Ceftazidime

General

• Type: 3rd generation cephalosporin
• Dosage Forms: injectable solution, powder for injection
• Dosage Strengths: injectable solution: 20mg/mL, 40mg/mL; powder for injection: 500mg, 1g, 2g, 6g
• Routes of Administration: IV, IM
• Common Trade Names: Fortaz, Tazicef, Tazidime

Adult Dosing

Infections, Bacterial

• 1 g IV/IM q8-12h
  • Max: 6 g/day

Indications by Disease

Disease	Dose	Context
Brain abscess	2gm IV q8hr	Trauma/Post-surgical
Discitis	2g IV three times daily	Inpatient Therapy
Neutropenic fever	2g IV q8hrs	Inpatient monotherapy
Peritoneal dialysis-associated peritonitis	1g IP daily	Empiric IP
Pneumonia (main)	2g q8h	HAP, High Risk

Pediatric Dosing

Infections, Bacterial

• Neonates 0-7 days old
  • 100 mg/kg/day IM/IV divided q12h
• Neonates >7 days old, <1200g
  • 100mg/kg/day IM/IV divided q12h
• Neonates >7 days old, >1200g
  • 150mg/kg/day IM/IV divided q8h
• 1mo - 12yo
  • 90-150 mg/kg/day IM/IV divided q8h
    • Max: 6 g/day
    • Reserve high dose for immunocompromised, cystic fibrosis, or meningitis

Indications by Disease

Disease	Dose	Context
Brain abscess	50mg/kg IV q8hrs (max 2g/dose)	Pediatric Trauma/Post-surgical
Osteomyelitis	30mg/kg IV q12 h	Newborn
Osteomyelitis	50mg/kg q8hr	Children

Special Populations

• Pregnancy: C; May use during pregnancy
• Lactation: No known risk
• Renal Dosing
  • Adult
    • CrCl 31-50: Give q12h
    • CrCl 16-30: Give q24h
    • CrCl 6-15: 1 g x1, then 500mg q24h
    • CrCl <5: 1 g x1, then 500mg q48h
    • HD: 1 g x1, then give 1 g after dialysis, no supplement
    • PD: 1 g x1, then 500mg q24h, no supplement
  • Pediatric
    • CrCl 30-50: Give q12h
    • CrCl 10-29: Give q24h
    • CrCl <10: Give q48h
    • HD/PD: No supplement

• Hepatic Dosing
  • Adult: No adjustment
  • Pediatric: No adjustment

Contraindications

• Allergy to class/drug
• Caution:
  • Hypersensitivity to [penicillin]
  • Renal impairment
  • Concurrent nephrotoxic agent
  • Seizure disorder
  • Recent abx-associated colitis

Adverse Reactions

Serious

• Seizure
• Agranulocytosis
• Thrombocytopenia
• Anemia, hemolytic
• Anaphylaxis
• C. difficile-associated diarrhea

Common

• Diarrhea
• Nausea/Vomiting
• Abdominal pain
• Rash
• Pruritus
• Urticaria
• Headache
• Dizziness
• ALT, AST elevation
• BUN, Cr elevation

Pharmacology

• Half-life: 1.9h
• Metabolism: Minimal
• Excretion: Urine primarily
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	X1
	MSSA	I
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	I
	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	R
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	R
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	S
	Stenotrophomonas maltophilia	I
	Yersinia enterocolitica	I
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	S
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

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

• Antibiotics (Main)