Efficacy of ertapenem in the treatment of serious infections caused by Enterobacteriaceae: analysis of pooled clinical trial data

• Published in: Journal of antimicrobial chemotherapy 2003-05, Vol.51 (5), p.1253-1260
• Main Authors: Gesser, Richard M., McCarroll, Kathleen, Teppler, Hedy, Woods, Gail L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; beta-Lactams; Biological and medical sciences; Ceftriaxone - therapeutic use; Cephalosporins - therapeutic use; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Double-Blind Method; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - microbiology; ertapenem; Escherichia coli; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Humans; intra-abdominal infection; Lactams - therapeutic use; Medical sciences; Middle Aged; Multicenter Studies as Topic; Penicillanic Acid - analogs & derivatives; Penicillanic Acid - therapeutic use; Pharmacology. Drug treatments; Piperacillin - therapeutic use; skin infection; Treatment Outcome; Urinary Tract Infections - drug therapy; Urinary Tract Infections - microbiology
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkg237

Objective: The efficacy of ertapenem, 1 g once a day, for treatment of adults with serious infections caused by Enterobacteriaceae was compared with ceftriaxone 1 g once a day [complicated urinary tract infection (CUTI) and community-acquired pneumonia (CAP)] or piperacillin–tazobactam, 3.375 g every 6 h (complicated intra-abdominal, complicated skin/skin structure and acute pelvic infections). Patients and methods: This combined analysis included the subgroup of all 1167 treated patients infected with Enterobacteriaceae from seven randomized double-blind studies. Results: Escherichia coli was the most common pathogen, accounting for 65.3% of all Enterobacteriaceae. Among evaluable patients with deep tissue (intra-abdominal, skin and pelvic) infections, the combined clinical cure rates were 84.8% (223 of 263) for ertapenem and 82.9% (194 of 234) for piperacillin–tazobactam [95% confidence interval (CI) for the difference, adjusting for infection, –4.9% to 8.9%]. Cure rates by infection for ertapenem and piperacillin–tazobactam, respectively, were: intra-abdominal, 85.1% (143 of 168) and 79.9% (119 of 149); pelvic, 86.8% (46 of 53) and 94% (47 of 50); skin/skin structure, 81% (34 of 42) and 80% (28 of 35). Among patients with CUTI, microbiological cure rates were 90.5% (220 of 243) for ertapenem and 92% (196 of 213) for ceftriaxone (95% CI for the difference, –7.1% to 4.1%). In patients with CAP, clinical cure rates were 95% (19 of 20) for ertapenem and 88.9% (16 of 18) for ceftriaxone. Conclusion: Ertapenem therapy was as effective as either piperacillin–tazobactam or ceftriaxone for serious infections caused by Enterobacteriaceae.