No

Antibiotic, Miscellaneous

Treatment of patients with urinary tract infections, lower respiratory tract infections, septicemia, skin/skin structure infections, intra-abdominal infections, and gynecological infections caused by susceptible gram-negative bacilli; often useful in patients with allergies to penicillins or cephalosporins

B

Hypersensitivity to aztreonam or any component

Rare cross-allergenicity to penicillins and cephalosporins; requires dosing adjustment in renal impairment

1% to 10%:

Dermatologic: Rash

Gastrointestinal: Diarrhea, nausea, vomiting

Local: Thrombophlebitis, pain at injection site

<1%: Hypotension, seizures, confusion, headache, vertigo, insomnia, dizziness, fever, breast tenderness, pseudomembranous colitis, aphthous ulcer, abnormal taste, halitosis, numb tongue, vaginitis, hepatitis, jaundice, elevated liver enzymes, thrombocytopenia, eosinophilia, leukopenia, neutropenia, myalgia, weakness, diplopia, tinnitus, sneezing, anaphylaxis

Symptoms of overdose include seizures

If necessary, dialysis can reduce the drug concentration in the blood

Avoid antibiotics that induce beta-lactamase production (cefoxitin, imipenem)

Reconstituted solutions are colorless to light yellow straw and may turn pink upon standing without affecting potency; use reconstituted solutions and I.V. solutions (in NS and D₅W) within 48 hours if kept at room temperature or 7 days if kept in refrigerator

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Monobactam structure makes cross-allergenicity with beta-lactams unlikely.

Absorption: I.M.: Well absorbed; I.M. and I.V. doses produce comparable serum concentrations

Distribution: Relative diffusion of antimicrobial agents from blood into cerebrospinal fluid (CSF): Good only with inflammation (exceeds usual MICs); widely distributed to most body fluids and tissues including breast milk; crosses placenta

V_d: Neonates: 0.26-0.36 L/kg; Children: 0.2-0.29 L/kg; Adults: 0.2 L/kg

Ratio of CSF to blood level (%): Inflamed meninges: 8-40; Normal meninges: ~1

Protein binding: 56%

Metabolism: Partial

Half-life:

Neonates: <7 days, less than or equal to 2.5 kg: 5.5-9.9 hours; <7 days, >2.5 kg: 2.6 hours; 1 week to 1 month: 2.4 hours

Children 2 months to 12 years: 1.7 hours

Adults: Normal renal function: 1.7-2.9 hours

End-stage renal disease: 6-8 hours

Time to peak: Within 60 minutes (I.M., I.V. push) and 90 minutes (I.V. infusion)

Elimination: 60% to 70% excreted unchanged in urine and partially in feces

Neonates: I.M., I.V.:

Postnatal age less than or equal to 7 days:

<2000 g: 30 mg/kg/dose every 12 hours

>2000 g: 30 mg/kg/dose every 8 hours

Postnatal age >7 days:

<1200 g: 30 mg/kg/dose every 12 hours

1200-2000 g: 30 mg/kg/dose every 8 hours

>2000 g: 30 mg/kg/dose every 6 hours

Children >1 month: I.M., I.V.: 90-120 mg/kg/day divided every 6-8 hours

Cystic fibrosis: 50 mg/kg/dose every 6-8 hours (ie, up to 200 mg/kg/day); maximum: 6-8 g/day

Adults:

Urinary tract infection: I.M., I.V.: 500 mg to 1 g every 8-12 hours

Moderately severe systemic infections: 1 g I.V. or I.M. or 2 g I.V. every 8-12 hours

Severe systemic or life-threatening infections (especially caused by Pseudomonas aeruginosa): I.V.: 2 g every 6-8 hours; maximum: 8 g/day

Dosing adjustment in renal impairment: Adults:

Cl_cr >50 mL/minute: 500 mg to 1 g every 6-8 hours

Cl_cr 10-50 mL/minute: 50% to 75% of usual dose given at the usual interval

Cl_cr <10 mL/minute: 25% of usual dosage given at the usual interval

Hemodialysis: Moderately dialyzable (20% to 50%); administer dose postdialysis or supplemental dose of 500 mg after dialysis

Peritoneal dialysis: Administer as for Cl_cr <10 mL/minute

Continuous arteriovenous or venovenous hemofiltration (CAVH/CAVHD): Dose as for Cl_cr 10-50 mL/minute

Periodic liver function test; monitor for signs of anaphylaxis during first dose

May interfere with urine glucose tests containing cupric sulfate (Benedict's solution, Clinitest®)

May rarely produce confusion

Rarely produces leukopenia and neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This medication can only be administered I.M. or I.V. You may experience nausea or GI distress. Frequent mouth care, frequent small meals, sucking lozenges, or chewing gum may help relieve these symptoms. May cause false readings with urine glucose testing. Diabetics should use alternate means of monitoring glucose. Report any unrelieved diarrhea or vomiting, pain at injection sites, unresolved fever, unhealed or new sores in mouth or vagina, vaginal discharge, or acute onset of respiratory difficulty. Breast-feeding precautions: Consult prescriber if breast-feeding.

Administer by IVP over 3-5 minutes at a maximum concentration of 66 mg/mL or by intermittent infusion over 20-60 minutes at a final concentration not to exceed 20 mg/mL

Powder for injection: 500 mg (15 mL, 100 mL); 1 g (15 mL, 100 mL); 2 g (15 mL, 100 mL)

Bosso JA and Black PG, "The Use of Aztreonam in Pediatric Patients: A Review," Pharmacotherapy, 1991, 11(1):20-5.

Brogden RN and Heel RC, "Aztreonam. A Review of Its Antibacterial Activity, Pharmacokinetic Properties and Therapeutic Use," Drugs, 1986, 31(2):96-130.

Creasey WA, Platt TB, Frantz M, et al, "Pharmacokinetics of Aztreonam in Elderly Male Volunteers," Br J Clin Pharmacol, 1985, 19:233-7.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Hellinger WC and Brewer NS, "Carbapenems and Monobactams: Imipenem, Meropenem, and Aztreonam," Mayo Clin Proc, 1999, 74(4):420-34.

Johnson DH and Cunha BA, "Aztreonam," Med Clin North Am, 1995, 79(4):733-43.

Settler FR, Schramm M, Swabb EA, "Safety of Aztreonam and SQ 26,992 in Elderly Patients With Renal Insufficiency," Rev Infect Dis, 1985, (Suppl 4):5622.

Stutman HR, Chartrand SA, Tolentino T, et al, "Aztreonam Therapy for Serious Gram-Negative Infections in Children," Am J Dis Child, 1986, 140(11):1147-51.