Dosage guidance:
Dosing: Avycaz (ceftazidime and avibactam) is a combination product; each 2.5 g vial contains 2 g ceftazidime and 0.5 g avibactam sodium in a 4:1 ratio. Dosage recommendations are based on the ceftazidime component.
Intra-abdominal infection, complicated (cIAI): Note: Use in combination with metronidazole; the manufacturer recommends treatment for 5 to 14 days.
Preterm neonates: Note: Dosing based on postmenstrual age (ie, corrected age).
IV:
Gestational age |
Postmenstrual age (PMA) |
Dose |
---|---|---|
31 to <37 weeks |
≤44 weeks |
20 mg ceftazidime/kg/dose every 8 hours |
>44 weeks |
30 mg ceftazidime/kg/dose every 8 hours |
Term neonates: Note: Dosing based on chronological age (PNA).
IV:
Gestational age |
Postnatal age (PNA) |
Dose |
---|---|---|
≥37 weeks |
≤28 days |
20 mg ceftazidime/kg/dose every 8 hours |
>28 days |
30 mg ceftazidime/kg/dose every 8 hours |
Urinary tract infection, complicated (cUTI) (including pyelonephritis): Note: The manufacturer recommends treatment for 7 to 14 days.
Preterm neonates: Note: Dosing based on PMA (ie, corrected age).
IV:
Gestational age |
Postmenstrual age (PMA) |
Dose |
---|---|---|
31 to <37 weeks |
≤44 weeks |
20 mg ceftazidime/kg/dose every 8 hours |
>44 weeks |
30 mg ceftazidime/kg/dose every 8 hours |
Term neonates: Note: Dosing based on chronological age (PNA).
IV:
Gestational age |
Postnatal age (PNA) |
Dose |
---|---|---|
≥37 weeks |
≤28 days |
20 mg ceftazidime/kg/dose every 8 hours |
>28 days |
30 mg ceftazidime/kg/dose every 8 hours |
Pneumonia, hospital-acquired and ventilator-associated (HAP/VAP): Note: The manufacturer recommends treatment for 7 to 14 days.
Preterm neonates: Note: Dosing based on PMA (ie, corrected age).
IV:
Gestational age |
Postmenstrual age (PMA) |
Dose |
---|---|---|
31 to <37 weeks |
≤44 weeks |
20 mg ceftazidime/kg/dose every 8 hours |
>44 weeks |
30 mg ceftazidime/kg/dose every 8 hours |
Term neonates: Note: Dosing based on chronological age (PNA).
IV:
Gestational age |
Postnatal age (PNA) |
Dose |
---|---|---|
≥37 weeks |
≤28 days |
20 mg ceftazidime/kg/dose every 8 hours |
>28 days |
30 mg ceftazidime/kg/dose every 8 hours |
Dosage guidance:
Dosing: Avycaz (ceftazidime and avibactam) is a combination product; each 2.5 g vial contains 2 g ceftazidime and 0.5 g avibactam sodium in a 4:1 ratio. Dosage recommendations are based on the ceftazidime component.
Intra-abdominal infection, complicated (cIAI): Note: Use in combination with metronidazole. The manufacturer recommends treating for 5 to 14 days depending upon severity and clinical response; a 5-day duration following source control is recommended for pediatric patients in guidelines (Ref).
Infants <3 months: IV: 30 mg ceftazidime/kg/dose every 8 hours.
Infants ≥3 to <6 months: IV: 40 mg ceftazidime/kg/dose every 8 hours.
Infants ≥6 months, Children, and Adolescents <18 years: IV: 50 mg ceftazidime/kg/dose every 8 hours; maximum dose: 2,000 mg ceftazidime/dose.
Adolescents ≥18 years: 2,000 mg ceftazidime every 8 hours.
Urinary tract infection, complicated (cUTI) (including pyelonephritis): Note: The manufacturer recommends treating for 7 to 14 days depending upon severity and clinical response; durations as short as 6 to 10 days may be appropriate in children ≥2 years and adolescents (Ref).
Infants <3 months: IV: 30 mg ceftazidime/kg/dose every 8 hours.
Infants ≥3 to <6 months: IV: 40 mg ceftazidime/kg/dose every 8 hours.
