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تعداد ایتم قابل مشاهده باقیمانده : 4 مورد

Ceftazidime: Drug information

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

For abbreviations and symbols that may be used in Lexicomp (show table)
Brand Names: US
  • Fortaz;
  • Tazicef
Brand Names: Canada
  • Fortaz
Pharmacologic Category
  • Antibiotic, Cephalosporin (Third Generation)
Dosing: Adult

Usual dosage range: Note: Infusion method: Dosing is presented in the indication-specific dosing based on the traditional infusion method over 30 minutes, unless otherwise specified.

Traditional intermittent infusion method: IV: 1 to 2 g every 8 hours infused over 30 minutes. For treatment of very severe life-threatening infections, especially in immunocompromised hosts: 2 g every 8 hours (manufacturer's labeling).

Extended infusion method (off-label method): IV: 2 g every 8 hours infused over 3 to 4 hours; may give first dose over 30 minutes, especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis) (Ram 2018; SCCM [Rhodes 2017]; Turner 2015).

Continuous infusion method (off-label method): IV: 6 g infused over 24 hours (Bulitta 2010; Lipman 1999; Lipsitz 2012); may give first dose of 2 g over 30 minutes, especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis) (SCCM [Rhodes 2017]).

Extended and continuous infusion methods are based largely on pharmacokinetic and pharmacodynamic modeling data; clinical efficacy data are limited (Bulitta 2010; Koomanachai 2010; Lipman 1999; Ram 2018; Turner 2015).

Bloodstream infection

Bloodstream infection (gram-negative bacteremia): For empiric therapy of known or suspected gram-negative bacteria (including Pseudomonas aeruginosa) or pathogen-directed therapy for organisms resistant to other agents:

IV: 2 g every 8 hours; for empiric therapy in patients with neutropenia, severe burns, sepsis, or septic shock, give as part of an appropriate combination regimen (Kanj 2020a; Moehring 2019; SCCM [Rhodes 2017]). Note: Some experts prefer the extended or continuous infusion method in critical illness or if treating a susceptible organism with an elevated minimum inhibitory concentration (Moehring 2019; SCCM [Rhodes 2017]).

Duration of therapy: Usual duration is 7 to 14 days depending on source, pathogen, extent of infection, and clinical response (Moehring 2019); a 7-day duration is recommended for patients with uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic therapy (Chotiprasitsakul 2018; Moehring 2019; Yahav 2018). Note: If neutropenic, extend treatment until afebrile for 2 days and neutrophil recovery (ANC ≥500 cells/mm3 and increasing) (IDSA [Freifeld 2011]). For P. aeruginosa bacteremia in neutropenic patients, some experts treat for a minimum of 14 days and until recovery of neutrophils (Kanj 2019b).

Antibiotic lock technique (catheter-salvage strategy): Note: For infections caused by susceptible organisms when the catheter cannot be removed; use in addition to systemic antibiotics.

Intracatheter: Prepare lock solution to final concentration of ceftazidime 5 to 10 mg/mL; may be combined with heparin (Allon 2009; Poole 2004; Vercaigne 2000). The ceftazidime concentration may vary by institution, catheter type, and whether heparin is utilized; solutions with heparin are preferred. Additional ceftazidime concentrations have been studied (IDSA [Mermel 2009]; Rijnders 2005). Instill into each lumen of the catheter access port using a volume sufficient to fill the catheter (2 to 5 mL) with a dwell time of up to 72 hours, depending on frequency of catheter use. Withdraw lock solution prior to catheter use; replace with fresh ceftazidime lock solution after catheter use. Antibiotic lock therapy is given for the same duration as systemic antibiotics (Girand 2020; IDSA [Mermel 2009]; Poole 2004).

Cystic fibrosis, acute pulmonary exacerbation

Cystic fibrosis, acute pulmonary exacerbation (off-label use): For empiric or targeted therapy of P. aeruginosa or other gram-negative bacilli:

Traditional intermittent infusion method: IV: Usual dose: 2 g every 6 to 8 hours or 150 to 200 mg/kg/day divided every 6 to 8 hours (Simon 2019); doses up to 200 to 400 mg/kg/day divided every 6 to 8 hours (maximum: 12 g daily) have also been recommended (Latzin 2008; Zobell 2013).

Extended infusion method: IV: 2 g every 8 hours over 3 to 4 hours (Bulitta 2010; Thompson 2016).

Continuous infusion method: IV: Usual dose: 6 g over 24 hours (Bulitta 2010); doses up to 100 to 200 mg/kg/day (maximum: 12 g daily) have also been studied (Hubert 2009; Zobell 2013).

Duration of therapy: Duration is usually 10 days to 3 weeks or longer based on clinical response (Flume 2009; Simon 2019).

