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All about: Ceftazidime

Big Image Pronouncation: (seff-TAZE-ih-deem)
Class: Antibiotic, Cephalosporin

Trade Names:
Ceptaz
- Powder for Injection 1 g (as pentahydrate w/L-arginine)
- Powder for Injection 2 g (as pentahydrate w/L-arginine)

Trade Names:
Fortaz
- Powder for Injection 500 mg (2.3 mEq sodium/g)
- Powder for Injection 1 g (2.3 mEq sodium/g)
- Powder for Injection 2 g (2.3 mEq sodium/g)
- Powder for Injection 6 g (2.3 mEq sodium/g)
- Injection 1 g with 2.2 g dextrose hydrous
- Injection 2 g with 1.6 g dextrose hydrous

Trade Names:
Tazicef
- Powder for Injection 1 g (2.3 mEq sodium/g)
- Powder for Injection 2 g (2.3 mEq sodium/g)
- Powder for Injection 6 g (2.3 mEq sodium/g)
- Injection 1 g
- Injection 2 g

Trade Names:
Tazidime
- Powder for Injection 500 mg (as pentahydrate w/L-arginine)
- Powder for Injection 1 g (as pentahydrate w/L-arginine)
- Powder for Injection 2 g (as pentahydrate w/L-arginine)
- Powder for Injection 6 g (as pentahydrate w/L-arginine)

Mechanism of Action

Pharmacology

Inhibits mucopeptide synthesis in bacterial cell wall.

Pharmacokinetics

Absorption

IV

C max is 45 to 90 mcg/mL (500 mg and 1 g doses).

IM

C max is 17 to 39 mcg/mL (500 mg and 1 g doses). T max is about 1 h.

Distribution

Ceftazidime is less than 10% protein bound. It is excreted in human milk in low concentrations.

Elimination

The t ½ is about 1.9 to 2 h. About 80% to 90% is excreted unchanged by the kidneys. Renal Cl is about 100 mL/min. Plasma Cl is about 115 mL/min.

Special Populations

Renal Function Impairment

The t ½ is significantly prolonged. Dosage adjustments are recommended.

Indications and Usage

Treatment of infections of lower respiratory tract, skin and skin structures, urinary tract, bone and joint; treatment of gynecological infections; treatment of intra-abdominal infections; treatment of septicemia and CNS infections including meningitis caused by susceptible strains of specific microorganisms; concomitant antibiotic therapy.

Contraindications

Hypersensitivity to cephalosporins.

Dosage and Administration

Adults

IV/IM 250 mg to 2 g every 8 to 12 h.

Children 1 mo to 12 yr of age

IV 30 to 50 mg/kg every 8 h (max, 6 g/day).

Newborns younger than 4 wk of age

IV 30 mg/kg every 12 h.

General Advice

  • Follow manufacturer's instructions for reconstitution and dilution.
  • Reconstituted solution should be light yellow to amber; darkened solution or powder does not indicate altered potency. Do not administer if solution is cloudy or precipitate is present.
  • When giving by IM route, add 3 mL diluent to 1 g vial to yield 280 mg/mL. Inject deeply into large muscle (eg, upper outer quadrant of gluteus muscle or lateral thigh); massage well.
  • When giving by IV route, add 10 mL sterile water for injection to 1 g vial to yield 280 mg/mL. Administer slowly over 3 to 5 min.
  • For intermittent infusions, reconstituted solution can be further diluted with 50 to 100 mL of D5W or sodium chloride 0.9% and infused over 30 min.

Storage/Stability

Store sterile powder at room temperature and protect from light. When reconstituted with sterile water for injection, solution is stable for 7 days if refrigerated and for 18 to 24 h when stored at room temperature. If frozen immediately after reconstitution, solution is stable for 3 mo. Completely thaw frozen preparation at room temperature before use. After thawing, solution may be stored for 18 to 24 h at room temperature or 4 days in refrigerator. Do not refreeze.

Drug Interactions

Aminoglycosides

Increased risk of nephrotoxicity.

Incompatibility

Aminoglycosides

Do not add aminoglycosides to ceftazidime solutions because inactivation of both drugs may result; administer at separate sites if concurrent therapy is indicated.

Sodium bicarbonate

Do not dilute ceftazidime with sodium bicarbonate.

Laboratory Test Interactions

May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-Tape ); false-positive test results for proteinuria with acid and denaturization-precipitation tests; false-positive direct Coombs test result in certain patients (eg, those with azotemia); false elevations in urinary 17-ketosteroid values.

Adverse Reactions

GI

Nausea; vomiting; diarrhea; anorexia; abdominal pain or cramps; flatulence; colitis, including pseudomembranous colitis.

Genitourinary

Pyuria; renal dysfunction; dysuria; reversible interstitial nephritis; hematuria; toxic nephropathy.

Hematologic

Eosinophilia; neutropenia; lymphocytosis; leukocytosis; thrombocytopenia; thrombocytosis; decreased platelet function; anemia; aplastic anemia; hemorrhage.

Hepatic

Hepatic function impairment; cholestatic jaundice; abnormal LFT results.

Miscellaneous

Hypersensitivity, including Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis; candidal overgrowth; serum sickness–like reactions (eg, skin rashes, polyarthritis, arthralgia, fever); phlebitis; thrombophlebitis, and pain at injection site.

Precautions

Monitor

Response to therapy

Monitor patient's response to therapy. Notify health care provider if infection does not appear to improve or worsens.

Adverse reactions

Monitor patient for GI, DERM, and general body adverse reactions, and signs of superinfection. Inform health care provider if noted and significant. Immediately report severe diarrhea, diarrhea containing blood or pus, or severe abdominal cramping.


Pregnancy

Category B .

Lactation

Excreted in breast milk.

Hypersensitivity

Reactions range from mild to life-threatening. Administer drug with caution to penicillin-sensitive patients because of possible cross-reactivity.

Renal Function

Use drug with caution in patients with renal function impairment. Dosage adjustment based on renal function may be required.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

Pseudomembranous colitis

Consider in patients in whom diarrhea develops.

Overdosage

Symptoms

Neuromuscular excitability, asterixis, seizures, encephalopathy.

Patient Information

  • Remind patient to check body temperature daily. If fever persists for more than a few days or if high fever (higher than 102°F) or shaking chills are noted, notify health care provider immediately.
  • Advise patient to maintain normal fluid intake while using this medication.
  • Remind diabetic patient to use enzyme-based tests (eg, Clinistix , Tes-Tape ) for monitoring urine glucose because drug may give false results with other tests.
  • Advise patient to report these symptoms to health care provider: nausea, vomiting, diarrhea, skin rash, hives, sore throat, bruising, bleeding, muscle or joint pain.
  • Instruct patient to report signs of superinfection: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
  • Warn patient that diarrhea that contains blood or pus may be a sign of serious disorders. Tell patient to seek medical care and not to treat at home.
  • Instruct patient to seek emergency care immediately if wheezing or difficulty breathing occurs.
  • Advise patient not to drink alcoholic beverages or to take alcohol-containing medications while taking this medication and for several days after discontinuing it.

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