Ertapénem
antibiotic
Third-party optionBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Ertapenem belongs to the "antibiotic" category. Antibiotics treat infections caused by bacteria. They are taken as a course, for a defined period, until the end of the prescription.
In the case of Ertapenem, this means: Treats a bacterial infection. Its use is generally limited in time, adjusted to the situation.
Under which brands it is found
In France, about 5 reimbursable presentations containing Ertapenem are recorded. It is found under several brand names and as generics.
- Ertapenem Arrow
- Ertapenem Hikma
- Ertapenem Qilu
- Ertapenem Sun
- Invanz
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
On the plate: potassium and vitamin K
On ertapenem, marked diarrhea causes a loss of potassium, and the antibiotic disrupts the intestinal bacteria that produce part of the vitamin K. Food helps to replenish these two nutrients, day after day.
Potassium is found in beans, lentils, tomatoes, potatoes (especially with the skin), sweet potatoes, bananas, apricots and citrus fruits. Milk, yogurt, as well as meat and fish also provide it. Severe or prolonged diarrhea lowers blood potassium, which the heart and muscles need.
Vitamin K comes mainly from leafy green vegetables: kale, spinach and chard. Cruciferous vegetables also provide it, such as broccoli, Brussels sprouts and cabbage. In addition to your treatment, these vegetables cover a good part of the needs that the intestinal flora was partly meeting.
How ertapenem works
Ertapenem belongs to the carbapenem family, a group of bactericidal antibiotics. It acts on the bacterial cell wall: it binds to the penicillin-binding proteins, known as PBPs, the enzymes that assemble that wall. By blocking these enzymes, it prevents the bacterium from building its envelope. Deprived of its wall, the bacterium dies.
In Escherichia coli, ertapenem binds strongly to PBPs 1a, 1b, 2, 3, 4 and 5, with a marked preference for PBPs 2 and 3. These two targets govern the shape and division of the bacterium. Blocking them disrupts the assembly of the wall, so that the bacterium can no longer divide or hold its structure together.
Why it is prescribed
Ertapenem is reserved for moderate to severe bacterial infections. It treats complicated intra-abdominal infections and complicated skin and soft tissue infections, including diabetic foot without bone involvement. It also covers community-acquired pneumonia, complicated urinary tract infections including pyelonephritis, and acute pelvic infections.
It is also used to prevent surgical site infections following elective colorectal surgery in adults. In this indication, it is given around the time of the procedure to reduce the risk of wound infection. The choice of ertapenem depends on the suspected organism and the severity, a decision that rests with the physician.
How it is administered
Ertapenem is not taken by mouth. It is given parenterally: as an intravenous infusion over 30 minutes, or as an intramuscular injection. The question of taking it with or without food therefore does not arise, unlike with a tablet.
Its plasma half-life is around 4 hours in young adults, and 2.5 hours in children aged 3 months to 12 years, which usually allows a single administration per day. The drug is also highly bound to blood proteins, about 95 % at usual concentrations. The prescribed course is followed to the end, without stopping the treatment on one's own as soon as one feels better.
The effects to know about
In adults, the most frequent adverse effects reported in trials are diarrhea (10.3 %), an increase in ALT (8.8 %), nausea (8.5 %), an increase in AST (8.4 %), a complication of the infused vein (7.1 %), headache (5.6 %), altered mental status (5.1 %) and fever (5.0 %). In children, the most common are diarrhea (11.7 %), vomiting (10.2 %), pain at the infusion site (7.0 %) and fever (4.9 %).
Seizures and other effects on the central nervous system have been reported with ertapenem: in trials, seizures occurred in 0.5 % of patients. The risk increases in the presence of a central nervous system disorder, such as a brain lesion or a history of seizures, or of impaired kidney function. Like other antibiotics, ertapenem can also cause diarrhea related to Clostridioides difficile, sometimes severe.
What the antibiotic shifts in the gut
Ertapenem targets the bacteria responsible for the infection, but along the way it affects part of the intestinal flora. Severe or prolonged diarrhea causes a loss of potassium and lowers blood potassium. Yet the body needs this mineral for the heart, muscle function and acid-base balance.
The intestinal flora renders another service: the bacteria in the lower part of the intestine produce a share of vitamin K, which is needed for blood clotting. When the antibiotic disrupts these bacteria, this internal production decreases. Dietary intake then takes over to cover the needs.
Interactions and monitoring
Two interactions call for attention. With valproic acid or divalproex, carbapenems, including ertapenem, lower the concentration of valproic acid, with a risk of seizures: this combination is generally advised against. With probenecid, the renal excretion of ertapenem decreases and its blood concentration rises, so that the combination is not recommended.
Monitoring focuses on the liver and the kidney. Elevations of transaminases, ALT and AST, are frequent, which warrants monitoring of liver function during treatment. The dose is adjusted according to kidney function, and the risk of seizures increases in cases of renal impairment, hence the value of monitoring the kidney as well.
Sources
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What is ertapenem used for?
Ertapenem is an antibiotic in the carbapenem class, given by injection to treat certain serious bacterial infections. The exact indication is a matter for the prescription. Refer to the package leaflet and to your doctor or pharmacist for your own situation.
What are the most commonly reported side effects?
The package leaflet notably mentions digestive problems such as diarrhoea and nausea, headaches, and reactions at the injection or infusion site. This list is not exhaustive. Read the package leaflet and report any symptom to your doctor or pharmacist.
Does ertapenem interact with other medications?
The package leaflet specifically flags an interaction with valproic acid and sodium valproate, whose blood levels ertapenem can lower. Tell the care team about every medication you take. The decision rests with your doctor or pharmacist, guided by the package leaflet.
How is ertapenem given and for how long?
It is given by injection, either as an intravenous infusion or an intramuscular injection, under medical supervision. The length of treatment depends on the infection and is set by the doctor. Do not change or stop anything on your own: refer to the package leaflet and to your doctor or pharmacist.
Can you receive ertapenem during pregnancy or breastfeeding?
The package leaflet states that use during pregnancy or breastfeeding calls for precautions and must be assessed on a case-by-case basis. Report a pregnancy, plans to become pregnant, or breastfeeding before any treatment. Only your doctor or pharmacist can decide, based on the package leaflet.
What can you do for your gut flora while taking an antibiotic like ertapenem?
Like broad-spectrum antibiotics, ertapenem also acts on the bacteria of the microbiome, and studies link courses of antibiotics to an imbalance of the gut flora. On this front, research is looking into probiotic strains such as Saccharomyces boulardii (a yeast) or Lactobacillus rhamnosus, most often in capsule form. Ask your doctor or pharmacist for advice before combining a probiotic with a treatment.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.