Diabetic foot infection, moderate to severe

Diabetic foot infection, moderate to severe (off-label use): IV: 1 to 2 g every 8 hours. For empiric therapy, give as part of an appropriate combination regimen. If at risk for P. aeruginosa (eg, significant water exposure, macerated wound) or P. aeruginosa is cultured, use 2 g every 8 hours. Duration (which may include oral step-down therapy) is usually 2 to 4 weeks in the absence of osteomyelitis (IDSA [Lipsky 2012]; Weintrob 2019).

Endophthalmitis, bacterial

Endophthalmitis, bacterial (empiric therapy) (off-label use): Intravitreal: 2 to 2.25 mg/0.1 mL NS or sterile water in combination with vancomycin (Durand 2020; Jackson 2003; Roth 1997); a repeat dose(s) may be considered at 24 to 48 hours based on culture result, severity of infection, and response to treatment (Durand 2020).

Intra-abdominal infection, health care–associated or high-risk community-acquired infection

Intra-abdominal infection, health care–associated or high-risk community-acquired infection:

Note: For community-acquired infection, reserve for severe infection or patients at high risk of adverse outcome and/or resistance (Barshak 2021; SIS/IDSA [Solomkin 2010]).

Cholecystitis, acute: IV: 2 g every 8 hours; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (Gomi 2018; SIS [Mazuski 2017]; SIS/IDSA [Solomkin 2010]; Vollmer 2021).

Other intra-abdominal infections (eg, cholangitis, perforated appendix, diverticulitis, intra-abdominal abscess): IV: 2 g every 8 hours in combination with metronidazole and, when appropriate, other agents (Barshak 2021; SIS [Mazuski 2017]; SIS/IDSA [Solomkin 2010]). Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Sawyer 2015; SIS [Mazuski 2017]); for diverticulitis or uncomplicated appendicitis managed without intervention, duration is 7 to 10 days (Barshak 2021; Pemberton 2021). Note: For patients who are critically ill or are at high risk for infection with drug-resistant pathogens, some experts favor the extended or continuous infusion method (Barshak 2021; WSES [Sartelli 2017]).

Intracranial abscess and spinal epidural abscess

Intracranial abscess (brain abscess, intracranial epidural abscess) and spinal epidural abscess: For empiric or directed therapy in patients at risk for P. aeruginosa or other resistant gram-negative bacteria (eg, neurosurgical or immunocompromised patients):

IV: 2 g every 8 hours as part of an appropriate combination regimen; duration generally ranges from 4 to 8 weeks for brain abscess and spinal epidural abscess, and 6 to 8 weeks for intracranial epidural abscess (Bodilsen 2018; Sexton 2021; Sexton 2019b; Southwick 2020).

Melioidosis

Melioidosis (Burkholderia pseudomallei infection) (off-label use): Initial intensive therapy: IV: 2 g every 6 to 8 hours (Lipsitz 2012; White 1989; Wiersinga 2012) or 2 g as a single dose followed by 6 g daily by continuous infusion. Duration is 10 to 14 days, although a longer duration may be necessary depending on disease severity and site of infection (Lipsitz 2012). Some experts recommend adding sulfamethoxazole and trimethoprim for patients with focal disease of the CNS, prostate, bone, joint, skin, or soft tissue (Currie 2019). Note: Following the course of parenteral therapy, eradication therapy with oral antibiotics for ≥12 weeks is recommended (Lipsitz 2012).

Meningitis, bacterial

Meningitis, bacterial: As a component of empiric therapy for health care-associated infection or as pathogen-specific therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):

IV: 2 g every 8 hours; for empiric therapy, use in combination with vancomycin (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]). Treatment duration for gram-negative bacilli is a minimum of 10 to 14 days, although some experts recommend ≥21 days (Hasbun 2020; IDSA [Tunkel 2017]).

Neutropenic fever, high-risk cancer patients

Neutropenic fever, high-risk cancer patients (empiric therapy): Note: High-risk patients are those expected to have an ANC ≤100 cells/mm3 for >7 days or an ANC ≤100 cells/mm3 for any expected duration if there are ongoing comorbidities (eg, sepsis, mucositis, significant hepatic or renal dysfunction) (IDSA [Freifeld 2011]); some experts use an ANC cutoff of <500 cells/mm3 to define high-risk patients (Wingard 2020).

IV: 2 g every 8 hours as part of an appropriate combination regimen; continue until afebrile for ≥48 hours and resolution of neutropenia (ANC ≥500 cells/mm3 and increasing) or standard duration for the specific infection identified, if longer than the duration for neutropenia (IDSA [Freifeld 2011]; Wingard 2020). Note: Some experts prefer the extended infusion method, particularly in those who are critically ill (SCCM [Rhodes 2017]; Wingard 2020).

