Ertapenem
| Evidence Level: L4 | Predicted Indications: 10 |
Table of Contents
Ertapenem: From Bacterial Pneumonia to Bacterial Arthritis
One-Sentence Summary
Ertapenem is a broad-spectrum carbapenem antibiotic, originally used for bacterial pneumonia (including streptococcal pneumonia) and infections caused by Peptostreptococcus. The TxGNN model predicts it may be effective for bacterial arthritis, but the data compiled for this report contain no registered clinical trials and 10 publications (mostly case reports, small cohorts and reviews) for this indication. Evidence is therefore limited, and the more actionable signals lie in other predicted indications (see the end of this report).
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Bacterial pneumonia, streptococcal pneumonia, Peptostreptococcus infection (the Singapore licence records contain no approved indication text) |
| Predicted New Indication | Bacterial arthritis |
| TxGNN Prediction Score | 99.72% |
| Evidence Level | L4 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 4 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data are not available in the data compiled for this report. Based on known information, ertapenem is a carbapenem (a beta-lactam class) that is active against many Enterobacterales, anaerobes and streptococci. Its efficacy in respiratory and other bacterial infections is established.
These organisms are also common causes of bone and joint infections, so the biological plausibility of use in bacterial arthritis is high. The supporting reports, however, are mostly individual cases (for example Klebsiella pneumoniae septic wrist arthritis and Citrobacter koseri septic arthritis with osteomyelitis treated with ertapenem) and small cohorts. They do not amount to controlled evidence.
Clinical Trial Evidence
Currently no related clinical trials registered for bacterial arthritis.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 24709258 | 2014 | Cohort | Antimicrob Agents Chemother | Retrospective study of 306 patients on long-term outpatient ertapenem; bone and joint infections were among the indications, after intra-abdominal infection and pneumonia |
| 31220276 | 2019 | Cohort | J Antimicrob Chemother | Subcutaneous suppressive β-lactam therapy in 10 patients with bone and joint infections |
| 22233826 | 2011 | Case report | J Chemother | Klebsiella pneumoniae septic wrist arthritis treated successfully with ertapenem and levofloxacin |
| 31352398 | 2019 | Case report | BMJ Case Rep | Citrobacter koseri osteomyelitis with septic arthritis in a diabetic foot treated successfully with ertapenem |
| 31585203 | 2020 | Case report/Review | Anaerobe | Clostridium paraputrificum septic arthritis and osteomyelitis of the shoulder |
| 37578166 | 2023 | Case report/Review | J Investig Med High Impact Case Rep | Prevotella bivia septic arthritis in an immunocompetent adult |
| 38924836 | 2024 | In vitro | Diagn Microbiol Infect Dis | Auranofin restores ertapenem susceptibility in carbapenem-resistant E. coli |
| 39193962 | 2024 | Cohort | Clin Lab | Pathogen distribution and antimicrobial resistance in bone and joint infections in young children |
| 41878879 | 2026 | Cohort | J Antimicrob Chemother | Temocillin as an alternative to carbapenems for bone and joint infections due to third-generation cephalosporin-resistant Enterobacterales |
| 29183082 | 2017 | Review | JAMA | Hidradenitis suppurativa review (not directly relevant to this indication) |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN16029P | Ertapenem Kabi Powder for Injection 1g/vial | Lyophilised powder for injection solution | Not stated |
| SIN11855P | Invanz for Injection 1 g/vial | Powder for injection solution | Not stated |
| SIN15602P | Ertapenem Mevon Powder for Concentrate for Solution for Infusion 1g/vial | Lyophilised powder for injection solution | Not stated |
| SIN16008P | Ertapik for Injection 1g/vial | Lyophilised powder for injection solution | Not stated |
Safety Considerations
- Contraindication-related conditions (from the knowledge graph, not label text): epilepsy, kidney disease, pyoureter, Clostridium difficile colitis, perinatal necrotizing enterocolitis.
- Drug Interactions: 38 interactions were recorded. The only one rated Major is bupropion. Moderate interactions are with picosulfuric acid, polyethylene glycol (3350 with electrolytes) and sodium sulfate. The remaining listed interactions have no assigned severity level.
- Other consideration: Ertapenem is highly protein-bound, and low serum albumin may reduce drug exposure.
Please refer to the package insert for the full warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: For bacterial arthritis, the biological plausibility is high, but the evidence is limited to case reports, small cohorts and reviews, with no registered trials. This corresponds to evidence level L4.
To proceed, the following is needed:
- Controlled studies (ideally randomised trials) of ertapenem in bacterial or septic arthritis and bone and joint infection
- The package-insert warnings and contraindications from the HSA (currently unavailable), which are required before safety screening
- Detailed mechanism-of-action data
- Approved indication text for the four Singapore licences, to confirm current label coverage
Other predicted indications of note:
- Urinary tract infection (L1, Proceed with Guardrails): Several completed Phase 3 trials exist, including a randomised comparison with ceftriaxone in complicated UTI (NCT01014013, n=271) and a combined analysis of two double-blind ertapenem versus ceftriaxone trials (PMID 15150185). This is largely an established use rather than a novel repurposing. Guardrails should cover antimicrobial stewardship and resistance, and the label status should be verified.
- Staphylococcus aureus infection (L2, Research Question): Cefazolin plus ertapenem is being tested in a Phase 2 trial for MSSA bacteremia (NCT04886284, recruiting, n=60), supported by salvage-therapy case series. Ertapenem would be an add-on partner, not monotherapy.
- Hyperamylasemia, polyclonal hyperviscosity syndrome, congenital analbuminemia, toxocariasis, blood group incompatibility, Ureaplasma urethritis and gonococcal urethritis: No plausible mechanism or clinical support was found. These are likely model artifacts, and all are Hold.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.