Dosing guidance:
Dosing: Dosing is presented based on the traditional infusion method over 30 minutes, unless otherwise specified as the extended infusion method over 3 hours (off-label method).
Clinical considerations: Use is generally reserved for patients with severe beta-lactam allergies; assess allergy and de-label if possible and/or consider beta-lactam desensitization. Clinical cross-reactivity can occur between aztreonam and ceftazidime; check skin testing before use in patients with ceftazidime allergy (Ref).
Bloodstream infection (gram-negative bacteremia, including P. aeruginosa) (alternative agent):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 2 g every 8 hours (Ref); for empiric therapy in patients with sepsis or septic shock who are at risk for multidrug-resistant infection, give as part of an appropriate combination regimen (Ref).
Duration of therapy: Usual duration is 7 to 14 days depending on source, pathogen, extent of infection, and clinical response (Ref); a 7-day duration is recommended for patients with uncomplicated Enterobacterales infection who respond appropriately to antibiotic therapy (Ref). Note: If neutropenic, extend treatment until afebrile for 2 days and neutrophil recovery (ANC ≥500 cells/mm3 and increasing) (Ref). For P. aeruginosa bacteremia in patients with neutropenia, some experts treat for a minimum of 14 days and until recovery of neutrophils (Ref).
Diabetic foot infection, moderate to severe (alternative agent) (off-label use):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 1 or 2 g every 8 hours as part of an appropriate combination regimen. Duration (which may include oral step-down therapy) is usually 2 to 4 weeks in the absence of osteomyelitis (Ref).
Intra-abdominal infection, health care–associated or high-risk community-acquired infection (alternative agent):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems). For community-acquired infection, reserve for severe infection or patients at high risk of adverse outcome and/or resistance (Ref).
Cholecystitis, acute uncomplicated: IV: 1 to 2 g every 8 hours as part of an appropriate combination; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (Ref).
Other intra-abdominal infection (eg, cholangitis, complicated cholecystitis, appendicitis, diverticulitis, intra-abdominal abscess): IV: 1 to 2 g every 8 hours as part of an appropriate combination regimen. Total duration of therapy varies and may include transition to oral antibiotics: following adequate source control is 4 to 5 days (Ref); for perforated appendicitis managed with appendectomy, 2 to 4 days may be sufficient (Ref). Without intervention, total duration is 7 to 10 days for appendicitis (Ref) and 10 to 14 days for diverticulitis (Ref).
Intracranial abscess (brain abscess) (alternative agent) (off-label use):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 2 g every 6 to 8 hours as part of an appropriate combination regimen; duration generally ranges from 4 to 8 weeks (Ref).
Meningitis, bacterial (alternative agent) (off-label use):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref). As a component of empiric therapy for health care–associated infection or pathogen-specific therapy (eg, Enterobacteriaceae, P. aeruginosa, or H. influenzae beta-lactamase positive]) (Ref).
IV: 2 g every 6 to 8 hours; for empiric therapy, use in combination with vancomycin (Ref). Treatment duration for gram-negative bacilli is a minimum of 10 to 14 days, although some experts recommend ≥21 days (Ref).
Metallo-beta-lactamase–producing Enterobacterales and multidrug-resistant Stenotrophomonas maltophilia infections (off-label use): IV: 2 g every 8 hours infused over 3 hours in combination with ceftazidime/avibactam (administered at the same time, if possible) (Ref).
Osteomyelitis (alternative agent) (off-label use):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 2 g every 8 hours for ≥6 weeks (including oral step-down therapy); for empiric therapy, use as part of an appropriate combination regimen (Ref).
Peritonitis, treatment (peritoneal dialysis) (alternative agent) (off-label route):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref). Intraperitoneal administration is preferred to IV administration unless the patient has sepsis (Ref).
Intermittent: Intraperitoneal: 2 g added to the dialysate solution once daily; allow to dwell ≥6 hours (Ref).