Osteomyelitis and/or discitis

Osteomyelitis and/or discitis: Note: For empiric therapy or pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):

IV: 2 g every 8 hours, generally for ≥6 weeks; for empiric therapy, use as part of an appropriate combination regimen (IDSA [Berbari 2015]; Osmon 2019).

Peritonitis, treatment

Peritonitis, treatment (peritoneal dialysis patients) (off-label use): As a component of empiric therapy or as pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa): Note: Intraperitoneal administration is preferred to IV administration (ISPD [Li 2016]). Consider a 25% dose increase in patients with significant residual renal function (urine output >100 mL/day) (ISPD [Li 2010]; ISPD [Li 2016]; Mancini 2018; Szeto 2018).

Intermittent: Intraperitoneal:

Continuous ambulatory peritoneal dialysis: 1 to 1.5 g added to one exchange once daily (allow to dwell ≥6 hours) (ISPD [Li 2016]).

Automated peritoneal dialysis: 20 mg/kg once daily administered in the longest dwell (Kim 2011).

Continuous (with every exchange) (dose is per liter of dialysate): Intraperitoneal: Loading dose: 500 mg/L of dialysate with first dialysate exchange; maintenance dose: 125 mg/L of dialysate with each subsequent dialysate exchange (ISPD [Li 2016]).

Pneumonia

Pneumonia:

Community-acquired pneumonia: For empiric therapy of inpatients at risk of infection with a resistant 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 for 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 (IDSA/ATS [Metlay 2019]; Ramirez 2020).

Hospital-acquired or ventilator-associated pneumonia: For empiric therapy (as part of an appropriate combination regimen) or pathogen-specific therapy of resistant gram-negative pathogen(s), including P. aeruginosa:

IV: 2 g every 8 hours. Duration varies based on disease severity and response to therapy; treatment is typically given for 7 days (IDSA/ATS [Kalil 2016]). Note: Some experts prefer extended or continuous infusion for critical illness or when treating a susceptible organism with an elevated MIC (Kim 2009; Klompas 2021; SCCM [Rhodes 2017]).

Prosthetic joint infection

Prosthetic joint infection (alternative agent): As a component of empiric therapy or as pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):

IV: 2 g every 8 hours; duration varies but is generally 4 to 6 weeks for patients who undergo resection arthroplasty (Berbari 2019; IDSA [Osmon 2013]).

Septic arthritis

Septic arthritis: As a component of empiric therapy or as pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):

IV: 2 g every 8 hours; for empiric therapy, use in combination with vancomycin. Total treatment duration is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy (Goldenberg 2019).

Skin and soft tissue infection, moderate to severe

Skin and soft tissue infection, moderate to severe: As empiric therapy or pathogen-directed therapy in patients with or at risk for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):

IV: 2 g every 8 hours. Usual duration is 10 to 14 days based on response to therapy (Hoepelman 1993; Kanj 2021). Note: For burn-associated infections, some experts suggest giving ceftazidime with an aminoglycoside (Kanj 2021).

Urinary tract infection, complicated

Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms):

IV: 1 to 2 g every 8 hours (Bader 2017; Hoepelman 1993). When used for empiric therapy, use alone or in combination with other appropriate agents. Switch to an appropriate oral regimen once symptoms improve, if culture and susceptibility results allow. Total duration of therapy ranges from 5 to 14 days and depends on clinical response and the antimicrobial chosen to complete the regimen (Hooton 2021; IDSA/ESCMID [Gupta 2011]).

Dosing: Renal 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 Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: IV:

Ceftazidime Dose Adjustments for Kidney Impairmenta

CrClb (mL/minute)

If the usual recommended dose is 1 g every 8 hoursc,d

If the usual recommended dose is 2 g every 8 hoursd

aChoose usual recommended dose based on indication and disease severity (See Adult Dosing), then choose the adjusted dose from that column based on the patient's estimated CrCl.

bCrCl may be estimated using Cockcroft-Gault formula.

cManufacturer's labeling, expert opinion.

dWelage 1984.

>50

No dose adjustment necessary

No dose adjustment necessary

31 to 50

1 g every 12 hours

2 g every 12 hours

16 to 30

1 g every 24 hours

2 g every 24 hours

≤15

500 mg every 24 hours

1 g every 24 hours

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2): 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 (Bilbao-Meseguer 2018; Udy 2010).

IV: 2 g every 6 hours (expert opinion), as patients with ARC may not achieve pharmacodynamic targets with standard dosage regimens when pseudomonal infections are confirmed or suspected (Jacobs 2018). Alternatively, Monte Carlo simulations suggest that a 2 g loading dose followed by a daily 10 g continuous infusion over 24 hours may optimize pharmacodynamic parameters in patients with ARC (Georges 2012).

