About Antibiotics: Ertapenem for Recalcitrant Hidradenitis Suppurativa

Original Article: Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

What are the key takeaways of this article?

Hidradenitis suppurativa (HS) is a follicular skin disorder that primarily affects the axillary, inframammary, genital, and perineum skin. HS presents as painful pustules, nodules, and abscesses that can lead to scarring and a decreased quality of life. Currently, oral antibiotics are a class of medication that is generally accepted as a core treatment option for HS. However, little is known regarding the efficacy and optimal duration of intravenous antibiotics, though some studies have demonstrated benefit from short-term use. In this study by Nosrati et al., the authors retrospectively investigated pre- and post-treatment presentation of HS as well as follow-up assessment of patient satisfaction through review of medical records and telephone survey.

Ertapenem is a parenteral carbapenem with a broad spectrum of activity covering gram positive, gram negative, and anaerobic bacteria. A total of 98 patients were given 1g of IV ertapenem daily at home for 12 to 16 weeks. This was taken alongside any baseline medications, which included topical or oral antibiotics, antiandrogens, or biologics for most patients. Notably, there were significant reductions found in the mean HS Physician Global Assessment scores (3.9 vs 2.7, p<0.01), reported pain rating (4.2 vs 1.8, p<0.01) with 10 being the absolute worst pain, C-reactive protein (5.4 vs 2.4mg/dL, p<0.01), interleukin-6 (25.2 vs 13.7, p<0.01), and leukocyte (11.34 vs 10, p<0.01) levels. Unsurprisingly for this medication, adverse events included diarrhea (8.2%) and nausea (2.0%), though 9 patients (9.2%) did require PICC line replacement as well. Overall, ertapenem treatment was correlated with patient satisfaction, as 80.3% of those surveyed were satisfied or very satisfied with the course of ertapenem.

It is important to note that the inclusion criteria for this study included patients with advanced HS who displayed suboptimal response to ongoing management with medications such as topical and oral antibiotics, antiandrogens, and anti-inflammatory therapies (i.e. adalimumab or infliximab). Additionally, this study only included a single-institution population with a lack of control group for comparison along with incongruent follow-up times, which may make the results less generalizable for most patients with HS. Still, this study reveals important findings for patients and practitioners alike, as it displays the benefit of long-term ertapenem for HS not controlled by initial therapies. Nevertheless, it is important to remember that practitioners in dermatology are in an excellent position to promote antibiotic stewardship and the approach to treatment presented in this study should be used cautiously due to the risk of antibiotic resistance.

Publication Date: March 10th, 2024

Reference: Nosrati A, Ch’en PY, Torpey ME, et al. Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa. JAMA Dermatol.Published online February 14, 2024. doi:10.1001/jamadermatol.2023.6201

Summary By: Taylor Skinner