Continuous (with every exchange): Intraperitoneal: Loading dose: 500 mg to 1 g/L of dialysate added to first dialysate exchange; maintenance dose: 250 mg/L of dialysate with each subsequent dialysate exchange (Ref).
Duration of therapy: ≥3 weeks for patients with adequate clinical response; for patients with no improvement after 5 days, remove catheter and treat with appropriate systemic antibiotics for 14 days after catheter removal (Ref).
Pneumonia (alternative agent):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
Community-acquired pneumonia: For empiric therapy of inpatients at risk of infection with a gram-negative pathogen(s), including P. aeruginosa:
IV: 2 g every 8 hours as part of an appropriate combination regimen. Total duration (which may include oral step-down therapy) is a minimum of 5 days; a longer course may be required for patients with an immunocompromising condition, severe or complicated infection, or for P. aeruginosa infection. Patients should be clinically stable with normal vital signs prior to discontinuation (Ref).
Hospital-acquired or ventilator-associated pneumonia: For empiric therapy or pathogen-specific therapy of gram-negative pathogen(s), including P. aeruginosa:
IV: 2 g every 8 hours; when used for empiric therapy, give as part of an appropriate combination regimen. Duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days (Ref).
Skin and soft tissue infection, moderate to severe (alternate agent):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 1 or 2 g every 8 hours; for empiric therapy, use as part of an appropriate combination regimen. Usual duration (including oral step-down therapy) is 5 to 14 days based on severity and clinical response (Ref).
Surgical (perioperative) prophylaxis (alternative agent) (off-label use):
Note: Reserve for procedures that warrant gram-negative coverage in patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 2 g within 60 minutes prior to surgical incision, as part of an appropriate combination regimen. Doses may be repeated in 4 hours if procedure is lengthy or if there is excessive blood loss (Ref). In cases where an extension of prophylaxis is warranted postoperatively, total duration should be ≤24 hours (Ref). Postoperative prophylaxis is not recommended in clean and clean-contaminated surgeries (Ref).
Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms) (alternative agent):
Note: Reserve for patients who cannot use other beta-lactams (eg, penicillins, cephalosporins, carbapenems) (Ref).
IV: 1 to 2 g every 8 hours (Ref). Switch to an appropriate oral regimen once symptoms improve if culture and susceptibility results allow (Ref). Total duration of therapy ranges from 5 to 14 days; for patients with symptomatic improvement within the first 48 to 72 hours of therapy, some experts recommend shorter courses of 7 to 10 days (Ref).
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function:
CrClc (mL/minute) |
If the usual recommended dose is 1 g every 8 hours |
If the usual recommended dose is 2 g every 6 or 8 hours |
---|---|---|
a Recommendations are expert opinion derived from: Fillastre 1985; Gerig 1984; Gross 2018; Mihindu 1983; Xu 2017; manufacturer's labeling. | ||
b Doses >1 g should be given IV. | ||
c Calculated using the Cockcroft-Gault equation. | ||
d A reduced dose while maintaining the frequency may be preferred in severe infections (Xu 2017), although maintaining the dose but prolonging the dosing interval has been described (Fillastre 1985; Mihindu 1983) and is utilized by some centers. | ||
e Dialyzable (~30% to 60% with low flux dialyzers [Fillastre 1985; Gerig 1984]); when scheduled dose falls on a dialysis day, administer after hemodialysis (Gross 2018). | ||
30 to <130 |
No dosage adjustment necessary |
No dosage adjustment necessary |
10 to <30d |
1 g every 12 hours or 1 g as a single dose then 500 mg every 8 hours |
2 g every 12 hours or 2 g as a single dose then 1 g every 6 or 8 hours |
<10d |
1 g every 24 hours or 1 g as a single dose then 250 mg every 8 hours |
2 g every 24 hours or 2 g as a single dose then 500 mg every 6 or 8 hours |
Hemodialysis, intermittent (thrice weekly)e |
1 g every 24 hours |
2 g every 24 hours |
Peritoneal dialysis |
1 g every 24 hours |
2 g every 24 hours |
Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2):
Note: Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Young patients (<55 years of age) admitted post-trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).
