Aztreonam


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IM/IV UTI 0.5 g or 1 g 8 or 12 hrly. Bone and joint infections; Intra-abdominal infections; Lower resp tract infections; Meningitis; Pelvic infections; Septicaemia; Skin and soft tissue infections 1-8 g daily in divided doses 6-12 hrly. All doses to be given by deep IM inj, slow IV inj over 3-5 min or IV infusion over 20-60 min. IM Cystitis; Gonorrhoea 1 g as a single dose. IV Cystic fibrosis 2 g 6-8 hrly by slow inj over 3-5 min or infusion over 20-60 min. Inhalation Pseudomonal lung infections in cystic fibrosis As aztreonam lysine: 75 mg tid over 2-3 min, w/ at least 4 hr apart for 28 days. Should be taken w/ bronchodilators prior to each dose.
Dosage Details
Inhalation/Respiratory
Pseudomonal lung infections in cystic fibrosis
Adult: As aztreonam lysine: 75 mg tid over 2-3 min, w/ at least 4 hr apart for 28 days. Should be taken w/ bronchodilators prior to each dose: 15 min to 4 hr (short-acting) and 30 min to 12 hr (long-acting) before inhaled aztreonam. May be taken in repeated 28 days cycle on therapy followed by 28 days off therapy.
Child: >6 yr Same as adult dose.

Intramuscular
Cystitis, Gonorrhoea
Adult: 1 g as a single dose.

Intravenous
Cystic fibrosis
Adult: 2 g 6-8 hrly by slow inj over 3-5 min or infusion over 20-60 min.

Parenteral
Bone and joint infections, Intra-abdominal infections, Lower respiratory tract infections, Meningitis, Pelvic infections, Septicaemia, Skin and soft tissue infections
Adult: 1-8 g daily in divided doses 6-12 hrly by deep IM inj, slow IV inj over 3-5 min or IV infusion over 20-60 min.
Child: 1 wk to <2 yr 30 mg/kg 6 or 8 hrly; 2-12 yr 30 mg/kg 6 or 8 hrly, may increase to 50 mg/kg to max 8 g daily. Doses may be given by deep IM inj, slow IV inj over 3-5 min or IV infusion over 20-60 min.

Parenteral
Urinary tract infections
Adult: 0.5 g or 1 g 8 or 12 hrly by deep IM inj, slow IV inj over 3-5 min or IV infusion over 20-60 min.
Renal Impairment
IM/IV:
Haemodialysis: A supplementary dose of 1/8 of the initial dose after each dialysis.
CrCl (mL/min) Dosage
<10 One-quarter of the initial dose.
10-30 Half of the initial dose.
Reconstitution
Inhalation: Reconstitute w/ the solvent provided, gently swirl. IM: Reconstitute vial w/ at least 3 mL of sterile water for inj, sterile bacteriostatic water for inj, normal saline, or bacteriostatic NaCl per g of aztreonam; immediately shake vigorously. IV: Bolus inj: Reconstitute vial w/ 6-10 mL of sterile water for inj. Infusion: Reconstitute vial w/ at least 3 mL of sterile water for inj per g of aztreonam; immediately shake vigorously. Then further dilute in an appropriate soln for infusion to a final concentration of ≤2%.
Incompatibility
Y-site: Aciclovir, amphotericin B, amphotericin B cholesteryl sulfate complex, amsacrine, anakinra, azithromycin, chlorpromazine, daunorubicin HCl, ganciclovir, lorazepam, metronidazole, mitomycin, mitoxantrone, prochlorperazine edisylate, streptozocin.
Contraindications
Hypersensitivity to aztreonam.
Special Precautions
History of β-lactam hypersensitivity. Renal and hepatic impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Inhalation: Cough, nasal congestion, fever, wheezing, bronchospasm. IM: Pain or swelling. IV: Phlebitis or thrombophlebitis. Hypersensitivity reactions e.g. urticaria, rashes, exfoliative dermatitis, angioedema, bronchospasm, eosinophilia. GI effects e.g. nausea, vomiting, abnormal taste, mouth ulcer. Overgrowth of non-susceptible organisms e.g. gm+ve cocci; pseudomembranous colitis or GI bleeding; jaundice, hepatitis, increased liver enzymes and, prothrombin and partial thromboplastin times prolongation. Rarely, anaphylaxis, toxic epidermal necrolysis.
Potentially Fatal: Clostridium difficile-associated diarrhoea from mild diarrhoea to fatal colitis.
IM/Inhalation/Respiratory/IV/Parenteral: B
MonitoringParameters
Monitor for signs of anaphylaxis during 1st dose; periodic LFT. Consider measuring FEV1 prior to initiation of inhalation therapy.
Drug Interactions
Concurrent use w/ oral anticoagulants may increase prothrombin time.
Lab Interference
May interfere w/ urine glucose tests using cupric sulfate (e.g. Benedict’s soln, Clinitest®). Positive Coombs’ test.
Action
Description: Aztreonam inhibits bacterial cell wall synthesis due to its high affinity for penicillin-binding protein 3 (PBP-3) of gm-ve bacteria. It is highly resistant to hydrolysis by many narrow-spectrum β-lactamases. It is also active against most Enterobacteriaceae (including E. coli, Citrobacter, Enterobacter, Klebsiella, Proteus, Providencia, Salmonella, Serratia, Shigella, Yersinia spp. and Morganella morganii).
Pharmacokinetics:
Absorption: Rapidly and completely absorbed (IM); low systemic absorption (inhalation). Time to peak plasma concentration: W/in 1 hr (IM and IV bolus); 1.5 hr (IV infusion).
Distribution: Widely distributed into body tissues and fluids including bile; CSF (especially in the presence of meningitis); crosses the placenta and enters foetal circulation; enters breast milk (small amounts). Plasma protein binding: Approx 56%.
Metabolism: Not extensively metabolised; SQ-26992 (inactive principal metabolite) is formed by opening of the β-lactam ring.
Excretion: Mainly via urine by renal tubular secretion and glomerular filtration (approx 60-70% as unchanged drug and metabolites for IM/IV; approx 10% for inhalation); faeces (approx 13-15% as unchanged drug and metabolites for IM/IV). Plasma half-life: Approx 1.7 hr (IM/IV); approx 2.1 hr (inhalation).
Chemical Structure

Chemical Structure Image
Aztreonam

Source: National Center for Biotechnology Information. PubChem Database. Aztreonam, CID=54117, https://pubchem.ncbi.nlm.nih.gov/compound/Aztreonam (accessed on Jan. 21, 2020)

Storage
Powd for inhalation: Store between 2-8°C. Powd for inj: Store below 25°C. Reconstituted inj soln: Store between 2-8°C for not more than 24 hr.
MIMS Class
References
Anon. Aztreonam. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 25/06/2015.

Azactam. U.S. FDA. https://www.fda.gov/. Accessed 25/06/2015.

Aztreonam Injection, Powder, Lyophilized, for Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 25/06/2015.

Buckingham R (ed). Aztreonam. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/06/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Aztreonam. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 25/06/2015.

Disclaimer: This information is independently developed by MIMS based on Aztreonam from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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