Parenteral Pseudomonal lung infections in cystic fibrosis
Adult: 100-150 mg/kg daily in 3 divided doses via IV inj, IV infusion or deep IM inj. Max: 9 g daily. Consideration must be given to local treatment guidelines. Child: 0-2 months 25-60 mg/kg daily in 2 divided doses; >2 months 30-100 mg/kg daily in 2-3 divided doses; up to 150 mg/kg daily (Max 6 g daily) in 3 divided doses may be given to infected immunocompromised or fibrocystic children or children with meningitis. Consideration must be given to local treatment guidelines. Elderly: >80 years Max: 3 g daily.
Parenteral Abdominal infections, Bacteraemia, Bone and joint infections, Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis, Febrile neutropenia, Gastrointestinal infections, Meningitis, Respiratory tract infections, Septicaemia, Skin and soft tissue infections
Adult: Dosage depends on the severity, sensitivity, site and type of infection. Dose range: 1-6 g daily in 2-3 divided doses. Usual dose for most infections: 1 g 8 or 12 hourly or 2 g 12 hourly. Severe infections (especially in immunocompromised patients): 2 g 8 or 12 hourly or 3 g 12 hourly. Doses may be given via IV inj, IV infusion or deep IM inj. Consideration must be given to local treatment guidelines. Child: 0-2 months 25-60 mg/kg daily in 2 divided doses; >2 months 30-100 mg/kg daily in 2-3 divided doses; up to 150 mg/kg daily (Max 6 g daily) in 3 divided doses may be given to infected immunocompromised or fibrocystic children or children with meningitis. Consideration must be given to local treatment guidelines. Elderly: >80 years Max: 3 g daily.
Parenteral Urinary tract infections
Adult: 0.5 g or 1 g 12 hourly. For complicated cases: 1-2 g 8 or 12 hourly. Doses may be given via IV inj, IV infusion or deep IM inj. Consideration must be given to local treatment guidelines. Child: 0-2 months 25-60 mg/kg daily in 2 divided doses; >2 months 30-100 mg/kg daily in 2-3 divided doses; up to 150 mg/kg daily (Max 6 g daily) in 3 divided doses may be given to infected immunocompromised or fibrocystic children or children with meningitis. Consideration must be given to local treatment guidelines. Elderly: >80 years Max: 3 g daily.
Renal Impairment
Severe infections: Increase unit dose by 50% or increase dosing frequency. Dosing recommendations may vary among individual products and between
countries (refer to specific product guidelines).
CrCl (mL/min)
Dosage
<5
Loading: 1 g. Maintenance: 0.5 g 48 hourly.
6-15
Loading: 1 g. Maintenance: 0.5 g 24 hourly.
16-30
Loading: 1 g. Maintenance: 1 g 24 hourly.
31-50
Loading: 1 g. Maintenance: 1 g 12 hourly.
Reconstitution
Instructions for reconstitution may vary among individual products and between countries (refer to specific product guidelines).
Incompatibility
Incompatible with aminoglycosides; should not be mixed in the same giving set or syringe. Precipitation may occur when vancomycin is added to ceftazidime in solution.
Contraindications
Hypersensitivity to ceftazidime and other cephalosporins, or history of severe hypersensitivity to any other type of β-lactam antibacterial agents (e.g. penicillins, monobactams, carbapenems).
Special Precautions
Patient with history of gastrointestinal disease, particularly colitis; history of seizure disorder. Renal impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Diarrhoea, increased INR; overgrowth of non-susceptible organisms (prolonged use). Blood and lymphatic system disorders: Eosinophilia, thrombocytosis. General disorders and administration site conditions: Phlebitis or thrombophlebitis (IV); pain or inflammation (IM). Investigations: Transient elevations in ALT, AST, lactate dehydrogenase, gamma-glutamyl transferase and alkaline phosphatase. Skin and subcutaneous tissue disorders: Maculopapular or urticarial rash. Potentially Fatal: Severe hypersensitivity reactions; antibacterial agent-associated colitis and pseudomembranous colitis; haemolytic anaemia.
IM/Inhalation/Respiratory/Intraperitoneal/Intravitreal/IV/Parenteral: B
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor renal function. Assess for signs and symptoms of anaphylaxis during 1st dose; nephrotoxicity, neurotoxicity, severe or bloody diarrhoea.
Drug Interactions
Concurrent administration of nephrotoxic agents such as aminoglycosides or potent diuretics (e.g. furosemide) may adversely affect renal function. Antagonistic effect with chloramphenicol. Ceftazidime may affect the gut flora, resulting in decreased reabsorption of estrogen and reduced efficacy of combined oral contraceptives.
Lab Interference
May cause false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution); false-positive serum or urine creatinine with Jaffe reaction. May cause positive Coombs' test.
Action
Description: Ceftazidime binds to 1 or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall. This results in the inhibition of cell wall biosynthesis, leading to bacterial cell lysis and death. Pharmacokinetics: Absorption: Time to peak plasma concentration: Approx 1 hour (IM). Distribution: Widely distributed throughout the body including bone, bile, skin, heart, pleural or lymphatic fluids, and CSF (higher concentrations achieved in inflamed meninges). Crosses the placenta and enters breast milk. Plasma protein binding: Approx 10%. Metabolism: Not metabolised. Excretion: Mainly via urine (approx 80-90% as unchanged drug). Elimination half-life: Approx 2 hours.
Chemical Structure
Ceftazidime Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5481173, Ceftazidime. https://pubchem.ncbi.nlm.nih.gov/compound/Ceftazidime. Accessed May 26, 2022.
J01DD02 - ceftazidime ; Belongs to the class of third-generation cephalosporins. Used in the systemic treatment of infections.
References
AFT Pharmaceuticals Ltd. Ceftazidime (as pentahydrate) 1 g or 2 g Powder for Injection data sheet 27 June 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 03/12/2021.Anon. Ceftazidime. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 03/12/2021.Anon. Ceftazidime. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/12/2021.Buckingham R (ed). Ceftazidime. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/12/2021.Ceftazidime Injection, Powder, for Solution (Sagent Pharmaceuticals). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/12/2021.Fortum (Sandoz [MY]). MIMS Malaysia. http://www.mims.com/malaysia. Accessed 03/12/2021.Fortum 3 g Powder for Solution for Injection or Infusion (Glaxo Operations UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 03/12/2021.Joint Formulary Committee. Ceftazidime. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/12/2021.
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