Ertapenem

INTRODUCTION

Indications

Moderate-to-severe: complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, complicated urinary tract infections (including pyelonephritis), acute pelvic infections including postpartum endomyometritis, septic abortion, and postsurgical gynecologic infections. Prophylaxis of surgical site infection following elective colorectal surgery.

Action

Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against the following aerobic gram-positive organisms: Staphylococcus aureus (methicillin-susceptible strains only), S. epidermidis Streptococcus agalactiae, S. pneumoniae (penicillin-susceptible strains only), and S. pyogenes. Also active against the following gram-negative aerobic organisms: Escherichia coli, Haemophilus influenzae (beta-lactamase–negative strains), Klebsiella pneumonia, Moraxella catarrhalis, and Providencia rettgeri. Additional anaerobic spectra include: Bacteroides fragilis, B. distasonis, B. ovatus, B. thetaiotamicron, B. uniformis, B. vulgatis Clostridium clostrioforme, Eubacterium lentum, Peptostreptococcus, Porphyromonas asaccharolytica, and Prevotella bivia.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting. GU: vaginitis. Local: phlebitis at IV site, pain at IM site. Misc: HYPERSENSITIVITY REACTION, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess injection site during and after IV administration, and report signs of phlebitis such as local pain, swelling, and inflammation.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry overgrowth on tongue, vaginal itching or discharge, and loose or foul-smelling stools.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, vaginal irritation, or GI problems (nausea, vomiting, diarrhea).

Pharmacokinetics

Absorption: 90% after IM administration; IV administration results in complete bioavailability.

Distribution: Enters breast milk.

Metabolism and Excretion: Mostly excreted by the kidneys.

Half-life: 1.8 hr (increased in renal impairment).