Ceftazidime

Ceftazidime

[1 vial $11.25]

ADMINISTRATION ROUTES:

  • IV or IM

ALTERNATIVE NAMES:

  • fortum

ICU INDICATIONS:

  1. treatment of infections caused by susceptible organisms (esp Pseudomonas)
  2. empiric treatment of hospital acquired pneumonia

PRESENTATION AND ADMINISTRATION:

  • IV:
    500mg, 1g and 2g vials of powder
    Add appropriate volume of water for injection to a vial then shake well until all powder is dissolved. Prepare the solutions as follows:

Inject slowly over 3-5 minutes
Store at room temperature
Compatible with:
Normal saline, Glucose and sodium chloride, glucose, 5% Hartmanns

  • IM:
    Reconstitute with 0.5% lignocaine adding 1.5ml to a 500mg vial, or 3ml to a 1gm vial. Do not give single doses of more than 1gm via this route.

DOSAGE:

  • IV:
    1-2g 8hrly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: 0.5-1g every 24 hours
    10-20: 1g every 24 hours
    >20-50: 1g every 12 hours
  • Dose in renal replacement therapy
    CAPD: 0.5-1g 24 hourly
    HD: 0.5-1g 24-48 hourly
    CVVHDF: 1g 12 hourly

DOSAGE IN PAEDIATRICS:

  • 25-50mg/kg 8 hourly

CLINICAL PHARMACOLOGY:

  • Ceftazidime is a 3rd generation cephalosporin. It has a bactericidal action resulting from inhibition of cell wall synthesis.
  • A wide range of gram-negative organisms is susceptible to ceftazidime in vitro, including strains resistant to gentamicin and other aminoglycosides. In addition, ceftazidime has been shown to be active against gram-positive organisms (although it is not 1st line for these infections). Ceftazidime has been shown to be active against the following organisms both in vitro and in clinical infections:
  • Gram-Negative Aerobes:
    Citrobacter spp., including Citrobacter freundii and Citrobacter diversus. Enterobacter spp., including Enterobacter cloacae and Enterobacter aerogenes. Escherichia coli. Haemophilus influenzae, including ampicillin-resistant strains. Klebsiella spp. (including Klebsiella pneumoniae). Neisseria meningitidis. Proteus mirabilis. Proteus vulgaris. Pseudomonas spp. (including Pseudomonas aeruginosa). Serratia spp.
  • Gram-Positive Aerobes:
    Staphylococcus aureus, including penicillinase- and non-penicillinase-producing strains. Streptococcus agalactiae (group B streptococci). Streptococcus pneumoniae. Streptococcus pyogenes (group A beta-hemolytic streptococci).
  • Anaerobes:
    Bacteroides spp. (Note: Many strains of Bacteroides fragilis are resistant).
  • Ceftazidime and the aminoglycosides have been shown to be synergistic in vitro against Pseudomonas aeruginosa and the enterobacteriaceae. Ceftazidime is not active in vitro against methicillin-resistant staphylococci, Streptococcus faecalis and many other enterococci, Listeria monocytogenes, Campylobacter spp., or Clostridium difficile.

CONTRAINDICATIONS:

  1. hypersensivity to cephalosporins

WARNINGS

  • Anaphylaxis:
    Cephalosporins are a common cause of anaphylactic reactions and cross reactivity with penicillins may occur
  • Pseudomembranous colitis
    Pseudomembranous colitis has been reported with nearly all antibacterial agents, including cefotaxime, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents.
  • Risk of seizures in patients with renal failure
    Elevated levels of ceftazidime in patients with renal insufficiency can lead to seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia (see PRECAUTIONS).

PRECAUTIONS

  • General:
    Prescribing Ceftazidime in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
    Positive direct Coombs’ tests have been reported during treatment with the cephalosporin antibiotics. It should be recognised that a positive Coombs’ test may be due to the drug. High and prolonged serum ceftazidime concentrations can occur from usual dosages in patients with transient or persistent reduction of urinary output because of renal insufficiency. The total daily dosage should be reduced when ceftazidime is administered to patients with renal insufficiency. Elevated levels of ceftazidime in these patients can lead to seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia.
    If patients fail to respond to monotherapy, an aminoglycoside or similar agent should be considered.
  • Laboratory Tests:
    No tests additional to usual ICU tests are required
  • Drug/Laboratory Test Interactions:
    None of note

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • None of note.

ADVERSE REACTIONS

  • Body as a Whole:
    Fever, candidiasis (including oral thrush), angioedema and anaphylaxis
  • Haematological System:
    haemolytic anaemia, eosinophilia, positive Coombs test, thrombocytosis, leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and lymphocytosis.
  • Urogenital System:
    increased creatinine
  • Digestive System:
    Diarrhoea, nausea, vomiting, and abdominal pain, slight elevations in one or more of the hepatic enzymes
  • Nervous System:
    Seizures encephalopathy, coma, asterixis, neuromuscular excitability, myoclonia, headache, dizziness, and paresthesia
  • Skin:
    pruritus, rash, Toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme

    Cephalosporin-Class Adverse Reactions
    In addition to the adverse reactions listed above that have been observed in patients treated with ceftazidime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics: fever, abdominal pain, superinfection, renal dysfunction, toxic nephropathy, haemorrhage, false positive test for urinary glucose, elevated bilirubin, elevated LDH, and pancytopenia.
    Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated

Critical Care Drug Manual

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