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# Aztreonam-avibactam (Avycaz)
## Overview
Aztreonam-avibactam is a combination of aztreonam, a monobactam antibiotic, and avibactam, a beta-lactamase inhibitor. This combination is active against many Gram-negative bacteria, including those resistant to other antibiotics due to the production of certain beta-lactamases.
## Primary Indications
* Complicated intra-abdominal infections (cIAI)
* Complicated urinary tract infections (cUTI), including pyelonephritis
* Nosocomial pneumonia (VAP)
* Treatment of infections caused by aerobic Gram-negative bacteria with limited or no alternative treatment options.
## Adult Dosing
* **cIAI, cUTI, VAP:** 2.5 grams (aztreonam 2 grams, avibactam 0.5 grams) administered intravenously every 6 hours for 5 to 14 days.
* **Resistant Gram-negative Infections:** Dose and duration depend on pathogen susceptibility and infection severity. Dosing may exceed standard recommendations up to 3.75 grams IV every 6 hours. Consult specific guidelines or infectious disease specialists.
## Pediatric Dosing
* **cUTI and cIAI (3 months to <18 years):**
* **3 months to <2 years:** 25 mg/kg aztreonam component / 6.25 mg/kg avibactam component IV every 8 hours.
* **2 years to <18 years:** 50 mg/kg aztreonam component / 12.5 mg/kg avibactam component IV every 8 hours.
* Maximum dose is limited by the adult dose of 2.5 grams / 625 mg per dose.
* **VAP (6 months to <18 years):**
* **6 months to <2 years:** 25 mg/kg aztreonam component / 6.25 mg/kg avibactam component IV every 6 hours.
* **2 years to <18 years:** 50 mg/kg aztreonam component / 12.5 mg/kg avibactam component IV every 6 hours.
* Maximum dose is limited by the adult dose of 2.5 grams / 625 mg per dose.
* *Dosing for pediatric patients may depend on local protocols guiding the administration of this combination.*
## Dose Adjustments
* **Renal Impairment (CrCl >= 30 mL/min):** No dose adjustment needed.
* **Renal Impairment (CrCl < 30 mL/min):** Dose reduction is necessary. Consult prescribing information for specific dose adjustments.
* **Hepatic Impairment:** No dose adjustment required in mild to moderate hepatic impairment. Insufficient data for severe hepatic impairment.
## Contraindications
* Hypersensitivity to aztreonam, avibactam, or any component of the formulation.
* Known severe hypersensitivity to penicillins or cephalosporins (cross-reactivity with aztreonam is considered low but possible).
## Adverse Effects
Common: Diarrhea, nausea, constipation, vomiting, headache, dizziness, insomnia, rash, pruritus, fever, injection site reactions.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, liver enzyme elevations.
## Key Drug Interactions
* Probenecid: May increase plasma concentrations of aztreonam.
* Valproic acid: Ketoconazole and other azole antifungals may decrease avibactam exposure.
* Monitor for potential additive effects with other drugs that lower seizure threshold.
## Monitoring
* Renal function.
* Liver function tests.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of *Clostridioides difficile*-associated diarrhea.
## Clinical Pearls
* Primarily indicated for infections caused by susceptible organisms, especially when resistance is suspected or confirmed.
* Requires reconstitution and further dilution for IV infusion. Infusion should be over 30 minutes.
* Aztreonam component is generally well-tolerated in patients with penicillin allergy.
* Due to the absence of activity against anaerobic bacteria, it should be used in combination with an agent with anaerobic coverage if anaerobic pathogens are suspected.
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*This information is for educational purposes only. Always refer to the most current prescribing information and consult with infectious disease or pharmacy specialists for specific patient management decisions.*
