Aztreonam: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
(25 intermediate revisions by 5 users not shown) | |||
Line 1: | Line 1: | ||
==General== | ==General== | ||
*Type: Monobactam | *Type: Monobactam [[antibiotic]] | ||
*Dosage forms: IM | *Dosage forms: powder for injection | ||
*Dosage strengths: 1g, 2g | |||
*Routes of Administration: IM, IV | |||
*Common Trade Names: Azactam | *Common Trade Names: Azactam | ||
===Other=== | ===Other=== | ||
* Antimicrobial activity more closely resembles AG's (only active against gram -) | *Antimicrobial activity more closely resembles AG's (only active against gram -) | ||
** Enterobacter, pseudomonas, H. influenzae, gonococci | **Enterobacter, pseudomonas, H. influenzae, gonococci | ||
** Little allergic cross-reactivity with B-lactam antibiotics | **Little allergic cross-reactivity with B-lactam antibiotics | ||
==Adult Dosing== | ==Adult Dosing== | ||
Line 22: | Line 24: | ||
*<7 days old | *<7 days old | ||
**<2000g | **<2000g | ||
*** | ***60mg/kg/day IV divided q12h | ||
***First ED Dose: | ***First ED Dose: 30mg/kg x 1 | ||
**>2000g | **>2000g | ||
*** | ***90mg/kg/day IV divided q8 | ||
***First ED Dose: | ***First ED Dose: 30mg/kg x 1 | ||
*7 days - 1 month | *7 days - 1 month | ||
**<1200g | **<1200g | ||
*** | ***60mg/kg/day IV divided q12h | ||
***First ED Dose: | ***First ED Dose: 30mg/kg x 1 | ||
**1200-2000g | **1200-2000g | ||
*** | ***90mg/kg/day IV divided q8 | ||
***First ED Dose: | ***First ED Dose: 30mg/kg x 1 | ||
**>2000g | **>2000g | ||
*** | ***120mg/kg/day IV divided q6 | ||
***First ED Dose: | ***First ED Dose: 30mg/kg x 1 | ||
===General (1 Month - 9 | ===General (1 Month - 9 Months)=== | ||
*General | *General | ||
**90- | **90-120mg/kg/day IV divided q6-8h | ||
**First ED Dose: 40mg/kg x 1 | |||
*Respiratory Infections in Cystic Fibrosis | *Respiratory Infections in Cystic Fibrosis | ||
**200mg/kg/day IV divided q6h | **200mg/kg/day IV divided q6h | ||
**First ED Dose: 40mg/kg x 1 | |||
**Max: 8g/day | **Max: 8g/day | ||
===General >9 Months)=== | |||
*90-120mg/kg/day IV divided q6-8 | |||
*First ED Dose: 40mg/kg x 1 | |||
==Special Populations== | |||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | |||
*Lactation: Safe | |||
*Renal | |||
**Adult | |||
***CrCl 10-30: 1-2g x1, then decrease dose 50% | |||
***CrCl <10: give usual dose x1, then decrease dose 75% | |||
***Hemodialysis: give 12.5% of initial dose as supplement | |||
***Peritoneal dialysis: no supplement | |||
**Pediatric | |||
***CrCl 10-30: decrease dose 50% | |||
***CrCl <10: decrease dose 75% | |||
***Hemodialysis: give supplement | |||
***Peritoneal dialysis: no supplement | |||
*Hepatic (Adult & Pediatric) | |||
**caution advised, but not defined | |||
==Contraindications== | ==Contraindications== | ||
Line 49: | Line 74: | ||
==Adverse Drug Reactions== | ==Adverse Drug Reactions== | ||
===Serious=== | |||
*[[Anaphylaxis]] | |||
*[[Allergic Reaction]] | |||
*[[Toxic Epidermal Necrolysis]] | |||
*[[Seizures]] | |||
*[[C diff]] | |||
*[[Hepatitis]] | |||
*Neutropenia | |||
*[[Thrombocytopenia]] | |||
*[[Anemia]] | |||
===Common=== | |||
*Phlebitis | |||
*Injection site reaction | |||
*[[Diarrhea]] | |||
*Nausea/vomiting | |||
*[[Rash]] | |||
*Transaminitis | |||
*Elevated creatinine | |||
*Eosinophilia | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 1.7h (4.7-6h ESRD) | ||
*Metabolism: | *Metabolism: CYP450, minimal liver | ||
