Adult Dosing
Uncomplicated urinary tract infections
Bone and joint infections
Complicated urinary tract infections
Uncomplicated pneumonia; mild skin and skin structure infections
Serious gynecologic and intra-abdominal infections
Meningitis
Very severe life-threatening infections in immunocompromised patients
Lung infections caused by Pseudomonas spp. in cystic fibrosis patients with normal renal function
- 30-50 mg/kg IV q8 hr
- Max: 6 g/day
Note:
- Usual adult dosage: 1 g IM/IV q8-12 hrs
- Determine the dosage and route by the susceptibility of the causative organisms, the severity of infection, and the condition and renal function of the patient
- Reserve higher dose for immunocompromised pediatric patients or pediatric patients with cystic fibrosis or meningitis
- Reserve use of pharmacy bulk package for IV infusion only
Orbital cellulitis [Non-FDA Approved]
Pediatric Dosing
Bacterial infections
- 1 mo-12 yrs
- 30-50 mg/kg IV q8 hr
- Max: 6 g/day
Note:
- Determine the dosage and route by the susceptibility of the causative organisms, the severity of infection, and the condition and renal function of the patient
- Reserve higher dose for immunocompromised pediatric patients or pediatric patients with cystic fibrosis or meningitis
- Reserve use of pharmacy bulk package for IV infusion only
Orbital cellulitis [Non-FDA Approved]
- 1 month to 12 years: 100-150 mg/kg/day
12 years: 2 g IV q8h
Bacterial Meningitis [Non-FDA approved]
- 150 mg/kg/day (up to 6 g/day) IV divided q8 h for age 1 mo to 12 yr; 30 mg/kg IV q12 hr for age <4 weeks old. Use adult dose and formulations for 12 years of age
[Outline]
Renal Dose Adjustment: (Based on CrCl)
Adults
- Initial loading dose of 1 g followed by the maintenance doses as described below
- 31-50 mL/min: 1 g IM/IV q12 hrs
- 16-30 mL/min: 1 g IM/IV q24 hrs
- 6-15 mL/min: 500 mg IM/IV q24 hrs
- <5 mL/min: 500 mg IM/IV q48 hrs
- Hemodialysis patients: Initial loading dose 1 g followed by 1 g after each session
- CAPD: 1 gram loading dose, then 500 mg q24 hrs
Child
- If renally insufficient, dose adjustment recommended. Recommend increasing dosing interval as in adults
- 30-50 mL/min: q12 hrs
- 10-29 mL/min: q24 hrs
- <10 mL/min: q48 hrs
Hepatic Dose Adjustment:
- Hepatic impairment: No dose adjustments
- Before institution of therapy, carefully inquire to determine whether the patient has had previous hypersensitivity reactions to ceftazidime, cephalosporins, penicillins, or other drugs
- Exercise caution if this product is to be given to penicillin-sensitive patients as cross-hypersensitivity among beta-lactam antibiotics has occurred in up to 10% of patients with a history of penicillin allergy
- On occurrence of allergic reactions, discontinue therapy. Serious acute hypersensitivity reactions may require treatment with epinephrine and other emergency measures, including oxygen, iv fluids, iv antihistamines, corticosteroids, pressor amines, and airway management
- Clostridium difficile associated diarrhea (CDAD) which may range from mild diarrhea to fatal colitis has been reported. It can occur during therapy or >2mo after discontinuation. Consider diagnosis if diarrhea presents after antibiotic administration
- To reduce the development of drug-resistant bacteria, use only to treat infections proven or strongly suspected to be caused by susceptible bacteria. Obtain susceptibility tests before starting therapy
- Antibiotic may alter colon flora, leading to C. difficile overgrowth. C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains cause increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy
- On suspection/confirmation of CDAD, discontinue use. Patients may need fluid, electrolyte, and protein supplementation along with antibiotics for C. difficile, surgical evaluation as needed
- Seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia have occurred on elevated levels of ceftazidime in patients with renal impairment. Reduce total daily dosage in patients with renal insufficiency
- Overgrowth of nonsusceptible organisms may occur; take appropriate measures on occurrence of superinfections
- Patients with renal and hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy are prone to decrease in prothrombin activity associated with cephalosporins; Monitor prothrombin time in patients at risk and administer exogenous vitamin K as indicated
Cautions: Use cautiously in:
- Renal impairment
- Hypersensitivity to penicillin
- History of GI disease
- History of antibiotic associated colitis
- Seizure disorder
- Concurrent nephrotoxic agents
Pregnancy Category:B
Breastfeeding: Limited information indicates that maternal doses of ceftazidime up to 2 grams produce low levels in milk that are not expected to cause adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 13 January 2011). Manufacturer advises caution.
