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# Aztreonam-avibactam (A v ycaz)
## Overview
Aztreonam-avibactam is a combination of aztreonam, a monobactam antibiotic, and avibactam, a beta-lactamase inhibitor. It is active against many Gram-negative bacteria, including those producing extended-spectrum beta-lactamases (ESBLs), carbapenemases, and class C beta-lactamases.
## Primary Indications
* Complicated urinary tract infections (cUTIs)
* Complicated intra-abdominal infections (cIAIs)
* Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)
* *Indicated for infections caused by susceptible Gram-negative aerobic bacteria, including *Pseudomonas aeruginosa* and Enterobacteriaceae, in patients with limited or no alternative treatment options.*
## Adult Dosing
The standard dose is 2.5 grams (aztreonam 2 grams / avibactam 0.5 grams) administered intravenously (IV) every 8 hours for 7 to 14 days, depending on the type and severity of infection.
## Pediatric Dosing
Dosing for pediatric patients varies by age and indication. Consult specific pediatric guidelines or the product monograph for detailed regimens. For patients aged 3 months to <18 years:
* **cUTI:** 100 mg/kg aztreonam / 12.5 mg/kg avibactam IV every 8 hours. Maximum dose: 2.5 grams per dose.
* **cIAI, HAP, VAP:** 125 mg/kg aztreonam / 15.6 mg/kg avibactam IV every 6 hours. Maximum dose: 2.5 grams per dose.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is required for moderate to severe renal impairment (CrCl < 50 mL/min).
* CrCl 30 to <50 mL/min: 1.5 grams IV every 8 hours.
* CrCl < 30 mL/min: 0.75 grams IV every 8 hours.
* Hemodialysis: 1 gram IV every 12 hours, with a supplemental dose of 0.75 grams after each dialysis session.
* **Hepatic Impairment:** No dose adjustment is generally needed for mild to moderate hepatic impairment. Data for severe hepatic impairment is limited.
## Contraindications
* Known hypersensitivity to aztreonam, avibactam, or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, headache, increased liver enzymes (AST, ALT), rash, fever.
* **Serious:** Hypersensitivity reactions (including anaphylaxis), *Clostridioides difficile*-associated diarrhea, seizures (particularly in patients with renal impairment).
## Key Drug Interactions
* Probenecid may increase aztreonam serum concentrations.
* Live bacterial vaccines: Concomitant use may reduce the efficacy of the vaccine.
## Monitoring
* Renal function (especially with dose adjustments).
* Liver function tests.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of *Clostridioides difficile*-associated diarrhea.
* Clinical response to therapy.
## Clinical Pearls
* Aztreonam is generally well-tolerated in patients with penicillin allergies but cross-reactivity can occur.
* Avibactam protects aztreonam from degradation by many common beta-lactamases, including carbapenemases.
* Administer via IV infusion over 30 minutes. Reconstitute and further dilute per manufacturer instructions.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and guidelines for complete details.*
