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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Ceftazidime

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
09-24-2010

Zambia Specific Information

  • Available formulation in Zambia: Powder for injection: 250 mg (as pentahydrate) in vial.
  • Highly effective against many strains of Pseudomonas aeruginosa. Also active against Klebsiella, Serratia, Proteus, E.coli, and Enterobacter spp.
  • Ventilator associated pneumonia: ceftazidime 1-2 gm IV q8h
  • Pseudomonas pneumonia: ceftazidime 2gm IV q8h (plus gentamicin)
Zambia Information Author: Paul A. Pham Pharm.D.

INDICATIONS

FDA

  • Lower respiratory tract infections including pneumonia caused by P. aeruginosa and other Pseudomonas spp.; H. influenzae; Klebsiella spp.; Enterobacter spp.; P. mirabilis; E. coli; Serratia spp.; Citrobacter spp.; S. pneumoniae; and MSSA. (cefotaxime or ceftriaxone preferred for S. pneumoniae)
  • Skin and skin-structure infections caused by P. aeruginosa; Klebsiella spp.; E. coli; Proteus spp., including P. mirabilis and indole-positive Proteus; Enterobacter spp.; Serratia spp.; MSSA; and S. pyogenes
  • Complicated and uncomplicated urinary tract infections caused by P. aeruginosa; Enterobacter spp.; Proteus spp., including P. mirabilis and indole-positive Proteus; Klebsiella spp.; and E. coli
  • Septicemia caused by P. aeruginosa, Klebsiella spp., H. influenzae,E. coli, Serratia spp., S. pneumoniae, and MSSA (cefotaxime or ceftriaxone preferred for )
  • Bone and joint infections caused by P. aeruginosa, Klebsiella spp., Enterobacter spp., and MSSA
  • Gynecologic infections (endometritis, pelvic cellulitis, and other GYN infections) caused by E. coli
  • Intra-abdominal Infections, including peritonitis caused by , Klebsiella spp., and MSSA and polymicrobial infections caused by aerobic and anaerobic organisms (in combination with metronidazole)
  • Central nervous system infections including meningitis, caused by H. influenzae and N. meningitidis,P. aeruginosa and S. pneumoniae (cefotaxime or ceftriaxone preferred for S. pneumoniae)
NON-FDA APPROVED USES

  • Shunt Infections
  • Diabetic foot infection (in combination with clindamycin)

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
FortazCeftazidimeGlaxoSmithKline and generic manufacturerIV or IM
vial
500mg
$7.12
      IV or IM
vial
6g
$82.80
TazicefCeftazidime Hospira and other generic manufacturersIV or IM
vial
1g
$4.57
      IV or IM
vial
2g
$15.44
      IV or IM
vial
6g
$29.88

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

  • Mild to moderate infections: 1gm IV q8-12h.
  • Uncomplicated UTI : 500 mg IV q12h.
  • Complicated UTI: 500mg IV q8h-q12h.
  • Severe infections or meningitis: 2 gm IV q8 (8gm/day max).
  • Bone and joint infections: 2 gm IV q12h.
  • P. aeruginosa pneumonia in CF pts: 2 gm IV q6h to q8h.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

GFR >30-50 ml/min: 1gm q12h (2gm q12h for CNS or severe infections); GFR 10-29 ml/min: 1gm q24h (2gm q24 for CNS or severe infections).

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

0.5Gm q24-48h (1gm q24h for CNS or severe infections).

DOSING IN HEMODIALYSIS

1 Gm loading, 1 Gm post-dialysis.

DOSING IN PERITONEAL DIALYSIS

0.5-1.0 Gm loading, 250mg per each 2 Liter of dialysate exchange per day.

DOSING IN HEMOFILTRATION

CVVH: 1-2 gm q12h. CVVHD with flow rate 1.5-2.5L/hr: 1-2gm q12h (2gm q12h for severe and CNS infections). CVVHD with flow rate 1 L/hr: 1-2 gm q24h (2gm q24h for severe and CNS infections).

ADVERSE DRUG REACTIONS

GENERAL

  • Generally well tolerated
OCCASIONAL

  • Phlebitis at infusion sites
  • Allergic reactions (cross-reaction in PCN-allergic patients lower compared to 1st and 2nd generation cephalosporin)
  • Diarrhea and colitis
  • Eosinophilia
  • Positive Coombs' test.
RARE

  • Anaphylaxis
  • Hemolytic anemia
  • CNS: convulsions (high dose with renal failure), confusion, disorientation, and hallucinations
  • Drug fever
  • Neutropenia and thrombocytopenia
  • Hepatitis
  • Interstitial nephritis

DRUG INTERACTIONS

Probenecid:increased in ceftazidime serum concentration due to inhibition of tubular secretion by probenecid. No dose adjustment needed; co-administer with caution in renal insufficiency.

SPECTRUM

Detailed Spectrum of Activity

RESISTANCE

  • MIC breakpoint for gram-negative non-lactose fermenters including P. aeruginosa is 8 mcg/mL.
  • MIC breakpoint for Enterobacteriaceae: < or equal 4 mcg/mL (sensitive); 8 mcg/mL (intermediate); > or equal 16 mcg/mL (resistant).

PHARMACOLOGY

Pharmacology

COMMENTS

Parenteral 3rd generation cephalosporin with good P. aeruginosa activity but resistance rates are up 20-25%. Acinetobacter is showing increasing resistance to ceftazidime (60-70% resistant). Cefepime is comparable to ceftazidime against GNB including P. aeruginosa but has better activity vs gram-positive cocci.

REFERENCES


 
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