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Aztreonam (systemic): Drug information

Aztreonam (systemic): Drug information
(For additional information see "Aztreonam (systemic): Patient drug information" and see "Aztreonam (systemic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Azactam
Pharmacologic Category
  • Antibiotic, Monobactam
Dosing: Adult

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

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

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

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

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

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

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

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

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

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

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 prophylaxis

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

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).

Dosing: Kidney Impairment: Adult

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:

Aztreonam Dosage Adjustments for Altered Kidney Functiona: IV, IMb

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).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. Use with caution (minor hepatic elimination occurs).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(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).

Cystic fibrosis, acute pulmonary exacerbation

Cystic fibrosis (Pseudomonas aeruginosa), acute pulmonary exacerbation: Limited data available:

Infants, Children, and Adolescents: IV: 200 to 300 mg/kg/day divided every 6 hours; maximum daily dose: 12 g/day (Ref). Administration of total daily dose by continuous infusion has been reported (Ref).

Intra-abdominal infection, complicated

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, health care-associated

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, treatment

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

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

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.

Dosing: Kidney Impairment: Pediatric

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.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer’s labeling. Use with caution (minor hepatic elimination occurs).

Adverse Reactions

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

Contraindications

Hypersensitivity to aztreonam or any component of the formulation

Warnings/Precautions

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.

Dosage Forms: US

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)

Generic Equivalent Available: US

Yes

Pricing: US

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.

Administration: Adult

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).

Administration: Pediatric

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.

Use: Labeled Indications

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.

Use: Off-Label: Adult

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

Medication Safety Issues
Sound-alike/look-alike issues:

Aztreonam may be confused with azidothymidine

Metabolism/Transport Effects

None known.

Drug Interactions

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

Pregnancy Considerations

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).

Breastfeeding Considerations

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.

Monitoring Parameters

Periodic renal and hepatic function tests; monitor for signs of anaphylaxis during first dose

Mechanism of Action

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.

Pharmacokinetics (Adult Data Unless Noted)

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%).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

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).

