No

Antibiotic, Cephalosporin (Third Generation)

Treatment of documented susceptible Pseudomonas aeruginosa infection and infections due to other susceptible aerobic gram-negative organisms; empiric therapy of a febrile, granulocytopenic patient

B

Hypersensitivity to ceftazidime, any component, or cephalosporins

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; use with caution in patients with a history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis, urticaria); may cause antibiotic-associated colitis or colitis secondary to C. difficile

1% to 10%:

Gastrointestinal: Diarrhea (1.3%)

Local: Pain at injection site (1.4%)

Miscellaneous: Hypersensitivity reactions (2%)

<1%: Anaphylaxis, fever, headache, dizziness, paresthesia, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, angioedema, nausea, vomiting, pseudomembranous colitis, eosinophilia, thrombocytosis, leukopenia, hemolytic anemia, elevated transaminases, increased BUN, increased creatinine, phlebitis, candidiasis, vaginitis, encephalopathy, asterixis, neuromuscular excitability

Other reactions with cephalosporins include seizures, urticaria, serum-sickness reactions, renal dysfunction, interstitial nephritis, toxic nephropathy, elevated BUN, elevated creatinine, cholestasis, aplastic anemia, hemolytic anemia, pancytopenia, agranulocytosis, colitis, prolonged PT, hemorrhage, superinfection

Symptoms of overdose include neuromuscular hypersensitivity, convulsions especially with renal insufficiency; many beta-lactam antibiotics have the potential to cause neuromuscular hyperirritability or seizures

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Increased effect: Probenecid may decrease cephalosporin elimination; aminoglycosides: in vitro studies indicate additive or synergistic effect against some strains of Enterobacteriaceae and Pseudomonas aeruginosa

Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity

Reconstituted solution and I.V. infusion in NS or D₅W solution are stable for 24 hours at room temperature, 10 days when refrigerated, or 12 weeks when frozen; after freezing, thawed solution is stable for 24 hours at room temperature or 4 days when refrigerated; 96 hours under refrigeration, after mixing

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.

Distribution: Widely distributes throughout the body including bone, bile, skin, CSF (diffuses into CSF with higher concentrations when the meninges are inflamed), endometrium, heart, pleural and lymphatic fluids

Protein binding: 17%

Half-life: 1-2 hours (prolonged with renal impairment); Neonates <23 days: 2.2-4.7 hours

Time to peak serum concentration: I.M.: Within 1 hour

Elimination: By glomerular filtration with 80% to 90% of the dose excreted as unchanged drug within 24 hours

Neonates 0-4 weeks: I.V.: 30 mg/kg every 12 hours

Infants and Children 1 month to 12 years: I.V.: 30-50 mg/kg/dose every 8 hours; maximum dose: 6 g/day

Adults: I.M., I.V.: 500 mg to 2 g every 8-12 hours

Urinary tract infections: 250-500 mg every 12 hours

Dosing interval in renal impairment:

Cl_cr 30-50 mL/minute: Administer every 12 hours

Cl_cr 10-30 mL/minute: Administer every 24 hours

Cl_cr <10 mL/minute: Administer every 48-72 hours

Hemodialysis: Dialyzable (50% to 100%)

Continuous arteriovenous or venovenous hemodiafiltration (CAVH) effects: Dose as for Cl_cr 30-50 mL/minute

Observe for signs and symptoms of anaphylaxis during first dose

Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction

May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins

May rarely cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This medication is administered I.M. or I.V. Drink 2-3 L fluid/day. If diarrhea occurs, yogurt or buttermilk may help. May cause false-positive test with Clinitest®; use another form of testing. May interfere with oral contraceptives; additional contraceptive measures are necessary. Report severe, unresolved diarrhea; vaginal itching or drainage; sores in mouth; blood, pus, or mucus in stool or urine; easy bleeding or bruising; unusual fever or chills; rash; or respiratory difficulty. Breast-feeding precautions: Consult prescriber if breast-feeding.

Parenteral: Any carbon dioxide bubbles that may be present in the withdrawn solution should be expelled prior to injection; ceftazidime can be administered IVP over 3-5 minutes at a maximum concentration of 100 mg/mL or I.V. intermittent infusion over 15-30 minutes at a final concentration of less than or equal to 40 mg/mL

Monitor serum creatinine with concurrent use of an aminoglycoside; a change in renal function necessitates a change in dose

Infusion, premixed (frozen) (Fortaz®): 1 g (50 mL); 2 g (50 mL)

Powder for injection: 500 mg, 1 g, 2 g, 6 g

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Vlasses PH, Bastion WA, Behal R, et al, "Ceftazidime Dosing in the Elderly: Economic Implications," Ann Pharmacother, 1993, 27(7-8):967-71.