Ceftazidime

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	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>

Ceftazidime

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
08-03-2009

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 pneumoniacaused by P. aeruginosaand 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 infectionscaused 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 infectionscaused by P. aeruginosa; Enterobacter spp.; Proteus spp., including P. mirabilis and indole-positive Proteus; Klebsiella spp.; and E. coli
Septicemiacaused by P. aeruginosa, Klebsiella spp., H. influenzae,E. coli, Serratia spp., S. pneumoniae, and MSSA (cefotaxime or ceftriaxone preferred for S. pneumoniae)
Bone and joint infectionscaused 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 E. coli, 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. influenzaeand N. meningitidis,P. aeruginosaand 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*
Fortaz	Ceftazidime	GlaxoSmithKline and generic manufacturer	IV or IM vial 500mg	$7.41
			IV or IM vial 6g	$54.14
Tazicef	Ceftazidime	Hospira	IV or IM vial 1g	$9.05
			IV or IM vial 2g	$19.97
			IV or IM vial 6g	$54.14

*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. aeruginosapneumonia 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 C. difficile 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 Enterobacteriaceae and Gram-negative non-lactose fermenters including P. aeruginosais 8 mcg/mL.

PHARMACOLOGY

Pharmacology

COMMENTS

Parenteral 3rd generation cephalosporin with good P. aeruginosaactivity 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. aeruginosabut has better activity vs gram-positive cocci.

REFERENCES

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Abbreviations