488 Intravenous ertapenem therapy for advanced hidradenitis suppurativa

Abstract

Ertapenem, a broad-spectrum antibiotic, has been used as an off-label treatment option for refractory hidradenitis suppurativa (HS). Previous studies have reported a significant improvement in quality of life, pain, and amount of drainage for HS patients treated with intravenous (IV) ertapenem. Additionally, key inflammatory markers, including erythrocyte sedimentation rate [ESR], c-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-alpha [TNF-a]), may be associated with disease severity in HS patients. Although clinical improvement with IV ertapenem is well recognized, changes in serum inflammatory markers have not been explored. We conducted a retrospective chart review of all patients receiving care at the Montefiore HS Treatment Center who initiated and completed at least six weeks of IV ertapenem therapy in 2019. All patients (n = 15) received daily IV ertapenem at a dose of 1 gram (500 mg renally dosed). Disease severity (HS-Physician Global Assessment [HS-PGA]; Numerical Rating Scale [NRS] pain scores) and serum inflammatory markers (ESR, CRP, IL-6, TNF-a) were quantified at baseline (week 0) and at follow-up visits (weeks 4-8) for HS patients receiving IV ertapenem. The average age of patients was 37.4 ± 12.2, and 73% were female. All patients were Hurley Stage III. Medications prior to initiating ertapenem included topical antibiotics (93%), oral antibiotics (100%), anti-androgen therapy (87%), oral corticosteroids (6.7%), and biologic immunotherapy (93%). Six patients (40%) had received surgery for HS. At follow-up visits, there were significant decreases in NRS pain scores (p=0.0083), HS-PGA scores (p=0.0005), and levels of inflammation, quantified by ESR (p=0.0012), CRP (p=0.0166) and IL-6 (p=0.0039). All patients reported decreased drainage. The dramatic improvement seen in both clinical and laboratory markers of HS disease severity supports the utility of IV ertapenem as an effective option for refractory HS.