IV: If usual recommended dose is 2 g every 6 to 8 hours: 2 g every 6 hours (Xu 2017; expert opinion). Consider prolonging the infusion time to over 4 hours (Ref).
CRRT:
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection) and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.
IV: 2 g as a single dose followed by 1 g every 8 hours or 2 g every 12 hours (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration):
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection) and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.
IV: 2 g as a single dose followed by 1 to 2 g every 12 hours. Ensure at least 1 dose is infused after PIRRT session ends on PIRRT days (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling. Use with caution (minor hepatic elimination occurs).
Refer to adult dosing.
(For additional information see "Aztreonam (systemic): Pediatric drug information")
General dosing: Infants, Children, and Adolescents: IV, IM: 90 to 120 mg/kg/day in divided doses every 6 to 8 hours; maximum daily dose: 8 g/day (Ref).
Intra-abdominal infection, complicated: Infants, Children, and Adolescents: Limited data available in ages <9 months: IV: 90 to 120 mg/kg/day in divided doses every 6 to 8 hours as part of an appropriate combination regimen; maximum dose: 2,000 mg/dose. Treatment duration varies based on specific source of infection, success of source control procedures, and clinical response; a total duration of 5 days is typically recommended in patients with adequate source control (Ref).
Meningitis or ventriculitis, healthcare-associated: Limited data available: Infants, Children, and Adolescents: IV: 120 mg/kg/day in divided doses every 6 to 8 hours; doses up to 200 mg/kg/day divided every 6 hours have been reported in patients 2 to 18 years of age; maximum daily dose: 8 g/day. Duration of treatment varies based on isolated pathogen, cerebrospinal fluid studies, and clinical presentation; treat gram-negative pathogens for at least 10 to 14 days (Ref).
Peritonitis (peritoneal dialysis), treatment: Infants, Children, and Adolescents: Intraperitoneal: Continuous: Loading dose: 1,000 mg per liter of dialysate; maintenance dose: 250 mg per liter (Ref).
Surgical prophylaxis: Children and Adolescents: IV: 30 mg/kg within 60 minutes before incision; may repeat in 4 hours for prolonged procedure or excessive blood loss; maximum dose: 2,000 mg/dose (Ref).
Urinary tract infection: Infants, Children, and Adolescents: Limited data available in ages <9 months: IV: 90 to 120 mg/kg/day in divided doses every 6 to 8 hours (Ref). Treatment duration depends on age of patient, response to therapy, and extent of involvement; in patients ≥2 years of age, treatment duration may be as short as 3 to 5 days for uncomplicated cystitis or 6 to 10 days for pyelonephritis; patients <2 years of age may require a longer course (eg, 7 to 14 days) (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants, Children, and Adolescents: IM, IV: The following adjustments have been recommended (Aronoff 2007). Note: Renally adjusted dose recommendations are based on doses of 90 to 120 mg/kg/day divided every 8 hours.
GFR ≥30 mL/minute/1.73 m2: No adjustment required.
GFR 10 to 29 mL/minute/1.73 m2: 15 to 20 mg/kg every 8 hours.
GFR <10 mL/minute/1.73 m2: 7.5 to 10 mg/kg every 12 hours.
Intermittent hemodialysis: 7.5 to 10 mg/kg every 12 hours.
Peritoneal dialysis (PD): 7.5 to 10 mg/kg every 12 hours.
CRRT: No adjustment required.
