated urinary tract infections. The USA
licence grants all these five indications; the EU licence grants
the first three. Further potential uses include home iv therapy,
directed therapy against Enterobacteriaceae with AmpC or extended-spectrum
cephalosporinases, and tentatively, surgical prophylaxis. Widening
the usage of carbapenems raises public health concerns, somewhat
allayed by the continued rarity of carbapenemases after 17 years
of imipenem use, and by the fact that carbapenemases occur mostly
in non-fermenters outside the spectrum of ertapenem, and co-require
impermeability to confer resistance in Enterobacteriaceae. Nevertheless,
if ertapenem is to be used widely, its effects on the resistance
ecology need to be monitored carefully.-lactamases,
MK-0826, -lactams
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