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Ceftazidime; Indications, Dosage, Side Effects, Interactions

Ceftazidime is a beta-lactam, third-generation broad-spectrum semisynthetic, bactericidal activity with antibacterial cephaloridine and used especially for Pseudomonas and other gram-negative infections in debilitated patients. Ceftazidime binds to and inactivates penicillin-binding proteins (PBP) located on the inner membrane of the bacterial cell wall. PBPs participate in the terminal stages of assembling the bacterial cell wall, and in reshaping the cell wall during cell division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis. Compared to the second and first generation cephalosporins, ceftazidime is more active against gram-negative bacteria and less active against gram-positive bacteria. Ceftazidine also crosses the blood-brain barrier and reaches therapeutic concentrations in the central nervous system (CNS).

Mechanism of Action of Ceftazidime

The bactericidal activity of ceftazidime results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs).Ceftazidime is a semisynthetic, broad-spectrum, beta-lactam antibiotic for parenteral administration. Ceftazidime is bactericidal in action exerting its effect by inhibition of enzymes responsible for cell-wall synthesis, primarily penicillin binding protein 3 (PBP3). A wide range of gram-negative organisms is susceptible to ceftazidime in vitro, including strains resistant to gentamicin and other aminoglycosides. In addition, ceftazidime has been shown to be active against gram-positive organisms. It is highly stable to most clinically important beta-lactamases, plasmid or chromosomal, which are produced by both gram-negative and gram-positive organisms and, consequently, is active against many strains resistant to ampicillin and other cephalosporins. Ceftazidime has activity against the gram-negative organisms Pseudomonas and Enterobacteriaceae. Its activity against Pseudomonas is a distinguishing feature of ceftazidime among the cephalosporins.

Indications of Ceftazidime

Bacterial infections
Bloodstream infections
Bone and joint infections
Central nervous system infections
Complicated urinary tract infections caused by susceptible Gram-negative microorganisms
Meningitis
Sepsis
Endocarditis
Endometritis
Febrile neutropenia
Intraabdominal infection
Melioidosis
Osteomyelitis
Otitis externa
Otitis media
Pelvic inflammatory disease
Peritonitis
Pneumonia
Pneumonia with cystic fibrosis
Pyelonephritis
Sinusitis
Skin or soft tissue infection
Cystitis
Urinary tract infection
Lower respiratory tract infection
Skin structures and soft tissue infections
Urinary tract infections
Ventilator-associated bacterial pneumonia caused by susceptible Gram-negative microorganisms
Hospital-acquired bacterial pneumonia caused by susceptible Gram-negative microorganisms
Susceptible intra-abdominal infection caused by the susceptible Gram-negative microorganism

Contra-Indications of Ceftazidime

Liver problems
Interstitial nephritis
Subacute cutaneous lupus erythematosus
Systemic lupus erythematosus
Allergies cephalosporins & beta-lactams

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Dosage of Ceftazidime

Strengths: 500 mg; 1 g; 2 g; 6 g; 1 g/50 mL; 2 g/50 mL;

Osteomyelitis

2 g IV every 8 hours
Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection.

Meningitis

2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection

Sepsis

2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection

Endocarditis

2 g IV every 8 hours
Treatment may be required for 6 weeks or more, depending on the nature and severity of the infection.

Joint Infection

2 g IV every 8 hours
Therapy should be continued for approximately 3 to 4 weeks, depending on the nature and severity of the infection.
Longer therapy, 6 weeks or more, may be required for prosthetic joint infections.

Intra abdominal Infection

2 g IV every 8 hours for 7 to 14 days, depending on the nature and severity of the infection

Otitis Media

Otitis media in hospitalized intubated patients: 2 g IV every 8 hours

Pelvic Inflammatory Disease

2 g IV or IM every 8 hours
Therapy should be continued for at least 48 hours after clinical improvement is demonstrated.
Oral therapy should then be continued to complete a 14-day course of treatment.