*Excretion: | *Excretion: Urine | ||
*Mechanism of Action: | *Mechanism of Action: Bactericidal; inhibits cell wall synthesis | ||
==[[Antibacterial Spectra]] <ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||R | |||
|- | |||
| ||[[Strep. Pneumoniae]]||R | |||
|- | |||
| ||[[Viridans strep]]||R | |||
|- | |||
| ||Strep. anginosus gp||R | |||
|- | |||
| ||[[Enterococcus faecalis]]||R | |||
|- | |||
| ||[[Enterococcus faecium]]||R | |||
|- | |||
| ||[[MSSA]]||R | |||
|- | |||
| ||[[MRSA]]||R | |||
|- | |||
| ||[[CA-MRSA]]||R | |||
|- | |||
| ||[[Staph. Epidermidis]]||R | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||R | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||'''S''' | |||
|- | |||
| ||[[N. meningitidis]]||'''S''' | |||
|- | |||
| ||[[Moraxella catarrhalis]]||'''S''' | |||
|- | |||
| ||[[H. influenzae]]||'''S''' | |||
|- | |||
| ||[[E. coli]]||'''S''' | |||
|- | |||
| ||[[Klebsiella]] sp||'''S''' | |||
|- | |||
| ||E. coli/Klebsiella ESBL+||R | |||
|- | |||
| ||E coli/Klebsiella KPC+||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC neg||'''S''' | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC pos||'''S''' | |||
|- | |||
| ||[[Serratia]] sp||'''S''' | |||
|- | |||
| ||Serratia marcescens||X1 | |||
|- | |||
| ||[[Salmonella]] sp||X1 | |||
|- | |||
| ||[[Shigella]] sp||'''S''' | |||
|- | |||
| ||[[Proteus mirabilis]]||'''S''' | |||
|- | |||
| ||[[Proteus vulgaris]]||'''S''' | |||
|- | |||
| ||[[Providencia sp.]]||'''S''' | |||
|- | |||
| ||[[Morganella sp.]]||'''S''' | |||
|- | |||
| ||[[Citrobacter freundii]]||'''S''' | |||
|- | |||
| ||[[Citrobacter diversus]]||'''S''' | |||
|- | |||
| ||[[Citrobacter sp.]]||'''S''' | |||
|- | |||
| ||[[Aeromonas sp]]||'''S''' | |||
|- | |||
| ||[[Acinetobacter sp.]]||R | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||'''S''' | |||
|- | |||
| ||[[Burkholderia cepacia]]||R | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||R | |||
|- | |||
| ||[[Yersinia enterocolitica]]||'''S''' | |||
|- | |||
| ||[[Francisella tularensis]]||X1 | |||
|- | |||
| ||[[Brucella sp.]]||X1 | |||
|- | |||
| ||[[Legionella sp.]]||R | |||
|- | |||
| ||[[Pasteurella multocida]]||'''S''' | |||
|- | |||
| ||[[Haemophilus ducreyi]]||X1 | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||R | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||R | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||R | |||
|- | |||
| ||[[Bacteroides fragilis]]||R | |||
|- | |||
| ||[[Prevotella melaninogenica]]||R | |||
|- | |||
| ||[[Clostridium difficile]]||R | |||
|- | |||
| ||[[Clostridium (not difficile)]]||R | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||X1 | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||R | |||
|} | |||
== | ===Key=== | ||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
*Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed, Philadelphia, PA: American College of Physicians, 2007. | |||
*Azactam (aztreonam) injection [prescribing information]. Princeton, NJ: Bristol-Myers Squibb; September 2018. | |||
*Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. [PubMed 26229122]10.1093/cid/civ482 | |||
*Bosso JA and Black PG, “The Use of Aztreonam in Pediatric Patients: A Review,” Pharmacotherapy, 1991, 11(1):20-5. [PubMed 1902290] | |||
*Bratzler DW, Dellinger EP, Olsen KM, et al, “Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery,” Am J Health Syst Pharm, 2013, 70(3):195-283. [PubMed 23327981] | |||
