Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous, as sodium [strength expressed as base]:
Tazicef: 1 g/50 mL (50 mL)
Solution, Intravenous, as sodium [strength expressed as base, preservative free]:
Fortaz in D5W: 1 g (50 mL [DSC]); 2 g (50 mL [DSC])
Solution Reconstituted, Injection:
Fortaz: 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea); 6 g (1 ea)
Tazicef: 1 g (1 ea [DSC])
Solution Reconstituted, Injection [preservative free]:
Tazicef: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea)
Generic: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea)
Solution Reconstituted, Intravenous:
Fortaz: 1 g (1 ea); 2 g (1 ea)
Tazicef: 1 g (1 ea [DSC])
Solution Reconstituted, Intravenous [preservative free]:
Tazicef: 1 g (1 ea); 2 g (1 ea)
Generic: 1 g (1 ea); 2 g (1 ea)
Pharmacology
Mechanism of Action
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.
Pharmacokinetics/Pharmacodynamics
Distribution
Widely throughout the body including bone, bile, skin, CSF (higher concentrations achieved when meninges are inflamed), endometrium, heart, pleural and lymphatic fluids
Excretion
Urine (80% to 90% as unchanged drug)
Time to Peak
Serum: IM: ~1 hour
Half-Life Elimination
1 to 2 hours, prolonged with renal impairment
Protein Binding
<10%
Use: Labeled Indications
Bloodstream infection (gram-negative bacteremia): Treatment of bloodstream infection caused by Pseudomonas aeruginosa, Klebsiella spp., Haemophilus influenzae, Escherichia coli, Serratia spp., Streptococcus pneumoniae, and Staphylococcus aureus (methicillin-susceptible strains).
Bone and joint infections: Treatment of bone and joint infections caused by P. aeruginosa, Klebsiella spp., Enterobacter spp., and S. aureus (methicillin-susceptible strains).
CNS infections: Treatment of CNS infections, including meningitis, caused by H. influenzae and Neisseria meningitidis. Ceftazidime has also been used successfully in cases of meningitis due to P. aeruginosa and S. pneumoniae.
Empiric therapy in immunocompromised patients: Empiric treatment of infections in immunocompromised patients.
Gynecologic infections: Treatment of endometritis, pelvic cellulitis, and other infections of the female genital tract caused by E. coli.
Intra-abdominal infections: Treatment of peritonitis caused by E. coli, Klebsiella spp., and S. aureus (methicillin-susceptible strains) and polymicrobial intra-abdominal infections caused by aerobic and anaerobic organisms and some Bacteroides spp. (many isolates of Bacteroides fragilis are resistant).
Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, caused by P. aeruginosa and other Pseudomonas spp.; H. influenzae, including ampicillin-resistant isolates; Klebsiella spp.; Enterobacter spp.; Proteus mirabilis; E. coli; Serratia spp.; Citrobacter spp.; S. pneumoniae; and S. aureus (methicillin-susceptible strains).
Skin and soft tissue infections: Treatment of skin and soft tissue infections caused by P. aeruginosa; Klebsiella spp.; E. coli; Proteus spp., including P. mirabilis and indole-positive Proteus; Enterobacter spp.; Serratia spp.; S. aureus (methicillin-susceptible strains); and Streptococcus pyogenes (group A beta-hemolytic streptococci).
Urinary tract infections: Treatment of complicated and uncomplicated urinary tract infections caused by P. aeruginosa; Enterobacter spp.; Proteus spp., including P. mirabilis and indole-positive Proteus; Klebsiella spp.; and E. coli.
Use: Off Label
Cystic fibrosis, acute pulmonary exacerbationb
Data from 2 randomized, multicenter trials support the use of ceftazidime in combination with tobramycin for the treatment of acute pulmonary exacerbations of cystic fibrosis Hubert 2009, Latzin 2008. Clinical experience also suggests the utility of ceftazidime as part of an appropriate combination regimen for this condition Simon 2019, Zobell 2013.
Diabetic foot infection, moderate to severecyes
Based on the Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections, ceftazidime is an effective and recommended agent as part of an appropriate combination regimen for the treatment of moderate to severe diabetic foot infection. Clinical experience also suggests the utility of ceftazidime in the treatment of this condition Weintrob 2019.
Endophthalmitis, bacterialb
Data from a randomized trial of immediate vitrectomy and intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis support the use of ceftazidime in this condition Kelsey 1995.
