Ertapenem or ticarcillin/clavulanate for the treatment of intra-abdominal infections or acute pelvic infections in pediatric patients

Meta‐analysis: ertapenem for complicated intra‐abdominal infections

“…Patients in the ertapenem treatment arms received 1 g of ertapenem once daily (except from one RCT, 22 in which a subset of the patients received 1.5 g of ertapenem once daily), administered by the intravenous or intramuscular route. In five of the overall seven RCTs, antipseudomonal penicillins/β‐lactamase inhibitor combinations were used as the comparator regimens (piperacillin/tazobactam and ticarcillin/clavulanic acid in four 16, 18, 20, 21 and one of the RCTs 17 respectively). In the remaining two RCTs, ertapenem was compared with the combination of ceftriaxone plus metronidazole.…”

“…We initially retrieved 48, 38 and 285 potentially eligible RCTs respectively. Finally, we identified seven RCTs, which fulfilled the criteria for inclusion in this meta‐analysis 16–22 …”

“…Regarding the characteristics of the included population, in four of the six RCTs involving patients with cIAIs, it was specifically reported that patients with severe infections (APACHE II score > 30 18, 19, 21 or of a life‐threatening degree 22 ) were excluded. Additionally, all but one 16 of the included studies, either involved patients infected with pathogens susceptible to study antimicrobial treatments, or, with at least one pathogen being susceptible to study treatments, in the case of polymicrobial infections, or excluded patients with infections caused by pathogens known to be resistant to study treatments 17–22 . It should also be noted that, in six of the overall seven included RCTs, 16, 18–22 the concomitant use of other antimicrobial agents was allowed.…”

Pharmacokinetics and Tolerability of Single-dose Intravenous Ertapenem in Infants, Children, and Adolescents

“…The recent use of twice daily dosing (15 mg/kg twice daily) in pediatric clinical trials for children less than 12 years of age was based on preliminary results from this investigation which was designed to better understand the impact of ontogeny on ertapenem biodisposition 14,16. This study was designed to assess the impact of development on the pharmacokinetics of ertapenem and to define the dose-exposure profile of ertapenem in children at escalating doses.…”

“…In pediatric patients, ertapenem appears to possess comparable efficacy to ceftriaxone in the treatment of urinary tact infections, skin and soft tissue infections and community acquired pneumonia 13,14. It also demonstrates efficacy comparable to that of ticarcillin/clavulanate in the treatment of pediatric intra-abdominal and pelvic infections 15,16. Notably, both pediatric investigations employed twice daily dosing regimens in the ertapenem arm for children 12 years and younger.…”