Hemodialysis, intermittent (thrice weekly): Dialyzable (55% to 88% utilizing low-flux filters [Leroy 1984; Nikolaidis 1985]):

IV: 500 mg to 1 g every 24 hours; administer after hemodialysis on dialysis days. Alternatively, 1 g three times weekly (after each dialysis session) may be utilized; a 2 g dose should be considered before a 72-hour interdialytic period when there is concern for resistant organisms. Note: Once-daily dosing has the highest probability of pharmacodynamic target attainment and should be utilized during empiric therapy or critical illness (Loo 2013).

Peritoneal dialysis: IV: 1 g every 24 hours (Demotes-Mainard 1993; Stea 1996).

CRRT: 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.

CVVH/CVVHD/CVVHDF: IV: 2 g every 8 to 12 hours; for organisms with high minimum inhibitory concentrations (MICs) or empiric therapy for severe infections (eg, sepsis), the risks/benefits favor dosing on the higher side of the recommended frequency (Heintz 2009; Traunmüller 2002). Alternatively, an initial 2 g loading dose, immediately followed by a daily continuous infusion of 3 g over 24 hours, will maintain concentrations ≥4 times the MIC for susceptible pathogens (Mariat 2006).

PIRRT (eg, sustained, low-efficiency diafiltration): 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 every 12 hours (Jang 2018; König 2017).

Note: Dosing recommendations based on Monte Carlo simulations utilizing 8- to 10-hour daily sessions with effluent rates of 67 to 83 mL/minute (Jang 2018) or 6-hour daily sessions with effluent rates of ~300 mL/minute (König 2017).

Dosing: Hepatic Impairment: Adult

No dosage adjustment necessary.

Dosing: Pediatric

(For additional information see "Ceftazidime: Pediatric drug information")

General dosing, susceptible infection (Red Book [AAP 2018]): IM, IV: Infants, Children, and Adolescents:

Non-Pseudomonas spp. infections: 90 to 150 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day.

Pseudomonas spp. infections:

Mild to moderate infections: 90 to 150 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day.

Severe infections: 200 to 300 mg/kg/day divided every 8 hours; maximum daily dose: 12 g/day.

Cystic fibrosis, lung infection caused by Pseudomonas spp. or other susceptible gram negative organisms:

Traditional intermittent infusion method:

Infants, Children, and Adolescents: IV: 200 to 400 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 12 g/day (Latzin 2008; Zobell 2013; Zobell 2017). Doses of 150 mg/kg/day in divided doses every 8 hours have also been reported (Reed 1987).

Continuous infusion method:

Children ≥5 years and Adolescents: IV: 100 to 200 mg/kg/day infused continuously over 24 hours; maximum daily dose: 12 g/day (Hubert 2009; Rappaz 2000; Riethmueller 2009; Zobell 2013; Zobell 2017). May give an initial loading dose (60 mg/kg; maximum dose: 2,000 mg/dose) once before starting the continuous infusion if rapid attainment of therapeutic drug concentrations is desired (eg, sepsis) (Guilhaumou 2019; Hubert 2009).

Endocarditis, treatment: Children and Adolescents: IV: 100 to 150 mg/kg/day divided every 8 hours; maximum daily dose: 4,000 mg/day; use in combination with gentamicin or vancomycin and gentamicin (plus rifampin if prosthetic material is present) depending on the cause of infection (AHA [Baltimore 2015]).

Intra-abdominal infections, complicated: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours in combination with metronidazole; maximum daily dose: 6 g/day (IDSA [Solomkin 2010]).

Meningitis, including healthcare-associated ventriculitis/meningitis: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day in divided doses every 8 hours; maximum daily dose: 6 g/day; use in combination with vancomycin for empiric coverage (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]).

Neutropenic fever, treatment (known susceptible gram-negative bacteria): Limited data available: Note: Ceftazidime is not recommended empiric management of neutropenic fever in high-risk children (Lehrnbecher 2012).

Traditional intermittent infusion method: Infants ≥6 months, Children, and Adolescents: IV: 100 to 150 mg/kg/day divided every 8 hours in combination with an aminoglycoside; maximum daily dose: 6 g/day (Corapçioglu 2005; Kamonrattana 2019; Laoprasopwattana 2007).

Continuous infusion method: Infants ≥6 months, Children, and Adolescents: IV: Loading dose: 60 to 100 mg/kg; maximum loading dose: 2,000 mg/dose; followed by 100 to 200 mg/kg/day infused continuously over 24 hours; maximum daily dose: 6 g/day (Cojutti 2019; Dalle 2002).