There are no dosage adjustments provided in manufacturer’s labeling. Use with caution (minor hepatic elimination occurs).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Hematologic & oncologic: Neutropenia (children 3% to 11%; adults <1%)
Hepatic: Increased serum transaminases (children, high dose: >3 times ULN: 15% to 20%; children, standard dose: increased serum AST 4%, increased serum ALT 7%)
Local: Pain at injection site (children 12%, adults 2%)
1% to 10%:
Cardiovascular: Phlebitis (intravenous: ≤2%), thrombophlebitis (intravenous: ≤2%)
Dermatologic: Skin rash (children 4%, adults ≤1%)
Gastrointestinal: Diarrhea (≤1%), nausea (≤1%), vomiting (≤1%)
Hematologic & oncologic: Eosinophilia (children 6%, adults <1%), thrombocythemia (children 4%, adults <1%)
Local: Erythema at injection site (intravenous: Children 3%, adults <1%), discomfort at injection site (intramuscular: ≤2%), swelling at injection site (intramuscular: ≤2%)
Renal: Increased serum creatinine (children 6%)
Miscellaneous: Fever (≤1%)
<1%, postmarketing, and/or case reports: Abdominal cramps, anaphylaxis, anemia, angioedema, breast tenderness, bronchospasm, chest pain, Clostridioides difficile–associated diarrhea, confusion, diaphoresis, diplopia, dizziness, dysgeusia, dyspnea, erythema multiforme, exfoliative dermatitis, flushing, gastrointestinal hemorrhage, halitosis, headache, hepatitis, hepatobiliary disease, hypotension, increased serum alkaline phosphatase, increased serum ALT (adults), increased serum AST (adults), induration at injection site, insomnia, jaundice, leukocytosis, malaise, myalgia, nasal congestion, numbness of tongue, oral mucosa ulcer, pancytopenia, paresthesia, petechia, positive direct Coombs test, prolonged partial thromboplastin time, prolonged prothrombin time, pruritus, pseudomembranous colitis, purpura, seizure, sneezing, thrombocytopenia, tinnitus, toxic epidermal necrolysis, urticaria, vaginitis, ventricular bigeminy (transient), ventricular premature contractions (transient), vertigo, vulvovaginal candidiasis, weakness, wheezing
Hypersensitivity to aztreonam or any component of the formulation
Concerns related to adverse effects:
• Beta-lactam allergy: Rare cross-allergenicity to penicillins, cephalosporins, or carbapenems may occur; use with caution in patients with a history of hypersensitivity to beta-lactams.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment; dosing adjustment required.
Special populations:
• Bone marrow transplantation: Use with caution in patients undergoing bone marrow transplant with multiple risk factors for toxic epidermal necrolysis (TEN) (eg, sepsis, radiation therapy, drugs known to cause TEN); rare cases of TEN in this population have been reported.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Injection [preservative free]:
Azactam: 1 g (1 ea); 2 g (1 ea) [sodium free]
Generic: 1 g (1 ea); 2 g (1 ea)
Yes
Solution (reconstituted) (Azactam Injection)
1 g (per each): $35.67
2 g (per each): $71.34
Solution (reconstituted) (Aztreonam Injection)
1 g (per each): $32.77 - $43.30
2 g (per each): $65.54 - $87.97
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Injection: Doses >1 g should be administered IV.
IM: Administer by deep injection into large muscle mass, such as upper outer quadrant of gluteus maximus or the lateral part of the thigh.
IV: Administer by slow IV push over 3 to 5 minutes or by intermittent infusion over 20 to 60 minutes. For extended infusion administration (off-label method), administer over 3 (Ref) or 4 hours (Ref); some experts prefer administration over 3 hours for infections caused by carbapenem-resistant Enterobacterales or S. maltophilia (Ref).
Parenteral:
IV: IV route is preferred for doses >1,000 mg or in patients with severe life-threatening infections. Administer by IVP over 3 to 5 minutes or by intermittent infusion over 20 to 60 minutes (Ref). For continuous infusion, infuse daily dose over 24 hours (Ref).
IM: Administer by deep IM injection into a large muscle mass such as the upper outer quadrant of the gluteus maximus or lateral part of the thigh. Doses >1,000 mg should be administered IV. Do not mix with any local anesthetic agent.
Treatment of urinary tract infections, lower respiratory tract infections, bloodstream infections, skin and soft tissue infections, intra-abdominal infections, and gynecological infections caused by susceptible gram-negative bacilli.
