II. Indications
- See Third Generation Anti-Pseudomonal Cephalosporin
- Conditions
- Gram-Negative, Multi-drug resistant intraabdominal Infections and Urinary Tract Infections
- No anaerobic coverage (add Metronidazole for abdominal infections)
- Pseudomonas infections
- Pseudomonas Osteochondritis
- Cystic Fibrosis lung infection
- Gram-Negative, Multi-drug resistant intraabdominal Infections and Urinary Tract Infections
- Ceftazidime Bacterial Coverage
- Pseudomonas aeruginosa (Main indication)
- EKP Gram Negative Bacteria (Escherichia coli, Klebsiella, Proteus)
- ESP Gram Negative Bacteria (Enterobacter, Serratia, Providencia)
- Also covers Citrobacter species
- Gram Positive Cocci poorly covered
- No Gram Negative Coccobacilli coverage
III. Pharmacokinetics
- Half-Life Ceftazidime: 2.7 hours (similar for Avibactam)
- Ceftazidime is excreted in urine (80-90% unchanged, avibactam is 100% unchanged on excretion)
- Adjust dose in Renal Failure
IV. Dosing: Adult (and age >12 years)
-
Urinary Tract Infections
- Give 0.25 to 0.5 g IM or IV every 8 to 12 hours
- Mild to Moderate Infections (Skin Infections)
- Give 0.5 to 1 g IM or IV every 8 hours
- Severe Infections (Sepsis, intra-abdominal infection, bone and joint infection, Neutropenic Fever)
- Give 2 g IV every 8 hours
-
Pseudomonas lung infection in Cystic Fibrosis
- Give 30 to 50 mg/kg IV every 8 hours (max 6 g/day)
-
Renal Dosing
- eGFR 31 to 50 ml/min
- Give 1 g IV every 12 hours
- eGFR 16 to 30 ml/min
- Give 1 g IV every 24 hours
- eGFR 6 to 15 ml/min
- Load 1 g IV, then give 500 mg every 24 hours
- eGFR <5 ml/min
- Load 1 g IV, then give 500 mg every 48 hours
-
Hemodialysis
- Load 1 g IV, then give 1 g IV after each Hemodialysis session
- eGFR 31 to 50 ml/min
V. Dosing: Child (age <12 years)
- Give 35 to 50 mg/kg IV every 8 hours (every 12 hours in age <1 week)
- Use 50 mg/kg in Meningitis
- Maximum: 6 g/day
VI. Safety
- Pregnancy Category B
- Consider safe in Lactation
- Ceftazidime is excreted in Breast Milk
VII. Efficacy
- Limited spectrum (focused Gram Negative bacillus and Pseudomonas coverage)
VIII. Adverse Effects
- Gastrointestinal (Nausea, Vomiting, Diarrhea, Constipation)
- Dizziness
- Anxiousness
- Abdominal Pain
- Paresthesias
- CNS toxicity
- Associated with high drug levels in renal dysfunction
IX. Resources
X. References
- Morrison and LoVecchio (2021) Crit Dec Emerg Med 35(1): 28