Peritonitis (peritoneal dialysis): Infants, Children, and Adolescents: Intraperitoneal:

Intermittent: 20 mg/kg/dose every 24 hours in the long dwell (ISPD [Warady 2012]); in adults, intermittent: 1,000 to 1,500 mg every 24 hours per exchange in the long dwell (≥6 hours) (Li 2010).

Continuous: Loading dose: 500 mg per liter of dialysate; maintenance dose: 125 mg per liter (ISPD [Warady 2012]).

Urinary tract infection: Infants, Children, and Adolescents: IV: 100 to 150 mg/kg/day divided every 8 hours (AAP 2011; Balighian 2018).

Dosing: Renal Impairment: Pediatric

Infants, Children, and Adolescents: The manufacturer recommends decreasing dosing frequency based on the calculated BSA-adjusted creatinine clearance. The following guidelines have been used by some clinicians (Aronoff 2007): Note: Renally adjusted dose recommendations are based on a usual dose of 25 to 50 mg/kg/dose every 8 hours:

GFR >50 mL/minute/1.73 m2: No adjustment required.

GFR 30 to 50 mL/minute/1.73 m2: 50 mg/kg/dose every 12 hours.

GFR 10 to 29 mL/minute/1.73 m2: 50 mg/kg/dose every 24 hours.

GFR <10 mL/minute/1.73 m2: 50 mg/kg/dose every 48 hours.

Hemodialysis: Dialyzable (50% to 100%): 50 mg/kg/dose every 48 hours, give after dialysis on dialysis days.

Peritoneal dialysis: 50 mg/kg/dose every 48 hours.

Continuous renal replacement therapy (CRRT): 50 mg/kg/dose every 12 hours.

Dosing: Hepatic Impairment: Pediatric

Infants, Children and Adolescents: No adjustment required.

Dosing: Geriatric

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as sodium [strength expressed as base]:

Tazicef: 1 g/50 mL (50 mL)

Solution Reconstituted, Injection:

Fortaz: 500 mg (1 ea); 1 g (1 ea)

Solution Reconstituted, Injection [preservative free]:

Tazicef: 1 g (1 ea); 6 g (1 ea)

Generic: 1 g (1 ea); 6 g (1 ea)

Solution Reconstituted, Intravenous:

Fortaz: 2 g (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

Tazicef: 1 g (1 ea); 2 g (1 ea)

Generic: 2 g (1 ea); 1 g (1 ea); 2 g (1 ea)

Generic Equivalent Available: US

May be product dependent

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Injection:

Fortaz: 500 mg (1 ea); 1 g ([DSC])

Generic: 1 g (1 ea)

Solution Reconstituted, Intravenous:

Fortaz: 2 g ([DSC]); 6 g ([DSC])

Generic: 2 g (1 ea); 3 g (1 ea); 6 g (1 ea)

Administration: Adult

IM: Ceftazidime can be administered deep IM into large mass muscle.

IV: Can be administered IV push over 3 to 5 minutes or by IV intermittent infusion over 15 to 30 minutes.

Intravitreal: Ceftazidime may be administered intravitreally as 2 to 2.25 mg/0.1 mL NS in combination with vancomycin (separate syringes) (Jackson 2003; Roth 1997).

Intraperitoneal: Intraperitoneal administration may be used in conjunction with IV use for systemic infections if continuous peritoneal dialysis is used (added to the dialysate in each exchange). Intraperitoneal administration alone may also be used for the treatment of peritonitis and added to the dialysate in intermittent (added to the longest dwell time per day) or continuous (loading dose, followed by a maintenance dose per liter of exchange) peritoneal dialysis.

Inhalation for nebulization (off-label use/route): Use with standard jet nebulizer connected to an air compressor; administer 1,000 mg diluted in 8 mL NS with mouthpiece or face mask (Orriols 1999).

Administration: Pediatric

Parenteral: Inadvertent intra-arterial administration may result in distal necrosis.

IM: Deep IM injection into a large muscle mass such as the upper outer quadrant of the gluteus maximus or lateral part of the thigh.

IV:

IV Push: Administer over 3 to 5 minutes.

Intermittent IV infusion: Administer over 15 to 30 minutes.

Continuous IV infusion: Infants ≥6 months, Children, and Adolescents:

Loading dose: In trials, loading doses (60 to 100 mg/kg) were generally infused over 1 hour (Cojutti 2019); in one trial for febrile neutropenia, a loading dose of 65 mg/kg (prepared in 20 mL D5W) was infused over 5 minutes in children and adolescents (Dalle 2002).

Maintenance infusion: Infuse daily dose over 24 hours (Cojutti 2019; Dalle 2002; Hubert 2009; Rappaz 2000; Riethmueller 2009; Zobell 2013; Zobell 2017). Insulation and ice packs should be used to maintain temperature at 15°C to 22°C (59°F to 71.6°F) throughout infusion (Jones 2019).