Melioidosis (Burkholderia pseudomallei infection)c
Melioidosis is a worldwide subtropical and tropical bacterial disease caused by contact with Burkholderia pseudomallei-contaminated water or soil Lipsitz 2012. A US Department of Health and Human Services workshop on treatment of and postexposure prophylaxis for B. pseudomallei and Burkholderia mallei infection supports the use of ceftazidime as a first-line agent for initial treatment of melioidosis Lipsitz 2012.
Peritonitis, treatment (peritoneal dialysis patients)yes
Based on the International Society for Peritoneal Dialysis peritonitis recommendations: 2016 update on prevention and treatment, ceftazidime is effective and recommended in the treatment of peritonitis associated with peritoneal dialysis.
Contraindications
Hypersensitivity to ceftazidime, other cephalosporins, penicillins, other beta-lactam antibiotics, or any component of the formulation
Dosage and Administration
Dosing: Adult
Usual dosage range: Note: Infusion method: Dosing is presented in the indication-specific dosing based on the traditional infusion method over 30 minutes, unless otherwise specified.
Traditional intermittent infusion method: IV: 1 to 2 g every 8 hours infused over 30 minutes. For treatment of very severe life-threatening infections, especially in immunocompromised hosts: 2 g every 8 hours (manufacturer's labeling).
Extended infusion method (off-label method): IV: 2 g every 8 hours infused over 3 to 4 hours; may give first dose over 30 minutes, especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis) (Ram 2018; SCCM [Rhodes 2017]; Turner 2015).
Continuous infusion method (off-label method): IV: 6 g infused over 24 hours (Bulitta 2010; Lipman 1999; Lipsitz 2012); may give first dose of 2 g over 30 minutes, especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis) (SCCM [Rhodes 2017]).
Extended and continuous infusion methods are based largely on pharmacokinetic and pharmacodynamic modeling data; clinical efficacy data are limited (Bulitta 2010; Koomanachai 2010; Lipman 1999; Ram 2018; Turner 2015).
Bloodstream infection (gram-negative bacteremia): For empiric therapy of known or suspected gram-negative bacteria (including Pseudomonas aeruginosa) or pathogen-directed therapy for organisms resistant to other agents:
IV: 2 g every 8 hours; for empiric therapy in patients with neutropenia, severe burns, sepsis, or septic shock, give as part of an appropriate combination regimen (Kanj 2019a; Moehring 2019; SCCM [Rhodes 2017]). Note: Some experts prefer the extended or continuous infusion method in critical illness or if treating a susceptible organism with an elevated minimum inhibitory concentration (Moehring 2019; SCCM [Rhodes 2017]).
Duration of therapy: Usual duration is 7 to 14 days depending on source, pathogen, extent of infection, and clinical response (Moehring 2019); a 7-day duration is recommended for patients with uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic therapy (Chotiprasitsakul 2018; Moehring 2019; Yahav 2018). Note: If neutropenic, extend treatment until afebrile for 2 days and neutrophil recovery (ANC ≥500 cells/mm3 and increasing) (IDSA [Freifeld 2011]). For P. aeruginosa bacteremia in neutropenic patients, some experts treat for a minimum of 14 days and until recovery of neutrophils (Kanj 2019b).
Antibiotic lock technique (catheter-salvage strategy): Note: For infections caused by susceptible organisms when the catheter cannot be removed; use in addition to systemic antibiotics.
Intracatheter: Prepare lock solution to final concentration of ceftazidime 5 to 10 mg/mL; may be combined with heparin (Allon 2009; Poole 2004; Vercaigne 2000). The ceftazidime concentration may vary by institution, catheter type, and whether heparin is utilized; solutions with heparin are preferred. Additional ceftazidime concentrations have been studied (IDSA [Mermel 2009]; Rijnders 2005). Instill into each lumen of the catheter access port using a volume sufficient to fill the catheter (2 to 5 mL) with a dwell time of up to 72 hours, depending on frequency of catheter use. Withdraw lock solution prior to catheter use; replace with fresh ceftazidime lock solution after catheter use. Antibiotic lock therapy is given for the same duration as systemic antibiotics (Girand 2019; IDSA [Mermel 2009]; Poole 2004).
Cystic fibrosis, acute pulmonary exacerbation (off-label use): For empiric or targeted therapy of P. aeruginosa or other gram-negative bacilli:
Traditional intermittent infusion method: IV: Usual dose: 2 g every 6 to 8 hours or 150 to 200 mg/kg/day divided every 6 to 8 hours (Simon 2019); doses up to 200 to 400 mg/kg/day divided every 6 to 8 hours (maximum: 12 g daily) have also been recommended (Latzin 2008; Zobell 2013).