  1. Afolabi TM, Goodlet KJ, Fairman KA. Association of antibiotic treatment duration with recurrence of uncomplicated urinary tract infection in pediatric patients. Ann Pharmacother. 2020;54(8):757-766. doi:10.1177/1060028019900650 [PubMed 31958969]
  2. American Academy of Pediatrics (AAP). In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.
  3. American Academy of Pediatrics (AAP) Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610. [PubMed 21873693]
  4. American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 195: prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131(6):e172-e189. [PubMed 29794678]
  5. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi:10.1086/676022 [PubMed 24799638]
  6. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  7. Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed, Philadelphia, PA: American College of Physicians, 2007.
  8. Autore G, Bernardi L, La Scola C, et al. Management of pediatric urinary tract infections: a Delphi study. Antibiotics (Basel). 2022;11(8):1122. doi:10.3390/antibiotics11081122 [PubMed 36009990]
  9. Ayroza-Galvão PA, Milstein-Kuschnaroff TM, Mimica IM, et al. Aztreonam in the treatment of bacterial meningitis. Chemotherapy. 1989;35(suppl 1):S39-S44. doi:10.1159/000238719 [PubMed 2731449]
  10. Azactam (aztreonam) injection, USP [prescribing information]. Princeton, NJ: Bristol-Myers Squibb Company; March 2023.
  11. Bader MS, Loeb M, Leto D, Brooks AA. Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents. Postgrad Med. 2020;132(3):234-250. doi:10.1080/00325481.2019.1680052 [PubMed 31608743]
  12. Balighian E, Burke M. Urinary tract infections in children. Pediatr Rev. 2018;39(1):3-12. doi:10.1542/pir.2017-0007 [PubMed 29292282]
  13. Barshak MB. Antimicrobial approach to intra-abdominal infections in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 6, 2023.
  14. Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. [PubMed 26229122] 10.1093/cid/civ482
  15. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 [PubMed 28467526]
  16. Bilbao-Meseguer I, Rodríguez-Gascón A, Barrasa H, Isla A, Solinís MÁ. Augmented renal clearance in critically ill patients: a systematic review. Clin Pharmacokinet. 2018;57(9):1107-1121. doi:10.1007/s40262-018-0636-7 [PubMed 29441476]
  17. Bodilsen J, Brouwer MC, Nielsen H, Van De Beek D. Anti-infective treatment of brain abscess. Expert Rev Anti Infect Ther. 2018;16(7):565-578. doi:10.1080/14787210.2018.1489722 [PubMed 29909695]
  18. Bosso JA, Black PG, Matsen JM. Efficacy of aztreonam in pulmonary exacerbations of cystic fibrosis. Pediatr Infect Dis J. 1987;6(4):393-397. doi:10.1097/00006454-198704000-00010 [PubMed 3588112]
  19. Bradley JS, Nelson JD, Kimberlin DK, et al, eds. Nelson's Pocket Book of Pediatric Antimicrobial Therapy. 28th ed. American Academy of Pediatrics; 2022.
  20. Bratzler DW, Dellinger EP, Olsen KM, et al, “Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery,” Am J Health Syst Pharm, 2013, 70(3):195-283. [PubMed 23327981]
  21. Brogden RN, Heel RC. Aztreonam. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1986;31(2):96-130. [PubMed 3512234]
  22. Burkart JM. Microbiology and therapy of peritonitis in peritoneal dialysis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 19, 2023.
  23. Castells M, Khan DA, Phillips EJ. Penicillin allergy. N Engl J Med. 2019;381(24):2338-2351. doi:10.1056/NEJMra1807761 [PubMed 31826341]
  24. Chen JR, Tarver SA, Alvarez KS, Wei W, Khan DA. Improving aztreonam stewardship and cost through a penicillin allergy testing clinical guideline. Open Forum Infect Dis. 2018;5(6):ofy106. doi:10.1093/ofid/ofy106 [PubMed 29977963]
  25. Chotiprasitsakul D, Han JH, Cosgrove SE, et al; Antibacterial Resistance Leadership Group. Comparing the outcomes of adults with enterobacteriaceae bacteremia receiving short-course versus prolonged-course antibiotic therapy in a multicenter, propensity score-matched cohort. Clin Infect Dis. 2018;66(2):172-177. doi:10.1093/cid/cix767 [PubMed 29190320]
  26. Cies JJ, LaCoursiere RJ, Moore WS 2nd, Chopra A. Therapeutic drug monitoring of prolonged infusion aztreonam for multi-drug resistant Pseudomonas aeruginosa: a case report. J Pediatr Pharmacol Ther. 2017;22(6):467-470. doi:10.5863/1551-6776-22.6.467 [PubMed 29290748]
  27. Cowart MC, Ferguson CL. Optimization of aztreonam in combination with ceftazidime/avibactam in a cystic fibrosis patient with chronic Stenotrophomonas maltophilia pneumonia using therapeutic drug monitoring: A case study. Ther Drug Monit. 2021;43(2):146-149. doi:10.1097/FTD.0000000000000857 [PubMed 33315762]