Use: Labeled Indications

Bloodstream infection (gram-negative bacteremia): Treatment of bloodstream infection caused by Pseudomonas aeruginosa, Klebsiella spp., Haemophilus influenzae, Escherichia coli, Serratia spp., Streptococcus pneumoniae, and Staphylococcus aureus (methicillin-susceptible strains).

Bone and joint infections: Treatment of bone and joint infections caused by P. aeruginosa, Klebsiella spp., Enterobacter spp., and S. aureus (methicillin-susceptible strains).

CNS infections: Treatment of CNS infections, including meningitis, caused by H. influenzae and Neisseria meningitidis. Ceftazidime has also been used successfully in cases of meningitis due to P. aeruginosa and S. pneumoniae.

Empiric therapy in immunocompromised patients: Empiric treatment of infections in immunocompromised patients.

Gynecologic infections: Treatment of endometritis, pelvic cellulitis, and other infections of the female genital tract caused by E. coli.

Intra-abdominal infection, health care–associated or high-risk community-acquired infection: Treatment of peritonitis caused by E. coli, Klebsiella spp., and S. aureus (methicillin-susceptible strains) and polymicrobial intra-abdominal infections caused by aerobic and anaerobic organisms and some Bacteroides spp. (many isolates of Bacteroides fragilis are resistant).

Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, caused by P. aeruginosa and other Pseudomonas spp.; H. influenzae, including ampicillin-resistant isolates; Klebsiella spp.; Enterobacter spp.; Proteus mirabilis; E. coli; Serratia spp.; Citrobacter spp.; S. pneumoniae; and S. aureus (methicillin-susceptible strains).

Skin and soft tissue infections: Treatment of skin and soft tissue infections caused by P. aeruginosa; Klebsiella spp.; E. coli; Proteus spp., including P. mirabilis and indole-positive Proteus; Enterobacter spp.; Serratia spp.; S. aureus (methicillin-susceptible strains); and Streptococcus pyogenes (group A beta-hemolytic streptococci).

Urinary tract infection: Treatment of complicated and uncomplicated urinary tract infection caused by P. aeruginosa; Enterobacter spp.; Proteus spp., including P. mirabilis and indole-positive Proteus; Klebsiella spp.; and E. coli.

Use: Off-Label: Adult

Cystic fibrosis, acute pulmonary exacerbation; Diabetic foot infection, moderate to severe; Endophthalmitis, bacterial; Melioidosis (Burkholderia pseudomallei infection); Peritonitis, treatment (peritoneal dialysis patients)

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

CefTAZidime may be confused with ceFAZolin, cefepime, cefoTEtan, cefOXitin, cefTRIAXone

Ceptaz may be confused with Septra

Tazicef may be confused with Tazidime

International issues:

Ceftim [Portugal] and Ceftime [Thailand] brand names for ceftazidime may be confused with Ceftin brand name for cefuroxime [U.S., Canada]; Cefiton brand name for cefixime [Portugal]

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Dermatologic: Pruritus (<2%), skin rash (<2%)

Endocrine & metabolic: Increased lactate dehydrogenase (6%), increased gamma-glutamyl transferase (5%)

Gastrointestinal: Diarrhea (1%)

Hematologic & oncologic: Eosinophilia (8%), positive direct Coombs test (4%; without hemolysis), thrombocythemia (2%)

Hepatic: Increased serum ALT (7%), increased serum AST (6%), increased serum alkaline phosphatase (4%)

Hypersensitivity: Hypersensitivity reactions (2%)

Local: Inflammation at injection site (1%), injection site phlebitis (1%)

Miscellaneous: Fever (<2%)

Frequency not defined:

Central nervous system: Seizure

Hematologic & oncologic: Agranulocytosis, leukopenia, lymphocytosis, neutropenia, thrombocytopenia

Renal: Increased blood urea nitrogen, increased serum creatinine

<1%, postmarketing, and/or case reports: Abdominal pain, anaphylaxis (severe in rare instances, including cardiopulmonary arrest), angioedema, candidiasis, Clostridioides difficile-associated diarrhea, dizziness, erythema multiforme, headache, hemolytic anemia, hyperbilirubinemia, jaundice, nausea, pain at injection site, paresthesia, renal insufficiency, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, vaginitis, vomiting

Contraindications

Hypersensitivity to ceftazidime, other cephalosporins, penicillins, other beta-lactam antibiotics, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Elevated INR: May be associated with increased INR, especially in nutritionally deficient patients, prolonged treatment, hepatic or renal disease. Monitor INR during treatment if patient is at risk; administer vitamin K as clinically indicated.

• Hemolytic anemia: Immune-mediated hemolytic anemia, sometimes fatal, has been observed in patients receiving cephalosporins, including ceftazidime. If a patient develops anemia while on ceftazidime, discontinue treatment until the etiology is determined.