Infants ≥6 months, Children, and Adolescents <18 years: IV: 50 mg ceftazidime/kg/dose every 8 hours; maximum dose: 2,000 mg ceftazidime/dose.
Adolescents ≥18 years: 2,000 mg ceftazidime every 8 hours.
Pneumonia, hospital-acquired and ventilator-associated (HAP/VAP): Note: The manufacturer recommends treating for 7 to 14 days; 7-day treatment durations are recommended in adults (Ref).
Infants <3 months: IV: 30 mg ceftazidime/kg/dose every 8 hours.
Infants ≥3 to <6 months: IV: 40 mg ceftazidime/kg/dose every 8 hours.
Infants ≥6 months, Children, and Adolescents <18 years: IV: 50 mg ceftazidime/kg/dose every 8 hours; maximum dose: 2,000 mg ceftazidime/dose.
Adolescents ≥18 years: IV: 2,000 mg ceftazidime every 8 hours.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Note: Dosage recommendations are based on the ceftazidime component.
Infants and Children <2 years: There are no dosage adjustments provided in the manufacturer's labeling; insufficient data to provide any recommendations for use in patients with eGFR <50 mL/minute/1.73 m2; use with caution.
Children ≥2 years and Adolescents <18 years: IV: Note: Use bedside Schwartz formula to estimate renal function for the purpose of drug dosing.
eGFR >50 mL/minute/1.73 m2: No dosage adjustment necessary.
eGFR 31 to 50 mL/minute/1.73 m2: 25 mg ceftazidime/kg/dose every 8 hours; maximum dose: 1,000 mg ceftazidime/dose.
eGFR 16 to 30 mL/minute/1.73 m2: 19 mg ceftazidime/kg/dose every 12 hours; maximum dose: 750 mg ceftazidime/dose.
eGFR 6 to 15 mL/minute/1.73 m2: 19 mg ceftazidime/kg/dose every 24 hours; maximum dose: 750 mg ceftazidime/dose.
eGFR ≤5 mL/minute/1.73 m2: 19 mg ceftazidime/kg/dose every 48 hours; maximum dose: 750 mg ceftazidime/dose.
End-stage renal disease (ESRD) on intermittent hemodialysis (IHD): Administer after hemodialysis on dialysis days; base dose upon patient's estimated renal function (eg, eGFR 6 to 15 mL/minute/1.73 m2 or eGFR ≤5 mL/minute/1.73 m2). Approximately 55% (based on a ceftazidime 1,000 mg dose and avibactam 100 mg dose) is removed following a 4-hour dialysis session.
Adolescents ≥18 years: IV: Note: Use Cockcroft-Gault formula to estimate renal function for the purpose of drug dosing.
CrCl >50 mL/minute: No dosage adjustment necessary.
CrCl 31 to 50 mL/minute: 1,000 mg ceftazidime every 8 hours.
CrCl 16 to 30 mL/minute: 750 mg ceftazidime every 12 hours.
CrCl 6 to 15 mL/minute: 750 mg ceftazidime every 24 hours.
CrCl ≤5 mL/minute: 750 mg ceftazidime every 48 hours.
End-stage renal disease (ESRD) on intermittent hemodialysis (IHD): Administer after hemodialysis on dialysis days; base dose upon patient's estimated renal function (eg, CrCl 6 to 15 mL/minute or CrCl ≤5 mL/minute). Approximately 55% (based on a ceftazidime 1,000 mg dose and avibactam 100 mg dose) is removed following a 4-hour dialysis session.
Infants, Children, and Adolescents: No dosage adjustment necessary.
(For additional information see "Ceftazidime and avibactam: Drug information")
Note: Dosage recommendations are expressed as total grams of the ceftazidime/avibactam combination. Not recommended for routine empiric use. Reserve use for patients with or at risk for certain extensively drug-resistant gram-negative pathogens (nonsusceptible to ≥1 agent in all but 2 or fewer antimicrobial classes) (eg, carbapenem-resistant Enterobacterales, P. aeruginosa with difficult-to-treat resistance [DTR-P. aeruginosa]) (Ref). Some experts extend infusion time (ie, over 3 hours instead of standard 2 hours) for infections caused by carbapenem-resistant Enterobacterales, DTR-P. aeruginosa, and S. maltophilia (Ref).