Extended infusion method: IV: 2 g every 8 hours over 3 to 4 hours (Bulitta 2010; Thompson 2016).
Continuous infusion method: IV: Usual dose: 6 g over 24 hours (Bulitta 2010); doses up to 100 to 200 mg/kg/day (maximum: 12 g daily) have also been studied (Hubert 2009; Zobell 2013).
Duration of therapy: Duration is usually 10 days to 3 weeks or longer based on clinical response (Flume 2009; Simon 2019).
Diabetic foot infection, moderate to severe (off-label use): IV: 1 to 2 g every 8 hours. For empiric therapy, give as part of an appropriate combination regimen. If at risk for P. aeruginosa (eg, significant water exposure, macerated wound) or P. aeruginosa is cultured, use 2 g every 8 hours. Duration (which may include oral step-down therapy) is usually 2 to 4 weeks in the absence of osteomyelitis (IDSA [Lipsky 2012]; Weintrob 2019).
Endophthalmitis, bacterial (empiric therapy) (off-label use): Intravitreal: 2 to 2.25 mg/0.1 mL NS or sterile water in combination with vancomycin (Durand 2019; Jackson 2003; Roth 1997); a repeat dose(s) may be considered at 24 to 48 hours based on culture result, severity of infection, and response to treatment (Durand 2019).
Intra-abdominal infection, health care-associated or high-risk community-acquired infection: Note: For community-acquired infection, reserve for severe infection or patients at high risk of adverse outcome and/or resistance (Barshak 2019; SIS/IDSA [Solomkin 2010]):
Cholecystitis, acute: IV: 2 g every 8 hours; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (Gomi 2018; SIS [Mazuski 2017]; SIS/IDSA [Solomkin 2010]; Vollmer 2019).
Other intra-abdominal infections (eg, cholangitis, perforated appendix, diverticulitis, intra-abdominal abscess): IV: 2 g every 8 hours in combination with metronidazole and, when appropriate, other agents. Total duration of therapy (which may include oral step-down therapy) is 4 to 7 days following adequate source control (Barshak 2019; SIS [Mazuski 2017]; SIS/IDSA [Solomkin 2010]); for infections managed without surgical or percutaneous intervention, a longer duration may be necessary (Barshak 2019; Pemberton 2019). Note: For patients who are critically ill or are at high risk for infection with drug-resistant pathogens, some experts favor the extended or continuous infusion method (Barshak 2019; WSES [Sartelli 2017]).
Intracranial abscess (brain abscess, intracranial epidural abscess) and spinal epidural abscess: For empiric or directed therapy in patients at risk for P. aeruginosa or other resistant gram-negative bacteria (eg, neurosurgical or immunocompromised patients):
IV: 2 g every 8 hours as part of an appropriate combination regimen; duration generally ranges from 4 to 8 weeks for brain abscess and spinal epidural abscess, and 6 to 8 weeks for intracranial epidural abscess (Bodilsen 2018; Sexton 2019a; Sexton 2019b; Southwick 2019).
Melioidosis (Burkholderia pseudomallei infection) (off-label use): Initial intensive therapy: IV: 2 g every 6 to 8 hours (Lipsitz 2012; White 1989; Wiersinga 2012) or 2 g as a single dose followed by 6 g daily by continuous infusion. Duration is 10 to 14 days, although a longer duration may be necessary depending on disease severity and site of infection (Lipsitz 2012). Some experts recommend adding sulfamethoxazole and trimethoprim for patients with focal disease of the CNS, prostate, bone, joint, skin, or soft tissue (Currie 2019). Note: Following the course of parenteral therapy, eradication therapy with oral antibiotics for ≥12 weeks is recommended (Lipsitz 2012).
Meningitis, bacterial: As a component of empiric therapy for health care-associated infection or as pathogen-specific therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours; for empiric therapy, use in combination with vancomycin (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]). Treatment duration for gram-negative bacilli is a minimum of 10 to 14 days, although some experts recommend ≥21 days (Hasbun 2019; IDSA [Tunkel 2017]).
Neutropenic fever, high-risk cancer patients (empiric therapy): Note: High-risk patients are those expected to have an ANC ≤100 cells/mm3 for >7 days or an ANC ≤100 cells/mm3 for any expected duration if there are ongoing comorbidities (eg, sepsis, mucositis, significant hepatic or renal dysfunction) (IDSA [Freifeld 2011]); some experts use an ANC cutoff of <500 cells/mm3 to define high-risk patients (Wingard 2019).