• Hypersensitivity: Hypersensitivity and anaphylaxis have been reported in patients receiving beta-lactam drugs. Use caution in patients with a history of hypersensitivity to penicillins or other beta-lactams; use is contraindicated in patients with cephalosporin allergy (according to the manufacturer). If severe hypersensitivity occurs, discontinue immediately and institute supportive emergency measures.

• Neurotoxicity: High ceftazidime levels in patients with renal insufficiency can lead to seizures, nonconvulsive status epilepticus, encephalopathy, coma, asterixis, myoclonia, and neuromuscular excitability. Adjust dosage based on renal function.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including Clostridioides difficile–associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• GI disease: Use with caution in patients with a history of GI disease, especially colitis.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

• Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.

Metabolism/Transport Effects

None known.

Drug Interactions

Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy

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

Chloramphenicol (Systemic): May diminish the therapeutic effect of CefTAZidime. Management: Consider using a different combination of antimicrobials, especially if bactericidal activity is desired. If these agents are combined, monitor for reduced antimicrobial effectiveness and/or therapeutic failure. Risk D: Consider therapy modification

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

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Cephalosporins. 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

Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Pregnancy Considerations

Ceftazidime crosses the placenta (Jørgensen 1987).

Due to pregnancy-induced physiologic changes, some pharmacokinetic parameters of ceftazidime may be altered (Giamarellou 1983; Jørgensen 1987; Nathorst-Böös 1995).

Breast-Feeding Considerations

Ceftazidime is present in breast milk.

In general, antibiotics that are present in breast milk may cause nondose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush or diarrhea (WHO 2002).

Although the manufacturer recommends that caution be exercised when administering ceftazidime to nursing women, ceftazidime is considered compatible with breastfeeding when used in usual recommended doses (WHO 2002).

Dietary Considerations

Some products may contain sodium.

Monitoring Parameters

Monitor renal function. Observe for signs and symptoms 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.

Pharmacodynamics and Pharmacokinetics

Distribution: Widely throughout the body including bone, bile, skin, cerebrospinal fluid (CSF) (higher concentrations achieved when meninges are inflamed), endometrium, heart, pleural and lymphatic fluids.

Vd:

Preterm neonates <32 weeks GA (van den Anker 1995):

PNA 3 days: 0.363 ± 0.059 L/kg.

PNA 10 days: 0.292 ± 0.044 L/kg.

Infants and children ≤2 years of age: Steady state: Median: 0.4 L/kg (range: 0.34 to 0.46) L/kg (Shi 2018).

Bile:serum ratio: ~11% to 70%; varies with time and gallbladder function (Berger 1988; Bouza 1983; Walstad 1986).

Bone:serum ratio: 14% to 45% (Leigh 1985).

CSF:

CSF:serum ratio: Days 2 to 4: Mean: 17.8% to 37% (Modai 1983).

CSF:serum ratio: Days 11 to 20: Mean: 5.4% to 23.5% (Modai 1983).

Lung:

Epithelial lining fluid:serum ratio: 20.6% ± 8.9% (administered as a continuous infusion) (Boselli 2004).

Protein binding: <10%.

Half-life elimination:

Preterm neonates <32 weeks GA (van den Anker 1995):

PNA 3 days: 8.7 ± 2.8 hours.

PNA 10 days: 5 ± 0.9 hours.

Adult: 1 to 2 hours, significantly prolonged with renal impairment.

Time to peak, serum: IM: ~1 hour.

Excretion: Urine (80% to 90% as unchanged drug).

Pharmacodynamics and Pharmacokinetics: Additional Considerations

Anti-infective considerations:

Parameters associated with efficacy: Time dependent; associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC).

Organism specific:

Gram negative bacteria (including P. aeruginosa): Goal: 35% to 40% fT > MIC (bacteriostatic in vitro); 60% to 70% fT > MIC (bactericidal in vitro); ~45% to 53% fT > MIC (microbiological response) (Craig 1995; MacVane 2014; Muller 2013).

Population specific:

Critically ill patients in the ICU: Minimum goal: ≥50% fT > MIC; preferred goal: ≥100% fT > MIC (Roberts 2014); some experts favor ≥100% fT >4 times the MIC (Guilhaumou 2019).

Postantibiotic effect: Generally little to no postantibiotic effect (Craig 1991; Craig 1995; Craig 1998).

Expected drug concentrations in adults with normal renal function:

Healthy volunteers: Cmax (peak): IV:

1 g, single dose, infused over 20 to 30 minutes: 69 mg/dL.

2 g, single dose, infused over 20 to 30 minutes: 170 mg/dL.