Metallo-beta-lactamase-producing Enterobacterales (labeled use) and multidrug-resistant Stenotrophomonas maltophilia infections (off-label use): IV: 2.5 g every 8 hours infused over 3 hours; use in combination with aztreonam (administered at the same time, if possible) (Ref).
Urinary tract infection:
Cystitis, acute uncomplicated or acute simple cystitis (infection limited to the bladder without signs/symptoms of upper tract, prostrate, or systemic infection) (off-label use): Note: Reserve for patients with difficult-to-treat P. aeruginosa or carbapenem-resistant Enterobacterales.
IV: 2.5 g every 8 hours (Ref).
Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms):
IV: 2.5 g every 8 hours (Ref). Switch to an appropriate oral regimen once symptoms improve, if culture and susceptibility results allow. Total duration of therapy ranges from 5 to 14 days; for patients with symptomatic improvement within the first 48 to 72 hours of therapy, some experts recommend shorter courses of 5 to 10 days (or 7 to 10 days if therapy is completed with ceftazidime/avibactam) (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Note: Dosage recommendations are expressed as total grams of the ceftazidime/avibactam combination.
Altered kidney function (Ref):
Note: Estimation of renal function for the purpose of drug dosing should be done using the Cockcroft-Gault formula.
IV:
CrCl >50 to <130 mL/minute: No dosage adjustment necessary.
CrCl >30 to 50 mL/minute: 1.25 g every 8 hours.
CrCl >15 to 30 mL/minute: 0.94 g every 12 hours.
CrCl >5 to 15 mL/minute: 0.94 g every 24 hours.
CrCl ≤5 mL/minute: 0.94 g every 48 hours.
Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2):
Note: Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Young patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).
IV: 2.5 g every 8 hours (Ref).
Hemodialysis, intermittent (thrice weekly): Dialyzable (~57% ceftazidime; 55% avibactam (Ref)): 0.94 g every 24 hours; in patients with minimal residual kidney function and less severe infections, may consider administering 0.94 g every 48 hours. When scheduled dose falls on a dialysis day, administer after hemodialysis (Ref).
Peritoneal dialysis:
IV: 0.94 g every 24 hours; in patients with minimal residual kidney function and less severe infections, may consider administering 0.94 g every 48 hours (Ref).
CRRT:
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.
IV: 1.25 g every 8 hours (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration):
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.
IV:
On PIRRT days: 1.25 g every 12 hours (administer 1 of the twice-daily doses after PIRRT session). Patients receiving prolonged daily treatments (eg, 12 hours a day) may require dosing every 8 hours (Ref).
On non-PIRRT days: Dose as for CrCl ≤15 mL/minute (Ref).
No dosage adjustment necessary.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults. Also see Ceftazidime monograph.
>10%: Hematologic & oncologic: Positive direct Coombs’ test (3% to 21%)
1% to 10%:
Dermatologic: Pruritus (2%)
Gastrointestinal: Constipation (2%), diarrhea (3%), nausea (3%), upper abdominal pain (1%), vomiting (>5%)
<1%:
Dermatologic: Maculopapular rash, skin rash, urticaria
Endocrine & metabolic: Hypokalemia
Gastrointestinal: Dysgeusia
Hematologic & oncologic: Leukopenia, thrombocytopenia, thrombocytosis
Hepatic: Increased gamma-glutamyl transferase, increased serum alanine aminotransferase, increased serum aspartate aminotransferase
Infection: Candidiasis
Local: Injection-site phlebitis
Nervous system: Anxiety
Renal: Acute kidney injury, kidney impairment, nephrolithiasis
Postmarketing: Gastrointestinal: Clostridioides difficile-associated diarrhea
Known serious hypersensitivity to ceftazidime, avibactam, other cephalosporins, or any component of the formulation
Concerns related to adverse effects:
• Hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactic) reactions and serious skin reactions have been reported in patients receiving beta-lactam drugs. Before initiating therapy, carefully investigate previous penicillin, cephalosporin, or carbapenem hypersensitivity. Use caution if given to a patient with a penicillin or other beta-lactam allergy; cross sensitivity has been established. If an allergic reaction occurs, discontinue and institute appropriate management.