IV: 2 g every 8 hours as part of an appropriate combination regimen; continue until afebrile for ≥48 hours and resolution of neutropenia (ANC ≥500 cells/mm3 and increasing) or standard duration for the specific infection identified, if longer than the duration for neutropenia (IDSA [Freifeld 2011]; Wingard 2019). Note: Some experts prefer the extended infusion method, particularly in those who are critically ill (SCCM [Rhodes 2017]; Wingard 2019).
Osteomyelitis and/or discitis:
Treatment: For empiric therapy or pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours, generally for ≥6 weeks; for empiric therapy, use as part of an appropriate combination regimen (IDSA [Berbari 2015]; Osmon 2019).
Prevention, following type III open fractures (severe contamination or comminution) for patients at risk for P. aeruginosa due to potential water exposure: IV: 2 g every 8 hours; ideally administer within 6 hours of injury. May be stopped after 72 hours or within 24 hours of wound closure. Note: For patients with risk factors for methicillin-resistant Staphylococcus aureus, or fecal or clostridial contamination, alternative or additional antibiotics are recommended (Schmitt 2019).
Peritonitis, treatment (peritoneal dialysis patients) (off-label use): As a component of empiric therapy or as pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa): Note: Intraperitoneal administration is preferred to IV administration (ISPD [Li 2016]). Consider a 25% dose increase in patients with significant residual renal function (urine output >100 mL/day) (ISPD [Li 2010]; ISPD [Li 2016]; Mancini 2018; Szeto 2018).
Intermittent: Intraperitoneal:
Continuous ambulatory peritoneal dialysis: 1 to 1.5 g added to one exchange once daily (allow to dwell ≥6 hours) (ISPD [Li 2016]).
Automated peritoneal dialysis: 20 mg/kg once daily administered in the longest dwell (Kim 2011).
Continuous (with every exchange) (dose is per liter of dialysate): Intraperitoneal: Loading dose: 500 mg/L of dialysate with first dialysate exchange; maintenance dose: 125 mg/L of dialysate with each subsequent dialysate exchange (ISPD [Li 2016]).
Pneumonia:
Community-acquired pneumonia: For empiric therapy of inpatients at risk of infection with gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours as part of an appropriate combination regimen. Total duration (which may include oral step-down therapy) is for a minimum of 5 days and varies based on disease severity and response to therapy; a longer course may be required for severe or complicated infection or for P. aeruginosa infection (File 2019; Kanj 2019c). Patients should be afebrile for ≥48 hours and clinically stable prior to discontinuation (File 2019; IDSA/ATS [Mandell 2007]).
Hospital-acquired or ventilator-associated pneumonia: For empiric therapy or pathogen-specific therapy of gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours as part of an appropriate combination regimen. Duration varies based on disease severity and response to therapy; treatment is typically given for 7 days (IDSA/ATS [Kalil 2016]), but a longer course may be required for severe or complicated infection or for P. aeruginosa infection (Kanj 2019c). Note: Some experts prefer the extended or continuous infusion method, particularly in those who are critically ill (Kim 2009; Klompas 2019; SCCM [Rhodes 2017]).
Prosthetic joint infection (alternative agent): As a component of empiric therapy or as pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours; duration varies but is generally 4 to 6 weeks for patients who undergo resection arthroplasty (Berbari 2019; IDSA [Osmon 2013]).
Septic arthritis: As a component of empiric therapy or as pathogen-directed therapy for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours; for empiric therapy, use in combination with vancomycin. Total treatment duration is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy (Goldenberg 2019).
Skin and soft tissue infection, moderate to severe: As empiric therapy or pathogen-directed therapy in patients with or at risk for gram-negative bacteria resistant to other antibiotics (eg, P. aeruginosa):
IV: 2 g every 8 hours. Usual duration is 10 to 14 days based on response to therapy (Hoepelman 1993; Kanj 2019d). Note: For burn-associated infections, some experts suggest giving ceftazidime with an aminoglycoside (Kanj 2019d).
Urinary tract infection, complicated (including pyelonephritis): IV: 1 to 2 g every 8 hours; use 2 g every 8 hours if P. aeruginosa is suspected (Bader 2017; Hoepelman 1993; Kanj 2019e). When used for empiric therapy, use alone or in combination with other appropriate agents. Switch to an appropriate oral regimen once patient has improvement in symptoms, if culture and susceptibility results allow. Duration of therapy depends on the antimicrobial chosen to complete the regimen and ranges from 5 to 14 days (Hooton 2019).
