Aztreonam


Thông tin kê toa tóm tắt
Chỉ định/Công dụng
Listed in Dosage.
Liều dùng/Hướng dẫn sử dụng
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.
Hướng dẫn pha thuốc
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%.
Tương kỵ
Y-site: Aciclovir, amphotericin B, amphotericin B cholesteryl sulfate complex, amsacrine, anakinra, azithromycin, chlorpromazine, daunorubicin HCl, ganciclovir, lorazepam, metronidazole, mitomycin, mitoxantrone, prochlorperazine edisylate, streptozocin.
Chống chỉ định
Hypersensitivity to aztreonam.
Thận trọng
History of β-lactam hypersensitivity. Renal and hepatic impairment. Childn. Pregnancy and lactation.
Phản ứng phụ
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.
Tương tác
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.
Tác dụng
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).
Đặc tính

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)

Bảo quản
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.
Phân loại MIMS
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.

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