aztreonam

Contraindicated in:

Hypersensitivity;
Lactation: Lactation (IV/IM formulation).

Use Cautiously in:

Severe renal impairment;
Cross-sensitivity with penicillins or cephalosporins may occur rarely; has been used safely in patients with a history of penicillin or cephalosporin allergy;
Patients with FEV₁<25% or >75% predicted, or patients colonized with Burkholderia cepacia (safety and effectiveness not established);
OB: Safety of IV/IM formulation not established in pregnancy; systemic absorption of oral inhalation expected to be minimal;
Lactation: Systemic absorption of oral inhalation expected to be minimal;
Pedi: Children <7 yr (oral inhalation) (safety and effectiveness not established);
Geri: Consider age-related ↓ in renal function in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest discomfort (oral inhalation)

Derm: rash

EENT: nasal congestion (oral inhalation), nasopharyngeal pain (oral inhalation)

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

Local: pain at IM site, phlebitis at IV site

Neuro: SEIZURES

Resp: cough (oral inhalation), wheezing (oral inhalation), bronchospasm (oral inhalation)

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

Interactions ⬆ ⬇

Drug-drug:

Levels may be ↑ by furosemide or probenecid.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 1 g/vial; 2 g/vial
Lyophilized powder for use with diluent provided in Altera Nebulizer System only (Cayston): 75 mg/vial with 1 mL ampule of diluent (0.17% NaCl)

Route/Dosage ⬆ ⬇

IM IV (Adults ): Moderately severe infections: 1–2 g every 8–12 hr; severe or life-threatening infections (including those due to Pseudomonas aeruginosa): 2 g every 6–8 hr; urinary tract infections: 0.5–1 g every 8–12 hr.
IV (Children 1 mo–16 yr): Mild to moderate infections: 30 mg/kg every 8 hr; moderate to severe infections: 30 mg/kg every 6–8 hr; cystic fibrosis: 50 mg/kg every 6–8 hr.
IV (Neonates >2 kg): 30 mg/kg every 6–8 hr.
IV (Neonates ≤2 kg): 30 mg/kg every 8–12 hr.
Inhaln (Adults and Children >7 yr): 75 mg three times daily for 28 days.

Renal Impairment

IV (Adults ): CCr 10–30 mL/min: 1–2 g initially; then 50% of usual dosage at usual interval; CCr <10 mL/min: 500 mg–2 g initially; then 25% of usual dosage at usual interval (⅛ of initial dose should also be given after each hemodialysis session).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Displays significant activity against gram-negative aerobic organisms only:
- Escherichia coli,
- Serratia,
- Klebsiella oxytoca or pneumoniae,
- Citrobacter,
- Proteus mirabilis,
- Pseudomonas aeruginosa,
- Enterobacter,
- Haemophilus influenzae.
Not active against:
- Staphylococcus aureus,
- Enterococcus,
- Bacteroides fragilis,
- Streptococci.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: monobactams

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following IM administration. IV administration results in complete bioavailability. Low absorption follows administration by oral inhalation.

Distribution: Widely distributed to tissues. High concentrations achieved in sputum with inhalation.

Metabolism/Excretion: 60–70% excreted unchanged by the kidneys. 10% of inhaled dose excreted unchanged in urine. Small amounts metabolized by the liver.

Half-Life: Adults: 1.5–2 hr; Children: 1.7 hr; Neonates: 2.4–9 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IM	rapid	60 min	6–8 hr
IV	rapid	end of infusion	6–8 hr
Inhaln	rapid	unknown	Several hr

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 self-treat diarrhea.
Advise patient to notify health care professional of new or worsening symptoms of infection or if anaphylaxis occurs.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Patients receiving IV aztreonam should consider temporarily discontinuing breastfeeding during therapy.
Inhaln: Instruct patient to use aztreonam as directed for the full 28-day course, even if feeling better. If a dose is missed, take all three daily doses, as long as doses are ≥4 hr apart. Skipping doses or not completing full course of therapy may ↓ effectiveness and ↑ likelihood of bacterial resistance. Inform patient of the importance of using a bronchodilator prior to treatment and in use and cleaning of nebulizer. Advise patient to read Patient Information before starting therapy.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

