Ceftazidime%25252525252525252520avibactam

# Ceftazidime-avibactam ## Overview Ceftazidime-avibactam (AVYCAZ) is a combination cephalosporin antibiotic and non-beta-lactam beta-lactamase inhibitor. It acts as a potent inhibitor of Class A (KPC), Class C (AmpC), and some Class D beta-lactamases. ## Primary Indications * Complicated intra-abdominal infections (cIAI), in combination with metronidazole. * Complicated urinary tract infections (cUTI), including pyelonephritis. * Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP). ## Adult Dosing * **eGFR >50 mL/min:** 2.5 g (ceftazidime 2 g/avibactam 0.5 g) IV every 8 hours. * **Infusion time:** Administer over 2 hours. ## Pediatric Dosing Patients 3 months to <18 years: * Dosing is weight-based (typically 50 mg/kg ceftazidime component) administered every 8 hours over 2 hours. * Consult institutional pediatric protocols or package insert for precise weight-banded dosing ranges. ## Dose Adjustments Requires adjustment for renal impairment (CrCl ≤50 mL/min). * **31–50 mL/min:** 1.25 g IV q8h. * **16–30 mL/min:** 0.94 g IV q12h. * **6–15 mL/min:** 0.94 g IV q24h. * **≤5 mL/min (including hemodialysis):** 0.94 g IV q48h. Administer immediately post-hemodialysis. ## Contraindications * Known severe hypersensitivity to ceftazidime, avibactam, or any component of the formulation. * History of severe beta-lactam hypersensitivity (anaphylaxis). ## Adverse Effects * **Common:** Nausea, vomiting, constipation, diarrhea, anxiety, and dizziness. * **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions, seizures (primarily in patients with renal impairment receiving inadequate dosage adjustments). ## Key Drug Interactions * **Probenecid:** May increase serum concentrations of ceftazidime; avoid concomitant use. * *Note:* No significant CYP450 interactions, as it is primarily renally excreted. ## Monitoring * Renal function (baseline and during therapy) to adjust dosage. * Signs/symptoms of hypersensitivity. * Development of secondary infections or *C. difficile* diarrhea. * Neurological status (risk of neurotoxicity in patients with renal failure). ## Clinical Pearls * **Spectrum:** Does not cover anaerobic organisms; must be combined with metronidazole for cIAI. * **Stability:** Once reconstituted, doses must be used promptly (generally within 12–24 hours depending on storage conditions). * **Infusion:** The 2-hour infusion time is critical for achieving time-above-MIC requirements; do not administer as a bolus. * **Resistance:** While it targets KPC and AmpC, it possesses minimal activity against metallo-beta-lactamases (e.g., NDM-1). *** **Disclaimer:** This information is for educational purposes only. Clinical guidelines and local resistance patterns change frequently. Always verify specific dosing, safety, and compatibility information against the most current institutional protocols and the official product prescribing information (package insert) before administration.