Invanz Mechanism of Action

Therapeutic Class: INVANZ (Ertapenem for Injection) is a sterile, synthetic, long-acting, parenteral, 1-β methyl-carbapenem that is structurally related to beta-lactam antibiotics, such as penicillins and cephalosporins, with activity against a wide range of gram-positive and gram-negative aerobic and anaerobic bacteria.
Microbiology: Ertapenem has in vitro activity against a wide range of gram-positive and gram-negative aerobic and anaerobic bacteria. The bactericidal activity of ertapenem results from the inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin binding proteins (PBPs). In Escherichia coli, it has strong affinity toward PBPs 1a, 1b, 2, 3, 4 and 5 with preference for PBPs 2 and 3. Ertapenem has significant stability to hydrolysis by most classes of beta-lactamases, including penicillinases, and cephalosporinases and extended spectrum beta-lactamases, but not metallo-beta-lactamases.
INVANZ has been shown to be active against most strains of the following microorganisms in vitro and in clinical infections (see INDICATIONS): Aerobic and Facultative Anaerobic Gram-Positive Microorganisms: Staphylococcus aureus (including penicillinase-producing strains); Streptococcus agalactiae; Streptococcus pneumoniae; Streptococcus pyogenes.
Note: Methicillin-resistant staphylococci are resistant to INVANZ. Many strains of Enterococcus faecalis and most strains of Enterococcus faecium are resistant.
Aerobic and Facultative Anaerobic Gram-Negative Microorganisms: Escherichia coli; Haemophilus influenzae (including beta-lactamase producing strains); Klebsiella pneumoniae; Moraxella catarrhalis; Proteus mirabilis.
Note: Most strains of Pseudomonas aeruginosa and Acinetobacter spp. are resistant to INVANZ.
Anaerobic Microorganisms: Bacteroides fragilis and other species in the B. fragilis Group; Clostridium species (excluding C. difficile); Eubacterium species; Peptostreptococcus species; Porphyromonas asaccharolytica; Prevotella species.
The following in vitro data are available, but their clinical significance is unknown.
INVANZ exhibits in vitro minimum inhibitory concentrations (MICs) of ≤ 1 mcg/mL against most (≥ 90%) strains of Streptococcus species including Streptococcus pneumoniae, ≤ 0.5 mcg/mL against most (≥ 90%) strains of Haemophilus species and ≤ 2 mcg/mL against most (≥ 90%) strains of the other aerobic and facultative anaerobic microorganisms and ≤ 4 mcg/mL against most (≥ 90%) strains of the strict anaerobic microorganisms in the following list; however, the safety and effectiveness of INVANZ in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical studies: Aerobic and Facultative Anaerobic Gram-Positive Microorganisms: Staphylococcus species, coagulase negative, methicillin susceptible; Streptococcus pneumoniae, penicillin resistant; Viridans streptococci.
Note: Methicillin-resistant staphylococci are resistant to INVANZ. Many strains of Enterococcus faecalis and most strains of Enterococcus faecium are resistant.
Aerobic and Facultative Anaerobic Gram-Negative Microorganisms: Citrobacter freundii; Enterobacter aerogenes; Enterobacter cloacae; Escherichia coli producing ESBLs; Haemophilus parainfluenzae; Klebsiella oxytoca; Klebsiella pneumoniae producing ESBLs; Morganella morganii; Proteus vulgaris; Serratia marcescens.
Note: Many strains of the previously mentioned organisms that are multiply resistant to other antibiotics, e.g., penicillins, cephalosporins (including third-generation) and aminoglycosides are susceptible to INVANZ. Most strains of Pseudomonas aeruginosa and Acinetobacter spp. are resistant to INVANZ.
Anaerobic Microorganisms: Fusobacterium species.