Ceftazidime (ceftazidime)

Following reconstitution of the commercially available powders for injection containing a mixture of ceftazidime (as the pentahydrate) and sodium carbonate, solutions contain ceftazidime sodium; dosage of the drug is expressed in terms of anhydrous ceftazidime.

To avoid unintentional overdosage, the commercially available Duplex(R) drug delivery system containing ceftazidime and dextrose injection should not be used in patients who require less than the entire 1- or 2-g dose in the container.

In patients with renal impairment, doses and/or frequency of administration of ceftazidime should be modified in response to the degree of renal impairment, severity of the infection, and susceptibility of the causative organism. Excessive dosage and elevated plasma concentrations of the drug in patients with renal impairment can precipitate serious neurotoxicity (e.g., seizures, encephalopathy, coma, asterixis, neuromuscular excitability, myoclonia).

The manufacturers recommend that adults with creatinine clearances of 50 mL/minute or less receive an initial loading dose of 1 g of ceftazidime and a maintenance dosage based on the patient's creatinine clearance. (See Table 1.)

Table 1. Maintenance Dosage for Adults with Renal Impairment

Creatinine Clearance (mL/minute) Dosage 31-50 1 g every 12 h 16-30 1 g every 24 h 6-15 500 mg every 24 h <5 500 mg every 48 h

In patients with renal impairment and severe infections who would generally receive a ceftazidime dosage of 6 g daily if their renal function were normal, the manufacturers state that doses in the above table may be increased by 50% or the dosing frequency may be increased appropriately.

Alternatively, some clinicians recommend that adults with creatinine clearances of 30-80 mL/minute receive the usual doses of ceftazidime every 12-24 hours, adults with creatinine clearances of 10-29 mL/minute receive the usual doses every 24-36 hours, and adults with creatinine clearances less than 10 mL/minute receive the usual doses every 36-48 hours.

Because ceftazidime is removed by hemodialysis, a supplemental dose of the drug is generally indicated after each dialysis period. The manufacturers recommend that adults undergoing hemodialysis receive an initial 1-g loading dose of ceftazidime followed by a 1-g dose after each dialysis period.

In adults undergoing intraperitoneal dialysis or continuous ambulatory peritoneal dialysis, the manufacturers recommend that an initial 1-g loading dose of ceftazidime be given followed by a 500-mg dose every 24 hours. Some clinicians recommend that patients undergoing peritoneal dialysis receive 500 mg of ceftazidime every 24 hours and a supplemental 500-mg dose of the drug at the end of each dialysis period. If ceftazidime (as a sodium carbonate formulation) is administered intraperitoneally in the dialysis solution, the manufacturers recommend that 250 mg of the drug be added to each 2 L of dialysis solution.

In children with impaired renal function, the frequency of dosing should be decreased based on the degree of impairment.

Modification of the usual dosage of ceftazidime is generally unnecessary in patients with impaired hepatic function, unless renal function is also impaired.

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

Antibiotics/Fecal Microbiota

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Fecal microbiota is a suspension of live bacteria, which may be compromised by concurrent use of antibiotics.(1)

CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota. Antibacterial treatment should be completed for 24 to 72 hours before initiating treatment with fecal microbiota. Do not use antibiotics for up to 8 weeks after fecal microbiota.(1)

DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota.

Antibiotics/Fecal Microbiota Spores

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1)

CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1)

DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores.

Antimicrobials/Live Typhoid Vaccine

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)

CLINICAL EFFECTS: Vaccination may be ineffective.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)

DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

• Chronic kidney disease stage 3A (moderate) GFR 45-59 ml/min
• Chronic kidney disease stage 3B (moderate) GFR 30-44 ml/min
• Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
• Chronic kidney disease stage 5 (failure) GFr<15 ml/min
• Clostridioides difficile infection
• Colitis

• Disease of liver
• Hypoprothrombinemia
• Kidney disease with likely reduction in glomerular filtration rate (GFr)
• Lower seizure threshold
• Myoclonus
• Seizure disorder

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Rare or Very Rare

• Abnormal hepatic function tests
• Acute generalized exanthematous pustulosis
• Agranulocytosis
• Anaphylaxis
• Angioedema
• Aplastic anemia
• Candidiasis
• Cholestasis
• Clostridioides difficile infection
• Colitis
• DRESS syndrome
• Eosinophilia
• Erythema multiforme
• Hallucinations
• Hemolytic anemia
• Hemorrhage
• Hepatitis
• Hyperbilirubinemia
• Hypersensitivity drug reaction
• Hypoprothrombinemia
• Interstitial nephritis
• Jaundice
• Kidney disease with reduction in glomerular filtration rate (GFr)
• Myocardial ischemia
• Myoclonus
• Obstructive hyperbilirubinemia
• Pancytopenia
• Pemphigus
• Pruritus of skin
• Renal failure
• Seizure disorder
• Serum sickness
• Stevens-johnson syndrome
• Thrombocytopenic disorder
• Toxic epidermal necrolysis
• Urticaria

More Frequent

• Acute abdominal pain
• Diarrhea
• Dyspepsia
• Nausea
• Vomiting

Less Frequent

• Gastritis
• Vulvovaginal candidiasis

Rare or Very Rare

• Acute cognitive impairment
• Agitation
• Arthralgia
• Dizziness
• Drug fever
• Fatigue
• Genital organ pruritus
• Headache disorder
• Paresthesia
• Phlebitis after infusion
• Prolonged prothrombin time
• Pruritus ani
• Skin rash
• Vaginitis

No enhanced messaging available.

No enhanced messaging available.

Safe use of ceftazidime during pregnancy has not been definitely established. Reproduction studies in mice and rats using ceftazidime dosages up to 40 times the usual human dosage have not revealed evidence of harm to the fetus. There are no adequate or controlled studies using ceftazidime in pregnant women, and the drug should be used during pregnancy only when clearly needed.

Because ceftazidime is distributed into milk, sodium carbonate formulations of the drug should be used with caution in nursing women.

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