II. Indications
-
Gram Negative aerobic Bacterial Infections
- Urinary Tract Infections
- Intraabdominal and gynecologic infections
- Pseudomonas aeruginosa infections
- Cystic Fibrosis respiratory symptoms (nebulized Cayston)
III. Mechanism
- Classified as a Monobactam
- Monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum
- Binds to and inactivates Penicillin-binding Protein-3 (PBP-3)
- Inhibits cross-linking of Bacterial cell wall components (similar to Carbapenems)
- Activity against Gram Negative Bacteria (including Pseudomonas aeruginosa)
- No significant Gram Positive activity
- Wide tissue distribution (includes joints, CNS and urine)
IV. Dosing: Adult
-
Urinary Tract Infection
- Give 0.5 to 1 gram IM or IV every 8 to 12 hours
- Moderate Gram Negative Infections (e.g. intraabdominal, gynecologic)
- Give 1 to 2 grams IM or IV every 8 to 12 hours
- Severe Gram Negative Infections or Pseudomonas Infections
- Give 2 grams IV every 6 to 8 hours
-
Cystic Fibrosis Respiratory Symptoms
- Nebulize 1 Cayston vial (75 mg) three times daily for 28 days (then hold for at least 28 days)
- Given only with Altera nebulizer, after both Bronchodilator and mucolytic
- Administer after Bronchodilator - short acting (15 min to 4 h) or long-acting (30 min to 12 h)
-
Renal Dosing (eGFR <30 ml/min)
- eGFR 10 to 30 ml/min: Give 1 to 2 g IV load, then give 50% of typical dose
- eGFR <10: Give 0.5 to 2 g IV load, then give 25% of typical dose
- Hemodialysis (life threatening infections)
- Give 12.5% of typical dose after each Hemodialysis run
V. Dosing: Child
-
Gram Negative Infections
- Give 30 mg/kg IV every 6 to 8 hours
-
Cystic Fibrosis Respiratory Symptoms (age >= 7 years old)
- Nebulize 1 Cayston vial (75 mg) three times daily for 28 days (then hold for at least 28 days)
- Given only with Altera nebulizer, after both Bronchodilator and mucolytic
- Administer after Bronchodilator - short acting (15 min to 4 h) or long-acting (30 min to 12 h)
-
Pseudomonas respiratory infection in Cystic Fibrosis (not FDA approved)
- Give 50 mg/kg IV every 6 to 8 hours
VI. Adverse Effects
- Intravenous formulation
- Hypersensitivity
- Gastrointestinal upset
- Seizures
- Hepatitis
- Gastrointestinal upset
- Nebulized Formulation
- Bronchospasm
- Cough
- Nasal congestion
- Wheezing
- Pharyngitis
- Chest Pain
- Vomiting
- Serious
VII. Safety
- Pregnancy Category B
- Safe in Lactation
VIII. Resources
- Aztreonam (DailyMed)
- Cayston Aztreonam Nebulizer Solution (DailyMed)
IX. References
- (2010) Med Lett Drugs Ther 52(1344): 63-4
- Hamilton (2020) Tarascon Pocket Pharmacopoeia