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# Aztreonam-Avibactam (Emblaveo)
## Overview
Aztreonam-avibactam is a fixed-dose combination of a monobactam antibiotic and a non-beta-lactam beta-lactamase inhibitor. It is specifically designed to overcome resistance mediated by metallo-beta-lactamases (MBLs), such as NDM-1, which are typically resistant to most other beta-lactam/beta-lactamase inhibitor combinations.
## Primary Indications
Treatment of complicated intra-abdominal infections (cIAI), complicated urinary tract infections (cUTI, including pyelonephritis), hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), and infections due to aerobic Gram-negative organisms where treatment options are limited.
## Adult Dosing
* **Standard dose:** 2 g (aztreonam) / 500 mg (avibactam) administered via IV infusion over 2 hours.
* **Frequency:** Every 8 hours.
* **Maximum daily dose:** 6 g aztreonam / 1.5 g avibactam.
## Pediatric Dosing
* **Pediatric (3 months to <18 years):** Safety and efficacy data are limited as of current regulatory approval cycles in some jurisdictions. Consult local formulary guidelines or institutional infectious disease protocols, as standardized weight-based dosing is still evolving globally.
## Dose Adjustments
* **Renal Impairment:** Requires significant dose reduction based on estimated glomerular filtration rate (eGFR). The dosing interval or the dose itself must be adjusted by a pharmacist/clinician using the Cockcroft-Gault equation; refer directly to the package insert or institutional renal dosing protocol.
* **Hepatic Impairment:** No dose adjustment typically required.
## Contraindications
* Known hypersensitivity to aztreonam, avibactam, or any component of the formulation.
* History of severe hypersensitivity (e.g., anaphylaxis) to any other beta-lactam antibiotic.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, increased liver enzymes (ALT/AST), and headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions, and seizures (rare, mostly in patients with severe renal impairment receiving unadjusted doses).
## Key Drug Interactions
* **Probenecid:** May increase serum concentrations of aztreonam; co-administration is generally not recommended.
* **Other Antibiotics:** Minimal interaction profile, but avoid stacking beta-lactams unless directed by ID service, as this increases secondary infection and toxicity risks.
## Monitoring
* **Renal Function:** Monitor serum creatinine and eGFR closely, especially in patients with fluctuating renal function.
* **Hepatic Function:** Monitor baseline and periodic LFTs.
* **Clinical Efficacy:** Monitor infection site signs, temperature, and WBC count.
* **Safety:** Monitor for signs of *C. difficile* infection and rash.
## Clinical Pearls
* **MBL Stability:** This combination is stable against most serine-beta-lactamases and metallo-beta-lactamases, making it a "last-line" agent for multidrug-resistant Gram-negative infections.
* **Infusion Time:** The 2-hour infusion duration is critical for maintaining time-above-MIC. Rapid infusions may sub-optimally treat the infection.
* **Spectrum:** Note that aztreonam-avibactam has **no Gram-positive or anaerobic activity**. It must be combined with other agents (e.g., metronidazole, vancomycin) if polymicrobial infection is suspected.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local formulary policies vary. Always verify current prescribing information, dose calculations, and compatibility via institutional electronic health records or official drug monographs (e.g., FDA/EMA labels) before administration.