  28. Crandon JL, Nicolau DP. Human simulated studies of aztreonam and aztreonam-avibactam to evaluate activity against challenging gram-negative organisms, including metallo-β-lactamase producers. Antimicrob Agents Chemother. 2013;57(7):3299-3306. doi:10.1128/AAC.01989-12 [PubMed 23650162]
  29. Creasey WA, Platt TB, Frantz M, et al, “Pharmacokinetics of Aztreonam in Elderly Male Volunteers,” Br J Clin Pharmacol, 1985, 19:233-7. [PubMed 4039189]
  30. de Wijkerslooth EML, Boerma EG, van Rossem CC, et al; APPIC Study Group. 2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non-inferiority randomised trial. Lancet. 2023;401(10374):366-376. doi:10.1016/S0140-6736(22)02588-0 [PubMed 36669519]
  31. Diarra A, Pascal L, Carpentier B, et al. Successful use of avibactam and aztreonam combination for a multiresistant Stenotrophomonas maltophilia bloodstream infection in a patient with idiopathic medullary aplasia. Infect Dis Now. 2021;51(7):637-638. doi:10.1016/j.idnow.2021.01.014 [PubMed 33870895]
  32. Dratwa M, Glupczynski Y, Lameire N, et al. Treatment of gram-negative peritonitis with aztreonam in patients undergoing continuous ambulatory peritoneal dialysis. Rev Infect Dis. 1991;13(suppl 7):S645-S647. doi:10.1093/clinids/13.supplement_7.s645 [PubMed 2068475]
  33. Dryden M, Zhang Y, Wilson D, Iaconis JP, Gonzalez J. A phase III, randomized, controlled, non-inferiority trial of ceftaroline fosamil 600 mg every 8 h versus vancomycin plus aztreonam in patients with complicated skin and soft tissue infection with systemic inflammatory response or underlying comorbidities. J Antimicrob Chemother. 2016;71(12):3575-3584. doi:10.1093/jac/dkw333 [PubMed 27585969]
  34. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063-e1143. doi:10.1097/CCM.0000000000005337 [PubMed 34605781]
  35. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  36. Falcone M, Daikos GL, Tiseo G, et al. Efficacy of ceftazidime-avibactam plus aztreonam in patients with bloodstream infections caused by Metallo-β-lactamase-producing enterobacterales. Clin Infect Dis. 2021;72(11):1871-1878. doi:10.1093/cid/ciaa586 [PubMed 32427286]
  37. Feris J, Moledina N, Rodriguez WJ, et al. Aztreonam in the treatment of gram-negative meningitis and other gram-negative infections. Chemotherapy. 1989;35(suppl 1):S31-S38. doi:10.1159/000238718 [PubMed 2731448]
  38. File TM. Treatment of community-acquired pneumonia in adults who require hospitalization. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  39. Fillastre JP, Leroy A, Baudoin C, et al. Pharmacokinetics of aztreonam in patients with chronic renal failure. Clin Pharmacokinet. 1985;10(1):91-100. doi:10.2165/00003088-198510010-00005 [PubMed 4038635]
  40. Fox MT, Amoah J, Hsu AJ, Herzke CA, Gerber JS, Tamma PD. Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis. JAMA Netw Open. 2020;3(5):e203951. doi:10.1001/jamanetworkopen.2020.3951 [PubMed 32364593]
  41. Freifeld AG, Bow EJ, Sepkowitz KA, et al; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. doi:10.1093/cid/cir073 [PubMed 21258094]
  42. Fuiano G, Sepe V, Viscione M, Nani E, Conte G. Effectiveness of single daily intraperitoneal administration of aztreonam and cefuroxime in the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int. 1989;9(4):273-275. [PubMed 2488380]
  43. Gerig JS, Bolton ND, Swabb EA, Scheld WM, Bolton WK. Effect of hemodialysis and peritoneal dialysis on aztreonam pharmacokinetics. Kidney Int. 1984;26(3):308-318. doi:10.1038/ki.1984.174 [PubMed 6542606]
  44. Glaser AP, Schaeffer AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin North Am. 2015;42(4):547-560. [PubMed 26475951]
  45. Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):3-16. doi:10.1002/jhbp.518 [PubMed 29090866]
  46. Gross AE, Xu H, Zhou D, Al-Huniti N. Simplified aztreonam dosing in patients with end-stage renal disease: results of a Monte Carlo simulation. Antimicrob Agents Chemother. 2018;62(11):e01066-18. doi:10.1128/AAC.01066-18 [PubMed 30150467]
  47. Gupta K. Acute complicated urinary tract infection (including pyelonephritis) in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  48. Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257 [PubMed 21292654]
  49. Hanberger H, Nilsson LE, Kihlström E, Maller R. Postantibiotic effect of beta-lactam antibiotics on Escherichia coli evaluated by bioluminescence assay of bacterial ATP. Antimicrob Agents Chemother. 1990;34(1):102-106. doi:10.1128/aac.34.1.102 [PubMed 2183707]
  50. Hayes D Jr, Kanga JF, Anstead MI, Kuhn RJ. Novel approach to the eradication of Pseudomonas aeruginosa in an infant with CF after outpatient treatment failure. Pediatr Pulmonol. 2008;43(5):511-513. doi:10.1002/ppul.20791 [PubMed 18383117]
  51. Heil EL, Bork JT, Abbo LM, et al. Optimizing the management of uncomplicated gram-negative bloodstream infections: consensus guidance using a modified delphi process. Open Forum Infect Dis. 2021;8(10):ofab434. doi:10.1093/ofid/ofab434 [PubMed 34738022]