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
General dosing, susceptible infection (Red Book [AAP 2015]): IM, IV: Infants, Children, and Adolescents:
Mild to moderate infections: 90 to 150 mg/kg/day divided every 8 hours; maximum daily dose: 3,000 mg/day
Severe infections: 200 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day; higher doses (300 mg/kg/day) have been recommended for cystic fibrosis patients
Cystic fibrosis, lung infection caused by Pseudomonas spp: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours (Bradley 2017); maximum daily dose: 6 g/day; higher doses have been used: 200 to 400 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 12 g/day (Zobell 2013)
Endocarditis, treatment: Children and Adolescents: IV: 100 to 150 mg/kg/day divided every 8 hours; maximum daily dose: 4,000 mg/day; use in combination with gentamicin or vancomycin and gentamicin (plus rifampin if prosthetic material is present) depending on the cause of infection (AHA [Baltimore 2015])
Intra-abdominal infections, complicated: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours in combination with metronidazole; maximum daily dose: 6 g/day (Solomkin 2010)
Meningitis: Infants, Children, and Adolescents: IV: 150 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day (Tunkel 2004)
Peritonitis (peritoneal dialysis): Infants, Children, and Adolescents: Intraperitoneal:
Intermittent: 20 mg/kg/dose every 24 hours in the long dwell (ISPD [Warady 2012]); in adults, intermittent: 1,000 to 1,500 mg every 24 hours per exchange in the long dwell (≥6 hours) (Li 2010)
Continuous: Loading dose: 500 mg per liter of dialysate; maintenance dose: 125 mg per liter (ISPD [Warady 2012])
Urinary tract infection: Infants and Children 2 to 24 months: IV: 100 to 150 mg/kg/day divided every 8 hours (AAP 2011)
Reconstitution
IM: Using SWFI, bacteriostatic water for injection, lidocaine 0.5%, or lidocaine 1%, reconstitute the 500 mg vials with 1.5 mL or the 1 g vials with 3 mL; final concentration of ~280 mg/mL
IV: Reconstitute intact vials as follows (Note: After reconstitution, may dilute further with a compatible solution [eg, D5W, NS] to administer via IV infusion):
Fortaz, Tazicef:
~100 mg/mL solution:
500 mg vial: 5.3 mL SWFI (withdraw 5 mL from the reconstituted vial to obtain a 500 mg dose)
1 g vial: 10 mL SWFI (withdraw 10 mL from the reconstituted vial to obtain a 1 g dose)
6 g vial: 56 mL SWFI (withdraw 10 mL from the reconstituted vial to obtain a 1 g dose)
~170 mg/mL solution: 2 g vial: 10 mL SWFI (withdraw 11.5 mL from the reconstituted vial to obtain a 2 g dose)
~200 mg/mL solution: 6 g vial: 26 mL SWFI (withdraw 5 mL from the reconstituted vial to obtain a 1 g dose)
Duplex container: Unlatch side tab, unfold, remove foil strip from drug chamber. Point set port in downward direction, fold container just below the diluent meniscus, and squeeze the diluent chamber until the seal between the diluent and drug powder opens. Agitate until dissolved.
Administration
IM: Ceftazidime can be administered deep IM into large mass muscle.
IV: Can be administered IV push over 3 to 5 minutes or by IV intermittent infusion over 15 to 30 minutes.
Intravitreal: Ceftazidime may be administered intravitreally as 2 to 2.25 mg/0.1 mL NS in combination with vancomycin (separate syringes) (Jackson 2003; Roth 1997).
Intraperitoneal: Intraperitoneal administration may be used in conjunction with IV use for systemic infections if continuous peritoneal dialysis is used (added to the dialysate in each exchange). Intraperitoneal administration alone may also be used for the treatment of peritonitis and added to the dialysate in intermittent (added to the longest dwell time per day) or continuous (loading dose, followed by a maintenance dose per liter of exchange) peritoneal dialysis.
Inhalation for nebulization (off-label use/route): Use with standard jet nebulizer connected to an air compressor; administer 1,000 mg diluted in 8 mL NS with mouthpiece or face mask (Orriols 1999).
Dietary Considerations
Some products may contain sodium.
Storage
Vials: Store intact vials at 20°C to 25°C (68°F to 77°F). Protect from light. Refer to manufacturer's labeling for specific storage instructions for reconstituted solution and solution further diluted for IV infusion (varies by diluent).