• Neurotoxicity: Severe neurological reactions have been reported with ceftazidime, including asterixis, coma, encephalopathy, myoclonus, neuromuscular excitability, seizures, and nonconvulsive status epilepticus. Risk may be increased in the presence of renal impairment; ensure dose adjusted for renal function. Discontinue therapy if patient develops neurotoxicity.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Renal impairment: In a complicated intra-abdominal infection clinical trial, adult patients with a CrCl of 30 to 50 mL/minute had lower clinical cure rates than those with CrCl >50 mL/minute; however, these patients received a daily dose that was 33% lower than what is currently recommended for patients with this degree of renal impairment. Decreased clinical response was not seen in patients with a baseline CrCl of 30 to 50 mL/minute in complicated UTI clinical trials. Monitor renal function at baseline and at least daily in adult and pediatric patients with changing renal function. Adjust the dose accordingly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous [preservative free]:
Avycaz: Ceftazidime 2 g and avibactam 0.5 g (1 ea)
No
Solution (reconstituted) (Avycaz Intravenous)
2.5 (2-0.5) g (per each): $452.10
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
IV: Administer by intermittent IV infusion over 2 hours.
IV: Administer by intermittent infusion over 2 hours. Some experts extend infusion time to 3 hours for infections caused by carbapenem-resistant Enterobacterales, P. aeruginosa with difficult-to-treat resistance, and S. maltophilia (Ref).
Vials: Store intact vials at 25°C (77°F) in original carton; excursions permitted between 15°C and 30°C (59°F and 86°F). Protect from light. After reconstitution, contents of the vial should be transferred within 30 minutes to an infusion bag for further dilution.
Intermittent IV infusion: Admixed solutions in NS, D5W, LR, or any combination of dextrose and sodium chloride injection containing up to dextrose 2.5% and sodium chloride 0.45% are stable up to 12 hours at room temperature and 24 hours at 2°C to 8°C (36°F to 46°F). Use solutions previously stored at 2°C to 8°C (36°F to 46°F) within 12 hours of subsequent storage at room temperature.
Treatment of complicated intra-abdominal infections (cIAI) in combination with metronidazole, caused by susceptible Gram-negative microorganisms including Citrobacter freundii complex, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa; treatment of complicated urinary tract infections (cUTI) including pyelonephritis caused by susceptible Gram-negative microorganisms including C. freundii complex, E. cloacae, E. coli, K. pneumoniae, P. mirabilis, and P. aeruginosa; treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HAP/VAP) caused susceptible Gram-negative microorganisms including K. pneumoniae, E. cloacae, E. coli, Haemophilus influenzae, Serratia marcescens, P. mirabilis, and P. aeruginosa (All indications: FDA approved in all ages).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy
Chloramphenicol (Systemic): May diminish the therapeutic effect of CefTAZidime. Management: Consider using a different combination of antimicrobials, especially if bactericidal activity is desired. If these agents are combined, monitor for reduced antimicrobial effectiveness and/or therapeutic failure. Risk D: Consider therapy modification
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination
Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Risk C: Monitor therapy
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy
Mycophenolate: Antibiotics may decrease serum concentrations of the active metabolite(s) of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor therapy
Probenecid: May increase the serum concentration of Avibactam. Risk X: Avoid combination
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Adverse events have not been observed in animal reproduction studies conducted with ceftazidime; adverse events have been observed in some animal reproduction studies conducted with avibactam.
Monitor for hypersensitivity reactions (including anaphylaxis); renal function (baseline [all patients], at least daily [patients with renal impairment or changing renal function]); number and type of stools/day for diarrhea; signs/symptoms of neurotoxicity (especially in patients with renal impairment).
Ceftazidime inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Avibactam inactivates some beta-lactamases and protects ceftazidime from degradation.