0003- E.R. Squibb & Sons, L.L.C.
- 0003-2560- AZACTAM
  - 0003-2560-16- 10 VIAL, SINGLE-DOSE in 1 CARTON (0003-2560-16) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

0003- E.R. Squibb & Sons, L.L.C.
- 0003-2570- AZACTAM
  - 0003-2570-16- 10 VIAL, SINGLE-DOSE in 1 CARTON (0003-2570-16) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

0409- Hospira, Inc.
- 0409-0829- Aztreonam
  - 0409-0829-01- 10 VIAL, SINGLE-DOSE in 1 CARTON (0409-0829-01) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE (0409-0829-11)

0409- Hospira, Inc.
- 0409-0830- Aztreonam
  - 0409-0830-01- 10 VIAL, SINGLE-DOSE in 1 CARTON (0409-0830-01) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE (0409-0830-11)

13538- Curia Italy S.r.l.
- 13538-001-
  - 13538-001-01- 200 kg in 1 DRUM (13538-001-01)

13538- Curia Italy S.r.l.
- 13538-008-
  - 13538-008-01- 200 kg in 1 DRUM (13538-008-01)

13538- Curia Italy S.r.l.
- 13538-009-
  - 13538-009-01- 200 kg in 1 DRUM (13538-009-01)

24525- Gilead Sciences, Inc.
- 24525-0025-
  24525-0025-1- 8 kg in 1 BAG (24525-0025-1)

24525- Gilead Sciences, Inc.
- 24525-0025-
  24525-0025-2- 6 kg in 1 BAG (24525-0025-2)

24525- Gilead Sciences, Inc.
- 24525-0025-
  24525-0025-3- 3.6 kg in 1 BAG (24525-0025-3)

50090- A-S Medication Solutions
- 50090-7494- AZACTAM
  50090-7494-0- 10 VIAL, SINGLE-DOSE in 1 CARTON (50090-7494-0) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

52952- Guangan Kingday Pharma & Chem Co., Ltd.
- 52952-001-
  - 52952-001-00- 1 kg in 1 DRUM (52952-001-00)

54087- Hospira Australia Pty Ltd
- 54087-160-
  54087-160-12- 5 TRAY in 1 BOX (54087-160-12) / 200 VIAL in 1 TRAY (54087-160-11) / 1 POWDER, FOR SOLUTION in 1 VIAL (54087-160-10)

61126- Latina Pharma S.p.A.
- 61126-710-
  61126-710-01- 1 BAG in 1 DRUM (61126-710-01) / 1 BAG in 1 BAG (61126-710-02) / 1 kg in 1 BAG

61958- Gilead Sciences, Inc.
- 61958-0901- Cayston
  61958-0901-1- 2 CARTON in 1 PACKAGE (61958-0901-1) / 1 KIT in 1 CARTON * 1 mL in 1 VIAL * 1 mL in 1 AMPULE

63323- Fresenius Kabi USA, LLC
- 63323-401- Aztreonam
  - 63323-401-20- 10 VIAL in 1 TRAY (63323-401-20) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (63323-401-01)

63323- Fresenius Kabi USA, LLC
- 63323-401- Aztreonam
  - 63323-401-24- 10 VIAL in 1 TRAY (63323-401-24) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (63323-401-41)

63323- Fresenius Kabi USA, LLC
- 63323-401- Aztreonam
  - 63323-401-26- 10 VIAL in 1 TRAY (63323-401-26) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (63323-401-21)

63323- Fresenius Kabi USA, LLC
- 63323-402- Aztreonam
  - 63323-402-20- 10 VIAL in 1 TRAY (63323-402-20) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (63323-402-01)

63323- Fresenius Kabi USA, LLC
- 63323-402- Aztreonam
  - 63323-402-24- 10 VIAL in 1 TRAY (63323-402-24) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (63323-402-41)

63323- Fresenius Kabi USA, LLC
- 63323-402- Aztreonam
  - 63323-402-30- 10 VIAL in 1 TRAY (63323-402-30) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (63323-402-03)

73301- LSNE, Inc.
- 73301-008-
  - 73301-008-01- 2 mL in 1 VIAL (73301-008-01)

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Indications ⬇

Contraind./Precautions ⬆ ⬇