  52. Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009;29(5):562-77. doi: 10.1592/phco.29.5.562 [PubMed 19397464]
  53. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
  54. Kafetzis D, Papadimitriou G, Stavridis C, Sinaniotis C, Papoulias G. Treatment of pyelonephritis with aztreonam: kinetic study in children. Chemioterapia. 1987;6(2)(suppl):284-285. [PubMed 3334567]
  55. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. doi: 10.1093/cid/ciw353 [PubMed 27418577]
  56. Kanj SS, Sexton DJ. Pseudomonas aeruginosa bacteremia and endocarditis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 4, 2023a.
  57. Kanj SS, Sexton DJ. Pseudomonas aeruginosa skin and soft tissue infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 5, 2023b.
  58. Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: a 2022 practice parameter update. J Allergy Clin Immunol. 2022;150(6):1333-1393. doi:10.1016/j.jaci.2022.08.028 [PubMed 36122788]
  59. Kline MW. The role of aztreonam in treatment of complicated urinary tract infections in children. Pediatr Infect Dis J. 1989;8(9)(suppl):S113-S132. doi:10.1097/00006454-198909001-00005 [PubMed 2682509]
  60. Lentnek AL, Williams RR. Aztreonam in the treatment of gram-negative bacterial meningitis. Rev Infect Dis. 1991;13(suppl 7):S586-S590. doi:10.1093/clinids/13.supplement_7.s586 [PubMed 2068463]
  61. Likitnukul S, McCracken GH Jr, Threlkeld N, Darabi A, Olsen K. Pharmacokinetics and plasma bactericidal activity of aztreonam in low-birth-weight infants. Antimicrob Agents Chemother. 1987;31(1):81-83. doi:10.1128/AAC.31.1.81 [PubMed 3105443]
  62. Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International. 2022;42(2):110-153. doi:10.1177/08968608221080586 [PubMed 35264029]
  63. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-e173. doi:10.1093/cid/cis346 [PubMed 22619242]
  64. Lipsky BA, Itani K, Norden C; Linezolid Diabetic Foot Infections Study Group. Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam/amoxicillin-clavulanate. Clin Infect Dis. 2004;38(1):17-24. doi:10.1086/380449 [PubMed 14679443]
  65. Mattie H. Clinical pharmacokinetics of aztreonam. Clin Pharmacokinet. 1988;14(3):148-155. doi: 10.2165/00003088-198814030-00003. [PubMed 3286083]
  66. Mazuski JE, Tessier JM, May AK, et al. The Surgical Infection Society (SIS) revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017;18(1):1-76. doi:10.1089/sur.2016.261 [PubMed 28085573]
  67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Resp Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST. [PubMed 31573350]
  68. Mihindu JC, Scheld WM, Bolton ND, Spyker DA, Swabb EA, Bolton WK. Pharmacokinetics of aztreonam in patients with various degrees of renal dysfunction. Antimicrob Agents Chemother. 1983;24(2):252-261. doi:10.1128/AAC.24.2.252 [PubMed 6685452]
  69. Moehring R, Anderson DJ. Gram-negative bacillary bacteremia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  70. Mojica MF, Ouellette CP, Leber A, et al. Successful treatment of bloodstream infection due to metallo-β-lactamase-producing Stenotrophomonas maltophilia in a renal transplant patient. Antimicrob Agents Chemother. 2016;60(9):5130-5134. doi:10.1128/AAC.00264-16 [PubMed 27551008]
  71. Osmon DR, Tande AJ. Nonvertebral osteomyelitis in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 21, 2023.
  72. Pemberton JH. Acute colonic diverticulitis: medical management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  73. Ramirez JA, Musher DM, Evans SE, et al. Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies. Chest. 2020;158(5):1896-1911. doi:10.1016/j.chest.2020.05.598 [PubMed 32561442]
  74. Ramsey C, MacGowan AP. A review of the pharmacokinetics and pharmacodynamics of aztreonam. J Antimicrob Chemother. 2016;71(10):2704-2712. doi:10.1093/jac/dkw231 [PubMed 27334663]
  75. Reed MD, Aronoff SC, Stern RC, et al. Single-dose pharmacokinetics of aztreonam in children with cystic fibrosis. Pediatr Pulmonol. 1986;2(5):282-286. doi:10.1002/ppul.1950020506 [PubMed 3774385]
  76. Refer to manufacturer's labeling.
  77. Sawyer RG, Claridge JA, Nathens AB, et al; STOP-IT Trial Investigators. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372(21):1996-2005. doi:10.1056/NEJMoa1411162 [PubMed 25992746]
  78. Schaad UB, Wedgwood-Krucko J, Guenin K, Buehlmann U, Kraemer R. Antipseudomonal therapy in cystic fibrosis: aztreonam and amikacin versus ceftazidime and amikacin administered intravenously followed by oral ciprofloxacin. Eur J Clin Microbiol Infect Dis. 1989;8(10):858-865. doi:10.1007/BF01963771 [PubMed 2512129]