Peritonitis

1 to 2 g IV every 8 hours for 10 to 14 days, depending on the nature and severity of the infection
Peritoneal dialysis patients (ceftazidime sodium):
Intermittent: 1 g/2 L dialysate intraperitoneally once daily
Continuous: 1 g /2 L dialysate intraperitoneally, followed by 250 to 500 mg/2 L dialysate

Pneumonia

1 to 2 g IV or IM every 8 hours
Therapy should be continued for 7 to 21 days, depending on the nature and severity of the infection.

Pneumonia with Cystic Fibrosis

Lung infections caused by Pseudomonas: 30 to 50 mg/kg IV every 8 hours to a maximum of 6 g/day, in patients with normal renal function

Sinusitis

Sinusitis in intubated patients: 2 g IV every 8 hours for 10 to 14 days, depending on the nature and severity of the infection

Skin or Soft Tissue Infection

1 to 2 g IV or IM every 8 hours
Therapy should be continued for approximately 7 to 10 days, or for 3 days after the acute inflammation disappears, depending on the nature and severity of the infection.
For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.
Vibrio vulnificus: 1 to 2 g IV every 8 hours plus doxycycline 100 mg IV or orally every 12 hours or ciprofloxacin 400 mg IV every 12 hours.

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Urinary Tract Infection

Uncomplicated: 250 mg IV or IM every 12 hours for approximately 3 to 7 days, depending on the nature and severity of the infection
Complicated: 500 mg IV or IM every 8 to 12 hours for 2 to 3 weeks, depending on the nature and severity of the infection
Parenteral therapy is generally not indicated for uncomplicated infections.

Pediatric Bacteremia

0 to 4 weeks, birthweight 1199 g or less: 30 to 50 mg/kg IV every 12 hours
0 to 7 days, birthweight 1200 to 2000 g: 30 to 50 mg/kg IV every 12 hours
0 to 7 days, birthweight 2001 g or more: 30 to 50 mg/kg IV every 8 to 12 hours
7 days to 4 weeks, birthweight 1200 g or more: 30 to 50 mg/kg IV every 8 to 12 hours
1 month to 12 years: 30 to 50 mg/kg IV every 8 hours; maximum dose is 6 g/day13 years or older

Side Effects

The most common

local tenderness or pain at the site of injection
skin color change, mild diarrhea
mild nausea
loss of appetite
vaginal discharge and itching
swelling of feet or legs
chest pain
constipation
a cough
diarrhea or loose stools
difficulty with breathing
dizziness
heartburn

More common

Abdominal or stomach pain, discomfort, or tenderness
chills or fever
difficulty with moving
a headache, severe and throbbing
joint or back pain
muscle aching or cramping
muscle pains or stiffness
chest pressure or squeezing pain in chest
excessive sweating
feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
sudden tingling or coldness in an arm or leg
sudden slow or difficult speech
sudden drowsiness or need to sleep
fast breathing
sharp pain when taking a deep breath
fast or slow heartbeat
coughing up blood
rust colored urine
decreased amount of urine

Rare

Anxiety
change in vision
seizures
abnormal or fast heart rate
tremors
weight loss
chest pain or tightness
confusion
a cough
Agitation
arm, back, or jaw pain
blurred vision
chest pain or discomfort
convulsions
extra heartbeats
fainting
hallucinations
a headache
irritability
lightheadedness
mood or mental changes
muscle pain or cramps

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Drug Interactions

Ceftazidime may interact with the following drugs, supplements, & may change the efficacy of drugs

aminoglycoside antibiotics (e.g., gentamicin, tobramycin)
probenecid
typhoid vaccine
cholera vaccine,
amoxicillin
BCG vaccine
Aspirin Low Strength (aspirin)
Diphenhydramine
Rosuvastatin
Duloxetine
Albuterol
Topiramate
Carbamazepine
Vitamin D3 (cholecalciferol)
Alprazolam
Cetirizine
Phenprocoumon
Picosulfuric acid
Warfarin

Pregnancy Catagory

FDA Pregnancy Category B

Pregnancy

It is not known if ceftazidime is safe for use by pregnant women. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

This medication may passes into breast milk. If you are a breast-feeding mother and are taking ceftazidime it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. It is not known if ceftazidime is safe for children under 6 months of age.