Please check your internet connection and try again.
# 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 designed to overcome resistance mediated by metallo-beta-lactamases (MBLs), such as NDM, as well as extended-spectrum beta-lactamases (ESBLs) and AmpC enzymes. Note: The brand name *Avycaz* refers to Ceftazidime-avibactam; Aztreonam-avibactam is marketed as **Emblaveo**.
## Primary Indications
Treatment of complicated intra-abdominal infections (cIAI), complicated urinary tract infections (cUTI, including pyelonephritis), hospital-acquired pneumonia (HAP), and infections due to aerobic Gram-negative organisms with limited treatment options (metallo-beta-lactamase producers).
## Adult Dosing
The standard dosage is **500 mg (aztreonam) / 137.5 mg (avibactam)** administered via intravenous infusion over 2 hours every 8 hours.
## Pediatric Dosing
Safety and efficacy in pediatric patients (younger than 18 years) have not been established. Use is generally restricted to compassionate use or expert infectious disease consultation for multi-drug resistant pathogens where no alternatives exist.
## Dose Adjustments
**Renal Impairment:** Requires significant dose adjustment based on estimated creatinine clearance (CrCl).
* CrCl 30–50 mL/min: Reduced frequency or reduced infusion duration may be required per institutional protocol.
* CrCl <30 mL/min: Requires strict dose reduction or extension of interval; refer to the package insert or your local pharmacy clinical guidelines.
* End-stage renal disease (ESRD)/Dialysis: Supplemental dosing is required post-hemodialysis.
## Contraindications
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.
* Laboratory: Increased transaminases (ALT/AST), elevated alkaline phosphatase, eosinophilia.
* Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including rash or angioedema).
## Key Drug Interactions
* Probenecid: May increase serum concentrations of aztreonam by inhibiting renal tubular secretion; close monitoring recommended.
* Beta-lactams: Concomitant use with other beta-lactams is generally unnecessary and may increase the risk of adverse effects.
## Monitoring
* Renal function (baseline and during therapy).
* Liver function tests (LFTs).
* Signs and symptoms of *C. difficile* (new-onset diarrhea).
* Signs of allergic reaction (rash, angioedema).
## Clinical Pearls
* Aztreonam-avibactam is a "last-resort" therapy for MBL-producing Gram-negative organisms, which are otherwise resistant to most cephalosporins and carbapenems.
* It does **not** have activity against Gram-positive organisms (e.g., *Staphylococcus, Streptococcus*) or anaerobes.
* Always ensure empirical coverage for Gram-positive and anaerobic pathogens if clinical suspicion is high, as this drug lacks this spectrum.
* Consult your local ASP (Antibiotic Stewardship Program) or Infectious Disease specialist before initiating therapy.
***
**Educational Disclaimer:** This information is for educational purposes and does not constitute medical advice. Dosing schedules and institutional protocols vary; always verify current prescribing information, package inserts, and local hospital guidelines before administering medication.
