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Background and Importance Evidence on ertapenem adjustment in haemodialysis is scarce. The recommended regimen is 0.5 g/24h, although pharmacokinetic studies suggest 0.5–1 g/post-dialysis. Optimised dosing may reduce catheter use, dialysis centre visits and adverse events.Aim and Objectives To compare effectiveness, safety, and resource utilisation of daily versus thrice-weekly administration.Material and Methods This retrospective study (2012–2024) assessed ertapenem in haemodialysis patients at a 420-bed hospital. A consensus protocol was developed recommending three thrice-weekly regimens: 0.5 g/post-dialysis, 1 g/post-dialysis, or 0.5–0.5–1 g/post-dialysis, individualised by physician. Patients were assigned to thrice-weekly or daily cohorts. Additional post-discharge visits for antibiotic administration were recorded. Data were expressed as percentages or medians (Q1–Q3) and analysed using Fisher’s exact and Mann–Whitney U tests.Results Thirty-one patients were included. Baseline demographics, comorbidities and infection sources were comparable: Group 1 Group 2 p value Age 64,6 68,5 0,57 Women (%) 25 75 0,097 Comorbidities (%) Arterial hypertension 100 92,9 0,452 Hypertensive heart disease 70,6 42,9 0,157 Diabetes 64,7 64,3 1 COPD 17,6 14,3 1 Immunosuppression 41,1 50 0,537 Infection source (%) 0,222 Urinary tract 41,2 Skin and soft tissue 35,3 Nosocomial pneumonia 11,8 Catheter-related bacteriemia 5,9 Median treatment duration was 13 (8–40.3) days. Causative microorganisms were similar: ESBL-producing Klebsiella pneumoniae (47.1% vs 42.9%), Escherichia coli (29.4% vs 35.7%), Enterobacter cloacae (6.2% vs 0%), ESBL-producing Proteus mirabilis (5.9% vs 0%). In the thrice-weekly cohort, regimens were 0.5 g (47.1%), 1 g in (35.3%), and 0.5–0.5–1 g (17.6%).Clinical cure rates were comparable (88.2% vs 78.6%, p=0.636), with no adverse events in either group. Hospital stay was similar: 13 (8–40.3) vs 16.5 (8.5–30.8) days (p=0.681). However, among discharged patients, daily regimens required significantly more additional visits and vascular access manipulations: 0 (0) vs 2.5 (1.3–6.0) days (p=0.028).Conclusion and Relevance Thrice-weekly ertapenem was effective and safe in haemodialysis patients. Compared with daily dosing, it reduced dialysis centre visits and intravenous access manipulation.Conflict of Interest No conflict of interest