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 (Ref).
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) (Ref).
Continuous infusion method (off-label method): IV: 6 g infused over 24 hours (Ref); may give first dose of 2 g over 30 minutes, especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis) (Ref).
Extended and continuous infusion methods are based largely on pharmacokinetic and pharmacodynamic modeling data; clinical efficacy data are limited (Ref).
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 (Ref). 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 (Ref).
Duration of therapy: Usual duration is 7 to 14 days depending on source, pathogen, extent of infection, and clinical response (Ref); a 7-day duration is recommended for patients with uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic therapy (Ref). Note: If neutropenic, extend treatment until afebrile for 2 days and neutrophil recovery (ANC ≥500 cells/mm3 and increasing) (Ref). For P. aeruginosa bacteremia in neutropenic patients, some experts treat for a minimum of 14 days and until recovery of neutrophils (Ref).
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 (Ref). 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 (Ref). 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 (Ref).
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 (Ref); doses up to 200 to 400 mg/kg/day divided every 6 to 8 hours (maximum: 12 g daily) have also been recommended (Ref).
Extended infusion method: IV: 2 g every 8 hours over 3 to 4 hours (Ref).
Continuous infusion method: IV: Usual dose: 6 g over 24 hours (Ref); doses up to 100 to 200 mg/kg/day (maximum: 12 g daily) have also been studied (Ref).
Duration of therapy: Duration is usually 10 to 14 days depending on clinical response (Ref).
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 (Ref).
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 (Ref).
Cholecystitis, acute: IV: 2 g every 8 hours; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (Ref).
Other intra-abdominal infections (eg, cholangitis, appendicitis, diverticulitis, intra-abdominal abscess): IV: 2 g every 8 hours in combination with metronidazole and, when appropriate, other agents (Ref). Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Ref). For diverticulitis or uncomplicated appendicitis managed without intervention, duration is 10 to 14 days (Ref); for perforated appendicitis managed with laparoscopic appendectomy, 2 to 4 days may be sufficient (Ref). 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 (Ref).
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 (Ref).
Melioidosis (Burkholderia pseudomallei infection) (off-label use): Initial intensive therapy: IV: 2 g every 6 to 8 hours (Ref) 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 (Ref). Some experts recommend adding sulfamethoxazole and trimethoprim for patients with focal disease of the CNS, prostate, bone, joint, skin, or soft tissue (Ref). Note: Following the course of parenteral therapy, eradication therapy with oral antibiotics for ≥12 weeks is recommended (Ref).
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 (Ref). Treatment duration for gram-negative bacilli is a minimum of 10 to 14 days, although some experts recommend ≥21 days (Ref).
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) (Ref); some experts use an ANC cutoff of <500 cells/mm3 to define high-risk patients (Ref).
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 (Ref). Note: Some experts prefer extended or continuous infusions for critical illness (Ref).
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 (Ref).
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 (Ref). Consider a 25% dose increase in patients with significant residual renal function (urine output >100 mL/day) (Ref).
Intermittent: Intraperitoneal:
Continuous ambulatory peritoneal dialysis: 1 to 1.5 g added to one exchange once daily (allow to dwell ≥6 hours) (Ref).
Automated peritoneal dialysis: 20 mg/kg once daily administered in the longest dwell (Ref).
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 (Ref).
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 (Ref).
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 (Ref). Note: Some experts prefer extended or continuous infusion for critical illness or when treating a susceptible organism with an elevated MIC (Ref).
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 (Ref).
Septic arthritis: As a component of empiric therapy or as pathogen-directed therapy for gram-negative pathogens (including P. aeruginosa):
IV: 2 g every 8 hours; for empiric therapy, use in combination with other appropriate agents. Total treatment duration is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy (Ref).
Skin and soft tissue infection, moderate to severe:
Note: For empiric or pathogen-directed therapy in patients with or at risk for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa) (Ref).
IV: 2 g every 8 hours; often used as part of an appropriate combination regimen. Usual duration (including oral step-down therapy) is 5 to 14 days based on severity and clinical response (Ref).
Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms):
IV: 1 to 2 g every 8 hours (Ref). 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 (Ref).
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: IV:
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 (Ref).
IV: 2 g every 6 hours (Ref), as patients with ARC may not achieve pharmacodynamic targets with standard dosage regimens when pseudomonal infections are confirmed or suspected (Ref). 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 (Ref).
Hemodialysis, intermittent (thrice weekly): Dialyzable (55% to 88% utilizing low-flux filters (Ref)):
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 (Ref).
Peritoneal dialysis: IV: 1 g every 24 hours (Ref).
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 (Ref). 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 (Ref).
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 (Ref).
Note: Dosing recommendations based on Monte Carlo simulations utilizing 8- to 10-hour daily sessions with effluent rates of 67 to 83 mL/minute (Ref) or 6-hour daily sessions with effluent rates of ~300 mL/minute (Ref).
No dosage adjustment necessary.
Refer to adult dosing.
(For additional information see "Ceftazidime: Pediatric drug information")
General dosing, susceptible infection (Ref): 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 (Ref). Doses of 150 mg/kg/day in divided doses every 8 hours have also been reported (Ref).
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 (Ref). 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) (Ref).
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 (Ref).
Intra-abdominal infection, complicated: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours in combination with metronidazole; maximum daily dose: 6 g/day (Ref).
Meningitis, including health care-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 (Ref).
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 (Ref).
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 (Ref).
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 (Ref).
Peritonitis (peritoneal dialysis): Infants, Children, and Adolescents: Intraperitoneal:
Intermittent: 20 mg/kg/dose every 24 hours in the long dwell (Ref); in adults, intermittent: 1,000 to 1,500 mg every 24 hours per exchange in the long dwell (≥6 hours) (Ref).
Continuous: Loading dose: 500 mg per liter of dialysate; maintenance dose: 125 mg per liter (Ref).
Urinary tract infection: Infants, Children, and Adolescents: IV: 100 to 150 mg/kg/day divided every 8 hours (Ref).
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 (Ref): 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.
Infants, Children and Adolescents: No adjustment required.
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
Hypersensitivity to ceftazidime, other cephalosporins, penicillins, other beta-lactam antibiotics, or any component of the formulation
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous, as sodium [strength expressed as base]:
Tazicef: 1 g/50 mL (50 mL)
Solution Reconstituted, Injection:
Fortaz: 500 mg (1 ea [DSC]); 1 g (1 ea [DSC])
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 [DSC])
Solution Reconstituted, Intravenous [preservative free]:
Tazicef: 1 g (1 ea); 2 g (1 ea)
Generic: 2 g (1 ea); 1 g/50 mL (1 ea [DSC]); 2 g/50 mL (1 ea [DSC])
May be product dependent
Solution (Tazicef Intravenous)
1 gm/50 mL (per mL): $0.34
Solution (reconstituted) (cefTAZidime Injection)
1 g (per each): $5.40 - $6.24
6 g (per each): $28.80 - $35.00
Solution (reconstituted) (cefTAZidime Intravenous)
2 g (per each): $12.00 - $13.20
Solution (reconstituted) (Tazicef Injection)
1 g (per each): $5.11
Solution (reconstituted) (Tazicef Intravenous)
1 g (per each): $7.14
2 g (per each): $11.46
6 g (per each): $36.67
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.
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 ([DSC]); 6 g (1 ea)
IM: Administer deep IM into large mass muscle.
IV:
IV push: Administer over 3 to 5 minutes.
IV infusion: Administer over 30 minutes (traditional method); may also administer over 3 to 4 hours (extended infusion method) or over 24 hours (continuous infusion method) based on patient-specific orders and/or institution-specific policies and procedures.
Intravitreal: May be administered intravitreally in combination with vancomycin (separate syringes) (Ref).
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.
Parenteral: Note: Inadvertent intra-arterial administration may result in distal necrosis.
IM: Inject deep IM into a large muscle mass (eg, upper outer quadrant of the gluteus maximus, lateral part of the thigh [as age-appropriate]).
