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# Aztreonam-avibactam (Avycaz) ## Overview Aztreonam-avibactam is a combination antibiotic. Aztreonam is a monobactam beta-lactam that targets Gram-negative bacteria. Avibactam is a beta-lactamase inhibitor that protects aztreonam from degradation by certain beta-lactamase enzymes, including some extended-spectrum beta-lactamases (ESBLs), Klebsiella pneumoniae carbapenemases (KPCs), and AmpC beta-lactamases. It is not active against metallo-beta-lactamases. ## Primary Indications * Complicated intra-abdominal infections (cIAI) - in combination with metronidazole * Complicated urinary tract infections (cUTI), including pyelonephritis * Nosocomial pneumonia, including ventilator-associated pneumonia (VAP) Aztreonam-avibactam should be reserved for situations where treatment options are limited due to suspected or confirmed resistance to other therapeutic agents. ## Adult Dosing * **cIAI:** 2.5 g (2g aztreonam / 0.5g avibactam) administered intravenously every 6 hours for 5 to 14 days. *Administer in combination with metronidazole.* * **cUTI (including pyelonephritis):** 2.5 g administered intravenously every 6 hours for 7 to 10 days. * **Nosocomial pneumonia (including VAP):** 2.5 g administered intravenously every 6 hours for 7 to 14 days. *Note: Dosing may vary based on local antibiogram data and specific pathogen susceptibility, especially for carbapenem-resistant Enterobacterales (CRE).* ## Pediatric Dosing Dosing is weight-based and depends on the indication and degree of renal impairment. Doses are typically administered every 8 hours. * **cIAI, cUTI, VAP (patients 3 months to <18 years):** 50 mg/kg aztreonam and 12.5 mg/kg avibactam per dose. Maximum dose should generally not exceed the adult dose recommendations (2g aztreonam/0.5g avibactam or 2.5g total). * Duration of therapy varies: cIAI 5-14 days, cUTI 10 days, VAP 7-14 days. *Specific pediatric dosing details, including for weight ranges and renal impairment, require careful review of the manufacturer's prescribing information or institutional guidelines.* ## Dose Adjustments Dose adjustments are required for renal impairment in both adults and pediatrics. Consult specific guidelines for detailed recommendations based on CrCl. No dose adjustment is needed for hepatic impairment. ## Contraindications * Known history of severe hypersensitivity to aztreonam, avibactam, or any component of the formulation. ## Adverse Effects Common adverse effects include: * Nausea * Vomiting *