• Type: Monobactam antibiotic
  • Dosage forms: powder for injection
  • Dosage strengths: 1g, 2g
  • Routes of Administration: IM, IV
  • Common Trade Names: Azactam


  • 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

  • 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


  • Allergy to class/drug

Adverse Drug Reactions



  • Phlebitis
  • Injection site reaction
  • Diarrhea
  • Nausea/vomiting
  • Rash
  • Transaminitis
  • Elevated creatinine
  • Eosinophilia


  • 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]

Group Organism 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
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


  • 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


  • 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]
  1. Sanford Guide to Antimicrobial Therapy 2014
  • Epocrates