  79. Settler FR, Schramm M, and Swabb EA, “Safety of Aztreonam and SQ 26,992 in Elderly Patients With Renal Insufficiency,” Rev Infect Dis, 1985, (Suppl 4):5622.
  80. Smink D. Soybel DI. Management of acute appendicitis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 12, 2023.
  81. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America (SIS/IDSA). Clin Infect Dis. 2010;50(2):133-164. doi:10.1086/649554 [PubMed 20034345]
  82. Southwick FS. Treatment and prognosis of bacterial brain abscess. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 5, 2023.
  83. Spelman D, Baddour LM. Acute cellulitis and erysipelas in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  84. 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. [PubMed 3766490]
  85. Stutman HR, Marks MI, Swabb EA. Single-dose pharmacokinetics of aztreonam in pediatric patients. Antimicrob Agents Chemother. 1984;26(2):196-199. doi:10.1128/aac.26.2.196 [PubMed 6541452]
  86. Swabb EA, Jenkins SA, Muir JG. Summary of worldwide clinical trials of aztreonam in patients with urinary tract infections. Rev Infect Dis. 1985;7(suppl 4):S772-S777. doi:10.1093/clinids/7.supplement_4.s772 [PubMed 3909336]
  87. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2022 guidance on the treatment of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clin Infect Dis. 2022b;75(2):187-212. doi:10.1093/cid/ciac268 [PubMed 35439291]
  88. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America guidance on the treatment of AmpC β-lactamase-producing Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia infections. Clin Infect Dis. 2022a;74(12):2089-2114. doi:10.1093/cid/ciab1013 [PubMed 34864936]
  89. Tennant SJ, Burgess DR, Rybak JM, Martin CA, Burgess DS. Utilizing Monte Carlo simulations to optimize institutional empiric antipseudomonal therapy. Antibiotics (Basel). 2015;4(4):643-652. doi:10.3390/antibiotics4040643 [PubMed 27025644]
  90. Thompson RZ, Martin CA, Burgess DR, Rutter WC, Burgess DS. Optimizing beta-lactam pharmacodynamics against Pseudomonas aeruginosa in adult cystic fibrosis patients. J Cyst Fibros. 2016;15(5):660-663. doi:10.1016/j.jcf.2016.04.002 [PubMed 27132188]
  91. Trotman RL, Williamson JC, Shoemaker DM, et al, "Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy," Clin Infect Dis, 2005, 41(8):1159-66. [PubMed 16163635]
  92. Trujillo H, Harry N, Arango A, et al. Aztreonam in the treatment of aerobic, gram-negative bacillary infections in pediatric patients. Chemotherapy. 1989;35(suppl 1):S25-S30. doi:10.1159/000238717 [PubMed 2731447]
  93. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284. doi:10.1086/425368 [PubMed 15494903]
  94. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34-e65. doi:10.1093/cid/ciw861 [PubMed 28203777]
  95. Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman J. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49(1):1-16. doi:10.2165/11318140-000000000-00000 [PubMed 20000886]
  96. Umaña MA, Odio CM, Castro E, Salas JL, McCracken GH Jr. Evaluation of aztreonam and ampicillin vs. amikacin and ampicillin for treatment of neonatal bacterial infections. Pediatr Infect Dis J. 1990;9(3):175-180. doi:10.1097/00006454-199003000-00006 [PubMed 2186351]
  97. Vollmer CM, Zakko SF, Afdhal NH. Treatment of acute calculous cholecystitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  98. Warady BA, Bakkaloglu S, Newland J, et al. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012;32(Suppl 2):S32-86. [PubMed 22851742]
  99. Weintrob AC, Sexton DJ. Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 4, 2023.
  100. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. 2002. Available at http://www.who.int/maternal_child_adolescent/documents/55732/en/
  101. Xu H, Zhou W, Zhou D, Li J, Al-Huniti N. Evaluation of aztreonam dosing regimens in patients with normal and impaired renal function: a population pharmacokinetic modeling and Monte Carlo simulation analysis. J Clin Pharmacol. 2017;57(3):336-344. doi:10.1002/jcph.810 [PubMed 27530649]
  102. Yahav D, Franceschini E, Koppel F, et al; Bacteremia Duration Study Group. Seven versus 14 days of antibiotic therapy for uncomplicated gram-negative bacteremia: a noninferiority randomized controlled trial. Clin Infect Dis. 2019;69(7):1091-1098. doi:10.1093/cid/ciy1054 [PubMed 30535100]
  103. Zobell JT, Young DC, Waters CD, et al. Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: I. aztreonam and carbapenems. Pediatr Pulmonol. 2012;47(12):1147-1158. [PubMed 22911974]
  104. Zobell JT, Young DC, Waters CD, et al. Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: VI. Executive Summary. Pediatr Pulmonol. 2013;48(6):525-537. doi: 10.1002/ppul.22757. [PubMed 23359557]
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