Ceftazidime%25252525252525252525252525252520avibactam

# Ceftazidime-avibactam ## Overview Ceftazidime-avibactam (AVYCAZ) is a combination cephalosporin antibiotic and non-beta-lactam beta-lactamase inhibitor. It extends the spectrum of ceftazidime to include most Class A (KPC, ESBL), Class C (AmpC), and some Class D (OXA-48) carbapenemases. ## Primary Indications * Complicated intra-abdominal infections (cIAI) in combination with metronidazole. * Complicated urinary tract infections (cUTI), including pyelonephritis. * Hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP). ## Adult Dosing * **cIAI/cUTI/HABP/VABP:** 2.5 g (ceftazidime 2 g / avibactam 0.5 g) intravenously every 8 hours. * **Infusion time:** Administered as an IV infusion over 2 hours. * **Duration:** 5 to 14 days based on the severity and site of infection. ## Pediatric Dosing * **Patients 3 months to <18 years:** Dosing is weight-based. * **<40 kg:** 50 mg/kg (ceftazidime component) administered every 8 hours (max dose 2 g/0.5 g). * **≥40 kg:** 2.5 g (2 g/0.5 g) administered every 8 hours. * **Infusion time:** 2 hours. ## Dose Adjustments * **Renal Impairment (CrCl ≤50 mL/min):** Requires dose reduction based on CrCl. * 31–50 mL/min: 1.25 g q8h. * 16–30 mL/min: 0.94 g (ceftazidime 0.75 g/avibactam 0.1875 g) q12h. * 6–15 mL/min: 0.94 g q24h. * ≤5 mL/min: 0.94 g q48h. * **Hemodialysis:** Administer dose after dialysis on dialysis days. * **Hepatic Impairment:** No dosage adjustment indicated. ## Contraindications * Known severe hypersensitivity to ceftazidime, avibactam, or other components of the product. * History of severe beta-lactam hypersensitivity (anaphylaxis). ## Adverse Effects * **Common:** Nausea, diarrhea, constipation, vomiting, headache, dizziness. * **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (anaphylaxis), and seizures (primarily in patients with renal impairment receiving inappropriately high doses). ## Key Drug Interactions * **Probenecid:** May increase serum concentrations of ceftazidime; concurrent use is not recommended. * No significant CYP450 interactions reported. ## Monitoring * **Renal Function:** Monitor CrCl throughout therapy, especially in patients with fluctuating renal function or elderly patients. * **Neurological symptoms:** Monitor for seizures, particularly if dosage adjustments for renal insufficiency are not followed. * **Clinical response:** Monitor for resolution of signs of infection; assess for secondary infections (superinfections) if condition worsens. ## Clinical Pearls * **Metronidazole Requirement:** For cIAI, ceftazidime-avibactam lacks anaerobic coverage; it must be combined with metronidazole. * **In Vitro vs. Clinical:** While it covers many carbapenem-resistant organisms, it is **not** active against metallo-beta-lactamases (e.g., NDM). * **Local Protocols:** Always verify dosing frequency and renal adjustment protocols against your institution's specific antimicrobial stewardship guidelines. *** *Education Disclaimer: This information is for educational purposes only. Always consult the most recent package insert, institutional infectious disease guidelines, or a licensed pharmacist/clinician before prescribing or administering medication.*