*Brogden RN, Heel RC. Aztreonam. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1986;31(2):96-130. [PubMed 3512234] | |||
<references/> | |||
*Epocrates | |||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Pharmacology]] | |||
[[Category:ID]] | [[Category:ID]] |
Latest revision as of 21:28, 19 September 2019
General
- Type: Monobactam antibiotic
- Dosage forms: powder for injection
- Dosage strengths: 1g, 2g
- Routes of Administration: IM, IV
- Common Trade Names: Azactam
Other
- Antimicrobial activity more closely resembles AG's (only active against gram -)
- Enterobacter, pseudomonas, H. influenzae, gonococci
- Little allergic cross-reactivity with B-lactam antibiotics
Adult Dosing
General (Moderate Severe)
- 1-2g IM/IV q8-12h
- Max: 8g/day
General (Severe)
- 2g IM/IV q6-8h
- Max: 8g/day
Pediatric Dosing
General (Neonates)
- <7 days old
- <2000g
- 60mg/kg/day IV divided q12h
- First ED Dose: 30mg/kg x 1
- >2000g
- 90mg/kg/day IV divided q8
- First ED Dose: 30mg/kg x 1
- <2000g
- 7 days - 1 month
- <1200g
- 60mg/kg/day IV divided q12h
- First ED Dose: 30mg/kg x 1
- 1200-2000g
- 90mg/kg/day IV divided q8
- First ED Dose: 30mg/kg x 1
- >2000g
- 120mg/kg/day IV divided q6
- First ED Dose: 30mg/kg x 1
- <1200g
General (1 Month - 9 Months)
- General
- 90-120mg/kg/day IV divided q6-8h
- First ED Dose: 40mg/kg x 1
- Respiratory Infections in Cystic Fibrosis
- 200mg/kg/day IV divided q6h
- First ED Dose: 40mg/kg x 1
- Max: 8g/day
General >9 Months)
- 90-120mg/kg/day IV divided q6-8
- First ED Dose: 40mg/kg x 1
Special Populations
- Pregnancy Rating: B
- Lactation: Safe
- Renal
- Adult
- CrCl 10-30: 1-2g x1, then decrease dose 50%
- CrCl <10: give usual dose x1, then decrease dose 75%
- Hemodialysis: give 12.5% of initial dose as supplement
- Peritoneal dialysis: no supplement
- Pediatric
- CrCl 10-30: decrease dose 50%
- CrCl <10: decrease dose 75%
- Hemodialysis: give supplement
- Peritoneal dialysis: no supplement
- Adult
- Hepatic (Adult & Pediatric)
- caution advised, but not defined
Contraindications
- Allergy to class/drug
Adverse Drug Reactions
Serious
- Anaphylaxis
- Allergic Reaction
- Toxic Epidermal Necrolysis
- Seizures
- C diff
- Hepatitis
- Neutropenia
- Thrombocytopenia
- Anemia
Common
- Phlebitis
- Injection site reaction
- Diarrhea
- Nausea/vomiting
- Rash
- Transaminitis
- Elevated creatinine
- Eosinophilia
Pharmacology
- Half-life: 1.7h (4.7-6h ESRD)
- Metabolism: CYP450, minimal liver
- Excretion: Urine
- Mechanism of Action: Bactericidal; inhibits cell wall synthesis
Antibacterial Spectra [1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed, Philadelphia, PA: American College of Physicians, 2007.
- Azactam (aztreonam) injection [prescribing information]. Princeton, NJ: Bristol-Myers Squibb; September 2018.
- Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. [PubMed 26229122]10.1093/cid/civ482
- Bosso JA and Black PG, “The Use of Aztreonam in Pediatric Patients: A Review,” Pharmacotherapy, 1991, 11(1):20-5. [PubMed 1902290]
- Bratzler DW, Dellinger EP, Olsen KM, et al, “Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery,” Am J Health Syst Pharm, 2013, 70(3):195-283. [PubMed 23327981]
- Brogden RN, Heel RC. Aztreonam. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1986;31(2):96-130. [PubMed 3512234]
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- Epocrates