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# Aztreonam/Avibactam (Avycaz)
## Overview
Aztreonam/avibactam is a combination antibiotic consisting of aztreonam, a monobactam beta-lactam antibiotic, and avibactam, a beta-lactamase inhibitor. It is active against many Gram-negative bacteria, including those producing certain serine beta-lactamases and some carbapenemases.
## Primary Indications
* Complicated intra-abdominal infections (cIAI)
* Complicated urinary tract infections (cUTI), including pyelonephritis
* Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)
These indications are for infections caused by susceptible Gram-negative aerobic bacteria.
## Adult Dosing
The recommended dose is 2.5 grams (2 grams aztreonam and 0.5 grams avibactam) administered intravenously every 6 hours.
* **cIAI:** Treat for a median duration of 7 days.
* **cUTI (including pyelonephritis):** Treat for 7 days.
* **HAP/VAP:** Treat for 7 days.
The total daily dose in adults is 10 grams.
## Pediatric Dosing
Dosing in pediatric patients (3 months to <18 years) is based on the indication and the patient's weight. Doses are administered intravenously every 6 hours.
* **cIAI:** 125 mg avibactam / 300 mg aztreonam per kg per dose, not to exceed 2.5 grams per dose. Treat for 4 to 14 days.
* **cUTI (including pyelonephritis):** 125 mg avibactam / 300 mg aztreonam per kg per dose, not to exceed 2.5 grams per dose. Treat for 4 to 9 days.
* **HAP/VAP:** 125 mg avibactam / 300 mg aztreonam per kg per dose, not to exceed 2.5 grams per dose. Treat for 6 to 14 days.
## Dose Adjustments
**Renal Impairment:** Dose adjustments are required for adults with significant renal impairment (CrCl < 30 mL/min) and for pediatric patients based on renal function. Refer to the full prescribing information for specific adjustments. **Hemodialysis:** Patients on hemodialysis require dose adjustments.
## Contraindications
* Known serious hypersensitivity to aztreonam or avibactam or its components.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, pyrexia, headache, and elevated liver enzymes. Serious adverse effects can include hypersensitivity reactions and *Clostridioides difficile*-associated diarrhea.
## Key Drug Interactions
No significant drug interactions are expected with aztreonam/avibactam due to avibactam's lack of significant inhibition of cytochrome P450 enzymes.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *Clostridioides difficile*-associated diarrhea.
* Assess for clinical and microbiological response.
* Renal function should be monitored, especially in patients with pre-existing renal impairment or those receiving concomitant nephrotoxic agents.
## Clinical Pearls
* Aztreonam is resistant to hydrolysis by many extended-spectrum beta-lactamases (ESBLs), carbapenemases, and Oxa-type beta-lactamases, making the combination useful for difficult-to-treat Gram-negative infections.
* It is important to obtain cultures and perform susceptibility testing to guide therapy, especially in patients with suspected resistance.
* Aztreonam is generally not active against Gram-positive or anaerobic bacteria.
* For pediatric dosing, ensure precise calculation based on weight and indication, and be aware of the maximum dose.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for complete details on dosing, administration, safety, and efficacy. Drug regimens may vary based on patient-specific factors and institutional protocols.
