View source for Aztreonam

==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
*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

===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==
*[[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==
*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]] <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==
*[[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

==References==
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[[Category:Pharmacology]]
[[Category:ID]]