Intravenous Ertapenem May Control Hidradenitis Suppurativa Symptoms

Hidradenitis in armpit
Hidradenitis in armpit
No durable control of Hidradenitis Suppurativa is seen with current management strategies including topical and/or oral antibiotics, immunomodulatory drugs, and local surgery.
This article is part of Infectious Disease Advisor’s in-depth coverage of IDWeek 2017™, which took place in San Diego, CA. Our staff will be reporting on the latest treatment advancements and research initiatives for skin infections. Check back regularly for highlights from IDWeek 2017.

A 6- to 12-week course of intravenous ertapenem was shown to result in immediate improvement of hidradenitis suppurativa symptoms for all patients and in varying rates of durable response following treatment completion, according to recent research presented at IDWeek 2017, held October 4-8 in San Diego, California.

In this prospective pilot trial, 23 patients with severe hidradenitis suppurativa (Hurley stage III) who were refractory to dermatologic management were recruited to receive a 6- to 12-week course of daily intravenous ertapenem (median 8 weeks). After completion of ertapenem, treatment response was monitored for ≥6 months based on clinical improvement in pain score/drainage and Hurley staging.

Within 2 weeks of initiating ertapenem, 100% of patients had a clinical response. By the end of treatment, 100% of patients had near-complete resolution of active inflammation/drainage and substantial improvement in pain scores.

All participants had relapse after treatment, with a median response duration of 4 weeks (range 2-12 weeks). A total of 3 patients had relapse to Hurley stage III, and ertapenem was reinitiated after 3 months, which resulted in a clinical response.

Many patients experienced clinical benefit despite pretreatment identification of bacteria from cutaneous drainage not susceptible to ertapenem. According to the researchers, this “suggests an unproven immune-modulatory activity.”

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Adverse events included diarrhea (n=4), Clostridium difficile infection (n=1), and peripherally inserted central catheter line-related deep vein thrombosis (n=3).

In conclusion, the study authors noted that “in select [patients] with severe [hidradenitis suppurativa], [intravenous] ertapenem is highly effective in the control of inflammation and can be useful in combination with local surgery.”

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Ramesh M, Jayaprakash R, Hanna Z, Gunasekaran K, Stein T, Abreu-Lanfranco O. More than just an anti-infective agent: a prospective pilot clinical trial to determine the effectiveness of IV ertapenem in severe hidradenitis suppurativa. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Poster 257.