Distribution: Vd:
Single dose: Adults: Mean: Ceftazidime: 18.1 L; Avibactam: 23.2 L
Multiple dose: Adults: Mean: Ceftazidime: 17 L; Avibactam: 22.2 L
Protein binding: Ceftazidime: <10%; Avibactam: 5.7% to 8.2%
Metabolism: Ceftazidime: ~80% to 90% of dose eliminated as unchanged drug; Avibactam: Not metabolized
Half-life elimination:
Single dose:
Ceftazidime:
Children ≥6 years to <12 years: Median: 1.6 hours (0.9 to 1.8 hours) (Bradley 2016)
Children ≥12 years and Adolescents: Median: 1.7 hours (0.9 to 2.8 hours) (Bradley 2016)
Adults: Mean: 3.27 hours
Avibactam:
Children ≥6 years to <12 years: Median: 1.7 hours (0.9 to 2 hours) (Bradley 2016)
Children ≥12 years and Adolescents: Median: 1.6 hours (0.9 to 2.8 hours) (Bradley 2016)
Adults: Mean: 2.22 hours
Multiple dose: Adults: Mean: Ceftazidime: 2.76 hours; Avibactam: 2.71 hours
Excretion: Ceftazidime: Urine (~80% to 90% as unchanged drug); Avibactam: Urine (97%)
Altered kidney function: Half-life increases in patients with impaired renal function; AUC of avibactam increases 2.6-fold, 3.8-fold, and 7-fold in patients with mild, moderate or severe renal impairment, respectively.
Anti-infective considerations:
Parameters associated with efficacy:
Ceftazidime (data on monotherapy for susceptible organisms): Time dependent; associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC):
Organism specific: Gram-negative bacteria (including P. aeruginosa): Goal: 35% to 40% fT > MIC (bacteriostatic in vitro); 60% to 70% fT > MIC (bactericidal in vitro); ~45% to 53% fT > MIC (microbiological response) (Craig 1995; MacVane 2014; Muller 2013).
Population specific: In critically ill patients in the ICU, minimum goal: ≥50% fT > MIC; preferred goal: ≥100% fT > MIC (Abdul-Aziz 2020; Al-Shaer 2020; Roberts 2014); some experts favor ≥100% fT >4 times the MIC (Guilhaumou 2019).
Ceftazidime (in combination with avibactam): Interrelationship between ceftazidime exposure, avibactam exposure, MIC, and efficacy is not fully elucidated; at avibactam exposures that were associated with bacteriostatic and bactericidal activity, mean ceftazidime fT > MIC (ceftazidime MIC in the presence of a fixed avibactam concentration): ~50% (Berkhout 2015; Nichols 2018).
Avibactam (in combination with ceftazidime): Time dependent, associated with fT > threshold concentration (threshold concentration: 1 mg/L); goal: ≥ ~20% to 50% (Berkhout 2015; Coleman 2014; Crass 2019; Nichols 2018).
Postantibiotic effect: Generally little to no postantibiotic effect (Berkhout 2021; Pillar 2016).
Expected drug concentrations in patients with normal renal function:
Pediatric patients (hospitalized): Single dose (2-hour infusion): Cmax (peak): IV:
Infants and children 3 months to <2 years of age: Ceftazidime 50 mg/avibactam 12.5 mg per kg: Ceftazidime: 91.7 mg/L; Avibactam: 16.3 mg/L (Bradley 2016).
Children 2 to <12 years of age: Ceftazidime 50 mg/avibactam 12.5 mg per kg (maximum ceftazidime 2,000 mg/avibactam 500 mg): Ceftazidime: ~80 mg/L; Avibactam: ~14 mg/L (Bradley 2016).
Children and adolescents 12 to <18 years of age: Ceftazidime 2,000 mg/avibactam 500 mg: Ceftazidime: 79.8 mg/L; Avibactam: 15.1 mg/L (Bradley 2016).
Adults: Cmax (peak): IV:
Note: Adult doses are expressed as the combined amount of ceftazidime and avibactam.
Single dose, 30-minute infusion (healthy volunteers): 2.5 g: Ceftazidime: 93.17 mg/L; Avibactam: 23.33 mg/L (Merdjan 2015).
Steady state, 30-minute infusion (healthy volunteers): 2.5 g every 8 hours: Ceftazidime: 114.53 mg/L; Avibactam: 22.22 mg/L (Merdjan 2015).
Steady state, 2-hour infusion (patients with nosocomial pneumonia, including ventilator-associated): 2.5 g every 8 hours: Ceftazidime: 61.9 to 79 mg/L; Avibactam: 12 to 15.5 mg/L (Li 2019).
Do you want to add Medilib to your home screen?