IV:
IV push: Administer over 3 to 5 minutes.
Intermittent IV infusion: Administer over 15 to 30 minutes (Ref). Note: Extended infusions (eg, infusing doses over 3 to 4 hours) have been described in adults and have been modeled in pediatric patients (Ref).
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 (Ref); 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 (Ref).
Maintenance infusion: Infuse daily dose over 24 hours (Ref). Insulation and ice packs should be used to maintain temperature at 15°C to 22°C (59°F to 71.6°F) throughout infusion (Ref).
Bloodstream infection (gram-negative bacteremia): Treatment of bloodstream infection caused by susceptible organisms (eg, Pseudomonas aeruginosa, Klebsiella spp., Haemophilus influenzae, Escherichia coli, Serratia spp.).
Bone and joint infections: Treatment of bone and joint infections caused by susceptible organisms (eg, P. aeruginosa, Klebsiella spp., Enterobacter spp.).
CNS infections: Treatment of CNS infections, including meningitis, caused by susceptible organisms (eg, H. influenzae, Neisseria meningitidis, P. aeruginosa).
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 intra-abdominal infections, including peritonitis, caused by susceptible organisms (eg, E. coli, Klebsiella spp.).
Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, caused by susceptible organisms (eg, P. aeruginosa and other Pseudomonas spp., H. influenzae, Klebsiella spp., Enterobacter spp., Proteus mirabilis, E. coli, Serratia spp., Citrobacter spp.).
Skin and soft tissue infections, moderate to severe: Treatment of skin and soft tissue infections caused by susceptible organisms (eg, P. aeruginosa, Klebsiella spp., E. coli, Proteus spp., Enterobacter spp., Serratia spp.).
Urinary tract infection: Treatment of complicated and uncomplicated urinary tract infections caused by susceptible organisms (eg, P. aeruginosa, Enterobacter spp., Proteus spp., Klebsiella spp., E. coli).
Cystic fibrosis, acute pulmonary exacerbation; Diabetic foot infection, moderate to severe; Endophthalmitis, bacterial; Melioidosis (Burkholderia pseudomallei infection); Peritonitis, treatment (peritoneal dialysis patients)
CefTAZidime may be confused with ceFAZolin, cefepime, cefoTEtan, cefOXitin, cefTRIAXone
Ceptaz may be confused with Septra
Tazicef may be confused with Tazidime
Ceftim [Portugal] and Ceftime [Thailand] brand names for ceftazidime may be confused with Ceftin brand name for cefuroxime [US, Canada]; Cefiton brand name for cefixime [Portugal]
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
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
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination
Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Risk C: Monitor therapy
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy
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
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).
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).
Some products may contain sodium.
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.
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.
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 and term neonates (GA: 25 to 41 weeks): 0.542 ± 0.201 L/kg (Low 1985).
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:
Preterm and term neonates: Mean: 45.7%; ranged from <3.4% (without inflamed meninges) to 92.7% (with meningitis) (Low 1985).
Adults:
Days 2 to 4: Mean: 17.8% to 37% (Modai 1983).
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:
Neonates: Note: Reported half-life varies; a mean half-life range of 7.3 to 7.57 hours has been described in groups of combined preterm and term neonates (Low 1985; Mulhall 1985).
Preterm neonates (weight: 1 to 2.2 kg): mean range: 4.47 to 4.97 hours (Prinsloo 1983).
Term neonates: 4.38 ± 1.79 hours (Prinsloo 1983).
Infants:
1 to 2 months: 2.8 ± 1.47 hours (Prinsloo 1983).
2 to 12 months: 2 ± 0.64 hours (Prinsloo 1983).
Adults: 1 to 2 hours, significantly prolonged with renal impairment.
Time to peak, serum: IM: Neonates: 1.45 ± 0.24 hours (range: 0.78 to 2.7 hours) (Mulhall 1985); Adults: ~1 hour.
Excretion: Urine (80% to 90% as unchanged drug).
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.
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