Diabetic foot infection, moderate to severe; Intracranial abscess (brain abscess); Meningitis, bacterial; Metallo-beta-lactamase–producing Enterobacterales and multidrug-resistant Stenotrophomonas maltophilia infections; Osteomyelitis; Peritonitis, treatment (peritoneal dialysis); Surgical (perioperative) prophylaxis
Aztreonam may be confused with azidothymidine
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Aztreonam crosses the placenta and can be detected in the fetus.
Information related to aztreonam for the treatment of urinary tract infections in pregnancy is limited. Use may be considered in pregnant patients allergic to preferred antibiotics (Glaser 2015; Jolley 2010).
Aztreonam is present in breast milk in concentrations <1% of the corresponding maternal serum concentration. In general, antibiotics that are present in breast milk may cause nondose-related modification of bowel flora (WHO 2002). The poor oral absorption of aztreonam from the gastrointestinal tract (<1%) (Clark 1992) may limit adverse effects to the infant.
Periodic renal and hepatic function tests; monitor for signs of anaphylaxis during first dose
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: IM: Well absorbed; IM and IV doses produce comparable serum concentrations.
Distribution: Widely into body tissues, cerebrospinal fluid, bronchial secretions, peritoneal fluid, bile, and bone.
Vd:
Neonates:
PNA <7 days:
Weight <2,500 g: ~0.36 to 0.58 L/kg (Likitnukul 1987; Stutman 1984).
Weight >2,500 g: 0.26 L/kg (Stutman 1984).
PNA ≥7 days: 0.3 L/kg (Stutman 1984).
Infants and Children: 0.2 to 0.29 L/kg (Stutman 1984).
Adults: 0.15 to 0.18 L/kg (Brogden 1986).
Relative diffusion of antimicrobial agents from blood into CSF: Good only with inflammation (exceeds usual MICs).
CSF:blood level ratio: Meninges: Inflamed: 8% to 40%; Normal: ~1%.
Protein binding: 56%.
Metabolism: Hepatic (minor %).
Half-life elimination:
Neonates:
PNA <7 days:
Weight <2,500 g: ~5.7 hours (Stutman 1984).
Weight >2,500 g: ~2.6 hours (Stutman 1984).
PNA ≥7 days: ~2.4 hours (Stutman 1984).
Infants and Children <12 years: ~1.7 hours (Stutman 1984).
Children ≥10 years and Adolescents with cystic fibrosis: 1.3 hours (Reed 1986).
Adults: Normal renal function: 1.5 to 2 hours.
End-stage renal disease: 6 to 8.4 hours (Brogden 1986).
Time to peak: IM: Within 60 minutes (Mattie 1988).
Excretion: Urine (60% to 70% as unchanged drug); feces (~12%).
Altered kidney function: Serum half-life is prolonged.
Anti-infective considerations:
Parameters associated with efficacy: Time dependent, associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC) and AUC24 to MIC ratio:
Organism specific:
Gram-negative organisms (eg, E. coli, P. aeruginosa): Goal: 50% to 60% fT > MIC (bacteriostatic); ≥65% fT > MIC (bactericidal) (Crandon 2013; Ramsey 2016).
Expected drug exposure in normal renal function:
Pediatric patients: Cmax (peak): 30 mg/kg (3-minute infusion), single dose: IV:
Neonates <1 week of age, <2.5 kg: 83 ± 21.3 mg/L (Stutman 1984).
Neonates <1 week of age, >2.5 kg: 97.8 ± 5 mg/L (Stutman 1984).
Neonates ≥1 week to 1 month of age: 97.4 ± 4.3 mg/L (Stutman 1984).
Infants and children ≤2 years of age: 118.7 ± 6.7 mg/L (Stutman 1984).
Children >2 to 12 years of age: 96.9 ± 16.2 mg/L (Stutman 1984).
Adults: Cmax (peak): Single dose (30-minute infusion): IV:
500 mg: 54 mg/L.
1 g: 90 mg/L.
2 g: 204 mg/L.
Postantibiotic effect: Generally little to no postantibiotic effect (<1 hour) for gram-negative bacilli (including P. aeruginosa) (Hanberger 1990; Ramsey 2016).
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