Duplex container: Store unactivated containers at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light. Do not freeze. Unactivated duplex containers with foil strip removed from the drug chamber must be protected from light and used within 7 days at room temperature. Once activated, must be used within 12 hours if stored at room temperature or within 3 days if stored under refrigeration.
Premixed frozen solution: Store at -20°C (-4°F). Thawed solution is stable for 8 hours at room temperature or for 3 days under refrigeration; do not refreeze.
Drug Interactions
Aminoglycosides: Cephalosporins (3rd Generation) may enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). 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. 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. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Probenecid: May increase the serum concentration of Cephalosporins. Monitor therapy
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. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
Test Interactions
Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction
Adverse Reactions
1% to 10%:
Dermatologic: Pruritus (<2%), skin rash (<2%)
Endocrine & metabolic: Increased lactate dehydrogenase (6%), increased gamma-glutamyl transferase (5%)
Gastrointestinal: Diarrhea (1%)
Hematologic & oncologic: Eosinophilia (8%), positive direct Coombs test (4%; without hemolysis), thrombocythemia (2%)
Hepatic: Increased serum ALT (7%), increased serum AST (6%), increased serum alkaline phosphatase (4%)
Hypersensitivity: Hypersensitivity reactions (2%)
Local: Inflammation at injection site (1%), injection site phlebitis (1%)
Miscellaneous: Fever (<2%)
Frequency not defined:
Central nervous system: Seizure
Hematologic & oncologic: Agranulocytosis, leukopenia, lymphocytosis, neutropenia, thrombocytopenia
Renal: Increased blood urea nitrogen, increased serum creatinine
<1%, postmarketing, and/or case reports: Abdominal pain, anaphylaxis (severe in rare instances, including cardiopulmonary arrest), angioedema, candidiasis, Clostridioides (formerly Clostridium) difficile-associated diarrhea, dizziness, erythema multiforme, headache, hemolytic anemia, hyperbilirubinemia, jaundice, nausea, pain at injection site, paresthesia, renal insufficiency, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, vaginitis, vomiting
Warnings/Precautions
Concerns related to adverse effects:
- Elevated INR: May be associated with increased INR, especially in nutritionally deficient patients, prolonged treatment, hepatic or renal disease. Monitor INR during treatment if patient is at risk; administer vitamin K as clinically indicated.
- Hemolytic anemia: Immune-mediated hemolytic anemia, sometimes fatal, has been observed in patients receiving cephalosporins, including ceftazidime. If a patient develops anemia while on ceftazidime, discontinue treatment until the etiology is determined.
- Hypersensitivity: Hypersensitivity and anaphylaxis have been reported in patients receiving beta-lactam drugs. Use caution in patients with a history of hypersensitivity to penicillins or other beta-lactams; use is contraindicated in patients with cephalosporin allergy (according to the manufacturer). If severe hypersensitivity occurs, discontinue immediately and institute supportive emergency measures.
- Neurotoxicity: High ceftazidime levels in patients with renal insufficiency can lead to seizures, nonconvulsive status epilepticus, encephalopathy, coma, asterixis, myoclonia, and neuromuscular excitability. Adjust dosage based on renal function.
- Superinfection: Prolonged use may result in fungal or bacterial superinfection, including Clostridioides (formerly Clostridium) difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
- GI disease: Use with caution in patients with a history of GI disease, especially colitis.
- Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.
- Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.
Monitoring Parameters
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.
Pregnancy
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events have not been observed in animal reproduction studies. Ceftazidime crosses the placenta and reaches the cord serum and amniotic fluid. An increase in most types of birth defects was not found following first trimester exposure to cephalosporins. Maternal peak serum concentration is unchanged in the first trimester. After the first trimester, serum concentrations decrease by approximately 50% of those in nonpregnant patients. Renal clearance is increased during pregnancy.
Patient Education
What is this drug used for?
- It is used to treat bacterial infections.
Frequently reported side effects of this drug
- Diarrhea
- Injection site irritation
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
- Tremors
- Abnormal movements
- Confusion
- Extra muscle movement
- Dark urine
- Yellow skin or eyes
- Change in amount of urine passed
- Not able to pass urine
- Chills
- Sore throat
- Bruising
- Bleeding
- Severe loss of strength and energy
- Seizures
- Clostridioides (formerly Clostridium) difficile (C. diff)-associated diarrhea like abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools.
- Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