Pricing: US

Solution (Tazicef Intravenous)

1 gm/50 mL (per mL): $0.34

Solution (reconstituted) (cefTAZidime and Dextrose Intravenous)

1GM 5%(50ML) (per each): $18.73

2GM 5%(50ML) (per each): $26.39

Solution (reconstituted) (cefTAZidime Injection)

1 g (per each): $3.91 - $6.24

6 g (per each): $26.03 - $35.00

Solution (reconstituted) (cefTAZidime Intravenous)

2 g (per each): $7.21 - $13.20

Solution (reconstituted) (Fortaz Injection)

1 g (per each): $14.23

500 mg (per each): $7.92

Solution (reconstituted) (Fortaz Intravenous)

2 g (per each): $28.45

Solution (reconstituted) (Tazicef Injection)

1 g (per each): $5.06

Solution (reconstituted) (Tazicef Intravenous)

1 g (per each): $7.07

2 g (per each): $11.35

6 g (per each): $36.31

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.

Brand Names: International
  • Baxidyme (PH);
  • Biotum (PL, UA);
  • Biozim (ID);
  • Caltum (ID);
  • Cef-H (MY);
  • Cefadime (TW);
  • Cefatum (MY);
  • Cefaz (HR);
  • Cefazima (BR);
  • Cefazime (SG);
  • Cefdim (ID);
  • Cefidime (EG);
  • Cefin (GR);
  • Cefpiran (PE);
  • Cefranz (PH);
  • Ceftadime (UA);
  • Ceftamil (RO);
  • Ceftaz (LK);
  • Ceftazash (ET);
  • Ceftazim (PT);
  • Ceftazivit (VN);
  • Ceftidin (IN);
  • Ceftim (IT);
  • Ceftiol (CL);
  • Ceftum (ID, JO, UA);
  • Celodim (ID);
  • Cestazid (PH);
  • Cetazine (TW);
  • Cetazum (ID);
  • Cezidin (MT);
  • Dimcef (KR);
  • Dimzef (PH);
  • Elzid (LK);
  • Extimon (ID);
  • Fivtum (PH);
  • Fortam (CH, UY);
  • Fortaz (BR);
  • Fortum (AE, AR, AT, AU, BB, BF, BG, BH, BJ, BM, BS, BZ, CI, CL, CN, CO, CR, CY, CZ, DE, DK, DO, EC, EE, EG, ET, FR, GB, GH, GM, GN, GT, GY, HK, HN, HU, ID, IE, IL, IN, IQ, IR, IS, JM, JO, KE, KR, KW, LB, LK, LR, LT, LV, LY, MA, ML, MR, MT, MU, MW, MX, MY, NE, NG, NI, NL, NO, NZ, OM, PA, PE, PH, PR, PY, QA, RO, RU, SA, SC, SD, SE, SI, SK, SL, SN, SR, SV, SY, TN, TR, TT, TW, TZ, UA, UG, VE, VN, YE, ZA, ZM, ZW);
  • Fortum Pro (HN);
  • Fortumset (FR);
  • Forzid (PH);
  • Glazidim (BE, FI, IT, LU);
  • Izadima (EC, PA);
  • Kefadim (BE, BF, BJ, BR, CI, EG, ET, GH, GM, GN, KE, LR, LU, MA, ML, MR, MU, MW, NE, NG, PK, SC, SD, SL, SN, TN, TW, TZ, UG, VN, ZM, ZW);
  • Kefazim (AT);
  • Kefraz (ZA);
  • Lacedim (ID);
  • Lemoxol (NO, NZ);
  • Maxidim (BD);
  • Megacef (PH);
  • Mirocef (HR);
  • Negacef (AE, BH, EG, KW, LB, SA);
  • Orzid (ET, ZA);
  • Parzidim (BH, LB);
  • Pharodime (ID);
  • Romacef (PH);
  • Septax (GR, IL);
  • Solvetan (DK, GR);
  • Spectrum (IT);
  • Starcef (IT);
  • Tagal (MX);
  • Taloxen (MX);
  • Tazicef (KR);
  • Tazidan (PH);
  • Tazidem (PH);
  • Tazime (CN, KR, SG);
  • Thidim (ID);
  • Tinacef (PY);
  • Trizidim (BD);
  • UIzadima (CR);
  • Xtrazidime (EG);
  • Yadim (HK);
  • Zadolina (CR, DO, GT, HN, MX, NI, SV);
  • Zefadym (PL);
  • Zeptrigen (PH);
  • Zetal (AU);
  • Zibac (ID);
  • Zidimax (BD);
  • Zidime (AE, BH, JO, QA);
  • Zidmbiotic (VN);
  • Zitadim (ID);
  • Zitum (BD);
  • Zytaz (IN)


For country abbreviations used in Lexicomp (show table)

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