Aztreonam

General

• Type: Monobactam
• Dosage forms: 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
    • 60 mg/kg/day IV divided q12h
    • First ED Dose: 30 mg/kg x 1
  • >2000g
    • 90 mg/kg/day IV divided q8
    • First ED Dose: 30 mg/kg x 1
• 7 days - 1 month
  • <1200g
    • 60 mg/kg/day IV divided q12h
    • First ED Dose: 30 mg/kg x 1
  • 1200-2000g
    • 90 mg/kg/day IV divided q8
    • First ED Dose: 30 mg/kg x 1
  • >2000g
    • 120 mg/kg/day IV divided q6
    • First ED Dose: 30 mg/kg x 1

General (1 Month - 9 Months)

• General
  • 90-120 mg/kg/day IV divided q6-8h
  • First ED Dose: 40 mg/kg x 1
• Respiratory Infections in Cystic Fibrosis
  • 200mg/kg/day IV divided q6h
  • First ED Dose: 40 mg/kg x 1
  • Max: 8g/day

General >9 Months)

• 90-120 mg/kg/day IV divided q6-8
• First ED Dose: 40 mg/kg x 1

Special Populations

• Pregnancy: 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

• 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

Organisms	Aztreonam
Strep, Group A, B, C, G	0
Strep. pneumoniae	0
Viridans strep	0
Strep. milleri	0
Enterococcus faecalis	0
Enterococcus faecium	0
Staph. aureus (MSSA)	0
Staph. aureus (MRSA)	0
Staph. aureus (CA-MRSA)	0
Staph. epidermidis	0
C. jeikeium	0
L. monocytogenes	0

See Also

• Antibiotics (Main)

Source

• Epocrates