Ceftazidime


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IM/IV Susceptible infections 1-2 g 8-12 hrly. Pseudomonal lung infections in cystic fibrosis 100-150 mg/kg 8 hrly. Max: 9 g/day. Prophylaxis of surgical infection in patients undergoing prostate surgery 1 g at the induction of anaesth, may repeat upon catheter removal.
Dosage Details
Parenteral
Prophylaxis of surgical infection in patients undergoing prostate surgery
Adult: 1 g at induction of anaesth repeated if necessary upon removal of catheter. It is given as deep IM inj, slow IV inj over 3-5 min or IV infusion for up to 30 min.
Elderly: >80 yr Max: 3 g daily.

Parenteral
Pseudomonal lung infections in cystic fibrosis
Adult: 100-150 mg/kg 8 hrly as deep IM inj, slow IV inj over 3-5 min or IV infusion for up to 30 min. Max: 9 g daily.
Child: <40 kg: 150 mg/kg daily in 3 divided doses. Max: 6 g daily.
Elderly: >80 yr Max: 3 g daily.

Parenteral
Bone and joint infections, Complicated intra-abdominal infections, Skin and skin structure infections, complicated
Adult: 1-2 g 8 hrly as deep IM inj, slow IV inj over 3-5 min or IV infusion for up to 30 min.
Child: <40 kg: 100-150 mg/kg daily in 3 divided doses. Max: 6 g daily.
Elderly: >80 yr Max: 3 g daily.

Parenteral
Bacterial meningitis, Empiric therapy for febrile neutropenic patients, Nosocomial pneumonia
Adult: 2 g 8 hrly as deep IM inj, slow IV inj over 3-5 min or IV infusion for up to 30 min.
Child: <40 kg: 150 mg/kg daily in 3 divided doses. Max: 6 g daily.
Elderly: >80 yr Max: 3 g daily.

Parenteral
Complicated urinary tract infections
Adult: 1-2 g 8-12 hrly as deep IM inj, slow IV inj over 3-5 min or IV infusion for up to 30 min.
Child: <40 kg: 100-150 mg/kg daily in 3 divided doses. Max: 6 g daily.
Elderly: >80 yr Max: 3 g daily.
Special Patient Group
Critically ill patients undergoing continuous renal replacement: Continuous venovenous haemodialysis or haemodiafiltration: Loading dose of 2 g, then, 1 g 8 hrly or 2 g 12 hrly; 2 g 8 hrly may be necessary for very resistant gm-ve pathogens. Continuous venovenous haemofiltration: Loading dose of 2 g, then, 1-2 g 12 hrly.
Renal Impairment
Loading dose: 1 g. Maintenance doses based on CrCl. May need to increase dose by 50% in severe infections. Peritoneal dialysis: Loading dose is followed by 500 mg 24 hrly; may add ceftazidime to the dialysis fluid (usually 125-250 mg for 2 L of dialysis fluid). Haemodialysis: Admin loading dose then 1 g after each dialysis period.
CrCl (mL/min) Dosage
<5 500 mg 48 hrly.
6-15 500 mg 24 hrly.
16-30 1 g 24 hrly.
31-50 1 g 12 hrly.
Reconstitution
IV: Reconstitute vials labelled as containing 500 mg, 1 g, or 2 g w/ 5.3 mL, 10 mL or 10 mL, respectively, of sterile water for inj or a compatible IV soln to provide soln containing approx 100 mg/mL, 100 mg/mL or 170 mg/mL, respectively. IM: Add 1.5 mL or 3 mL of sterile or bacteriostatic water for inj or 0.5% or 1% lidocaine HCl inj to vials labelled as 500 mg or 1 g, respectively, to provide soln containing approx 280 mg/mL.
Incompatibility
Incompatible w/ aminoglycosides, vancomycin. Y-site: Acetylcysteine, amiodarone, amphotericin B cholesteryl sulfate complex, amsacrine, azithromycin, caspofungin, dobutamine, doxorubicin liposome, erythromycin lactobionate, idarubicin, midazolam, pantoprazole, pemetrexed, pentamidine, phenytoin, warfarin. Na bicarbonate is not recommended as diluents since it is less stable than other IV fluids.
Contraindications
Hypersensitivity to ceftazidime or other cephalosporins.
Special Precautions
Patient w/ history of penicillin allergy, seizure disorder. Renal impairment. Pregnancy and lactation.
Adverse Reactions
Diarrhoea, nausea, vomiting, abdominal pain, metallic taste; eosinophilia, thrombocytosis; pruritus, rash (maculopapular, erythematous), urticaria, photosensitivity, angioedema, fever; transient increases in serum concentrations of AST, ALT, alkaline phosphatase, LDH, γ-glutamyltransferase, bilirubin, serum creatinine concentrations; local reactions (e.g. phlebitis, pain or inflammation at inj site), candidiasis, vaginitis. Rarely, transient leucopenia, neutropenia thrombocytopenia, agranulocytosis, lymphocytosis.
Potentially Fatal: Anaphylactic reactions, Clostridium difficile-associated diarrhoea and colitis.
IM/Inhalation/Respiratory/Intraperitoneal/Intravitreal/IV/Parenteral: B
MonitoringParameters
Monitor renal function. Observe for signs and symptoms of anaphylaxis during 1st dose.
Overdosage
Symptoms: Seizure activity, encephalopathy, asterixis, neuromuscular excitability, coma. Management: Symptomatic and supportive treatment. In the presence of renal insufficiency, haemodialysis or peritoneal dialysis may aid in the removal of the drug from the body.
Drug Interactions
May increase nephrotoxicity of aminoglycosides. May diminish therapeutic effect of BCG, typhoid vaccine, Na picosulfate. May increase anticoagulant effect of vit K antagonists (e.g. warfarin). May increase serum level w/ probenecid.
Lab Interference
Positive direct Coombs' test and false-positive urinary glucose test using cupric sulfate (Benedict's soln, Fehling's soln or Clinitest). False-positive urine or serum creatinine w/ Jaffe reaction.
Action
Description: Ceftazidime binds to 1 or more of the penicillin-binding proteins (PBPs) which inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
Pharmacokinetics:
Absorption: Time to peak plasma concentration: Approx 1 hr (IM), 5 min (IV bolus).
Distribution: Widely distributed in body tissues and fluids; therapeutic concentrations occur in CSF when meninges are inflamed. Crosses the placenta, distributed in amniotic fluid and enters breast milk. Volume of distribution: 0.18-0.31 L/kg. Plasma protein binding: Approx 10%.
Metabolism: Not metabolised.
Excretion: Via urine by glomerular filtration (approx 80-90% as unchanged drug w/in 24 hr). Plasma half-life: Approx 2 hr.
Chemical Structure

Chemical Structure Image
Ceftazidime

Source: National Center for Biotechnology Information. PubChem Database. Ceftazidime, CID=5481173, https://pubchem.ncbi.nlm.nih.gov/compound/Ceftazidime (accessed on Jan. 21, 2020)

Storage
Store between 20-25°C. Protect from light.
MIMS Class
References
Anon. Ceftazidime. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/11/2014.

Buckingham R (ed). Ceftazidime. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/11/2014.

Ceftazidime Injection, Powder for Solution (Sandoz Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/11/2014.

Joint Formulary Committee. Ceftazidime. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/11/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Ceftazidime. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/11/2014.

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