ceftazidime

REMS

Treatment of the following infections caused by susceptible organisms:
- Skin and skin structure infections,
- Bone and joint infections,
- Urinary tract infections,
- Gynecological infections,
- Lower respiratory tract infections,
- Intra-abdominal infections,
- Septicemia,
- Febrile neutropenia,
- Meningitis.

Action ⬆ ⬇

Binds to the bacterial cell wall membrane, causing cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Similar to that of second-generation cephalosporins, but activity against staphylococci is less, while activity against gram-negative pathogens (particularly Pseudomonas aeruginosa) is greater, even for organisms resistant to first- and second-generation agents.
Notable is increased action against:
- Citrobacter,
- Enterobacter,
- Haemophilus influenzae(including β-lactamase-producing strains),
- Escherichia coli,
- Klebsiella pneumoniae,
- Neisseria meningitidis,
- Proteus,
- Providencia,
- Pseudomonas aeruginosa,
- Serratia,
- Moraxella catarrhalis.
Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following IM administration; IV administration results in complete bioavailability.

Distribution: Widely distributed. Crosses the placenta; enters breast milk in low concentrations. CSF penetration better than with first- and second-generation agents.

Protein Binding: 17%.

Metabolism/Excretion: 80–90% excreted unchanged in urine.

Half-Life: Neonates: 2.2–4.7 hr; Adults: 2 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	6–12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to cephalosporins;
Serious hypersensitivity to penicillins.

Use Cautiously in:

Renal impairment (↓ dosing/↑ dosing interval recommended if CCr ≤50 mL/min);
History of GI disease, especially colitis;
Lactation: Direct drug effects and modification of bowel flora may occur in the nursing infant;
Geri: Dose adjustment may be necessary due to age-related in renal function.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash, pruritus, urticaria

GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), abdominal pain, diarrhea, nausea, vomiting

Hemat: bleeding, blood dyscrasias, hemolytic anemia

Local: pain at IM site, phlebitis at IV site

Neuro: encephalopathy, SEIZURES (HIGH DOSES IN PATIENTS WITH RENAL IMPAIRMENT)

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS) , superinfection

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of loop diuretics or nephrotoxic agents includingaminoglycosides may ↑ risk of nephrotoxicity.
Bactericidal activity ↓ by chloramphenicol.

Route/Dosage ⬆ ⬇

IM IV (Adults and Children ≥12 yr): Pneumonia and skin/skin structure infections: 500 mg–1 g every 8 hr. Bone and joint infections: 2 g every 12 hr.Severe and life-threatening infections: 2 g every 8 hr.Complicated urinary tract infections: 500 mg every 8–12 hr.Uncomplicated urinary tract infections: 250 mg every 12 hr.Cystic fibrosis lung infection caused by
Pseudomonas aeruginosa
: 30–50 mg/kg every 8 hr (max daily dose = 6 g).
IM IV (Children 1 mo–12 yr): 100–150 mg/kg/day divided every 8 hr (maximum dose:6 g/day).
IM IV (Neonates ≤4 wk): 50 mg/kg every 8–12 hr.

Renal Impairment

IM IV (Adults ): CCr 31–50 mL/min: 1 g every 12 hr; CCr 16–30 mL/min: 1 g every 24 hr; CCr 6–15 mL/min: 500 mg every 24 hr; CCr <5 mL/min: 500 mg every 48 hr.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 1 g/vial; 2 g/vial; 6 g/vial
Premixed infusion: 1 g/50 mL; 2 g/50 mL

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.

Lab Test Considerations:

May cause positive results for Coombs' test.
- May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
- May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, and lymphocytosis.

Implementation ⬆ ⬇

Do not confuse ceftazidime with cefazolin, cefoxitin, cefotetan, or ceftriaxone.
IM: Reconstitute IM doses with sterile or bacteriostatic water for injection. May be diluted with lidocaine to a concentration of 280 mg/mL to minimize injection discomfort.
- Inject deep into a well-developed muscle mass; massage well.

IV Administration:

IV: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis.
- If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.
Reconstitute with 10 mL of 0.9% NaCl, D5W, or sterile water. Do not use preparations containing benzyl alcohol for neonates.
Rate: Administer at a maximum concentration of 180 mg/mL slowly over 3–5 min.
Intermittent Infusion: Diluent: Reconstituted solution may be further diluted with 0.9% NaCl, D5W, D10W, D5/0.25% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, or LR solution.Concentration: Maximum of 40 mg/mL . Dilution causes carbon dioxide to form inside vial, resulting in positive pressure; vial may require venting after dissolution to preserve sterility of vial. Solution may appear yellow to amber; darkening does not alter potency. Solution is stable for 18 hr at room temperature and 7 days if refrigerated.
Rate: Administer over 30 min.

Patient/Family Teaching ⬆ ⬇

Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Rep: Advise females of reproductive potential to notify health professional if pregnancy is planned or suspected or if breastfeeding. Monitor infants exposed to ceftazidime for GI disturbances (thrush or diarrhea).

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