aztreonam (Rx)

Brand and Other Names:Azactam
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

solution, inhalation

  • 75mg

powder for injection

  • 1g
  • 2g
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Systemic Infections

Moderately severe: 1-2 g IV/IM q8-12hr; not to exceed 8 g/day

Severe or life-threatening: 2 g IV/IM q6-8hr; not to exceed 8 g/day

Pseudomonal Infections

2 g IV/IM q6-8hr; not to exceed 8 g/day

Urinary Tract Infections

0.5-1 g IV/IM q8-12hr; not to exceed 8 g/day

Graft-Versus-Host Disease (Orphan)

Treatment of oral manifestations of graft-versus-host disease (GVHD)

Orphan indication sponsors

  • Oral Solutions, Inc, 787 Seventh Ave, 48th Floor, New York, NY 10019

Dosing Modifications

Renal impairment

  • CrCl 10-30 mL/min: 1-2 g loading dose, then 50% of usual dosage
  • CrCl <10 mL/min: 1-2 g loading dose, then 25% of usual dosage

Dosing Considerations

Susceptible organisms

  • Gram-negative: Citrobacter spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens

Dosage Forms & Strengths

solution, inhalation

  • 75mg

powder for injection

  • 1g
  • 2g
more...

Mild-to-Moderate Infections

<9 month: Safety and efficacy not established

>9 month: 30 mg/kg IV q8hr; not to exceed 120 mg/kg/day 

Moderate-to-Severe Infections

<9 month: Safety and efficacy not established

>9 month: 30 mg/kg IV q6-8hr; not to exceed 120 mg/kg/day 

Cystic Fibrosis

<9 month: Safety and efficacy not established

>9 month: 50 mg/kg IV q6-8hr; not to exceed 200 mg/kg/day; not to exceed 8 g/day 

>7 years: 75 mg via nebulizer three times daily, at least 4 hr apart, for 28days; not to be repeated for another 28 days

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Interactions

Interaction Checker

and aztreonam

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Inhalation

            • Cough (54%)
            • Sore throat (12%)
            • Wheezing (16%)
            • Fever (13%)

            Injection

            • Pain at injection site (12%; children); (2%; adults)
            • Increase in serum transaminases (4-6%)
            • Neutropenia (3-11%, children); (<1%, adults)

            1-10%

            Inhalation

            • Chest discomfort (8%)
            • Abdominal pain (7%)
            • Vomiting (6%)
            • Bronchospasm (3%)
            • Skin rash (2%)

            Injection

            • Rash (4%)
            • Thrombocytopenia (4%, children); (<1% adults)
            • Diarrhea (1%)
            • Nausea (1%)
            • Vomiting (1%)
            • Fever (<1%)

            < 1%

            Inhalation

            Facial edema

            Joint swelling

            Tightness in chest and throat

            Bronchospasm

            Skin rash

            Injection

            Abnormal taste

            Anaphylaxis

            Anemia

            Angioedema

            Aphthous ulcer

            Breast tenderness

            Bronchospasm

            Clostridium difficile-associated diarrhea (CDAD)

            Confusion

            Diplopia

            Dizziness

            Dsypnea

            Electrocardiographic changes (transient)

            Erythema multiforme

            Eosinophilia

            Fever

            Flushing

            Halitosis

            Headache

            Hepatitis

            Hypotension

            Insomnia

            Jaundice

            Leukocytosis

            Neutropenia

            Pancytopenia

            Seizures

            Thrombocytopenia

            Tinnitus

            Tongue numbness

            Toxic epidermal necrolysis

            Urticaria

            Vaginitis

            Vertigo

            Weakness

            Wheezing

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            CDAD has been reported with use of nearly all antibacterial agents, including aztreonam

            Dose reduction required with renal impairment

            Coadministration with nephrotoxic drugs increases risk of renal impairment

            Prolonged use may result in superinfection

            Use caution in toxic epidermal necrolysis and renal impairment

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug is excreted in milk in low concentrations; use not recommended (American Academy of Pediatrics committee states that drug is compatible with nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Monobactam; inhibits cell wall synthesis by binding to penicillin binding proteins

            Absorption

            IM form well absorbed; IM/IV forms yield comparable serum concentrations

            Peak plasma time: IM/IV push, ≤60 min; IV infusion, 1.5 hr

            Distribution

            Distributed widely to most body fluids and tissues; crosses placenta; enters breast milk

            Relative diffusion of antimicrobial agents from blood into CSF: Good only with inflammation (exceeds usual MICs); CSF level ~1% of blood level with normal meninges, 8-40% with inflamed meninges

            Protein bound: 58%

            Vd: Neonates, 0.26-0.36 L/kg; children, 0.2-0.29 L/kg; adults, 0.2 L/kg

            Metabolism

            Metabolized in liver

            Elimination

            Half-life: Adults with normal renal function, 1.7-2.9 hr; adults with end-stage renal disease, 6-8 hr

            Excretion: Urine (60-70% as unchanged drug), feces (13-15%)

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            Administration

            IV Incompatibilities

            Additive: Metronidazole, nafcillin

            Y-site: Acyclovir, alatrofloxacin, amphotericin B, amphotericin B cholesteryl sulfate, amsacrine, azithromycin, chlorpromazine, daunorubicin, ganciclovir, lorazepam, metronidazole, mitomycin, mitoxantrone, prochlorperazine, streptozocin, vancomycin(?; may depend on concentration)

            IV Compatibilities

            Additive (partial list): Ampicillin(?), cefazolin, cefoxitin(?), ciprofloxacin, linezolid, tobramycin, vancomycin (may be incompatible at high concentrations of both drugs)

            Syringe: Clindamyin

            Y-site (partial list): Allopurinol, amikacin, cephalosporins (most), cimetidine, ciprofloxacin, cisatracurium, diltiazem, diphenhydramine, dopamine, famotidine, fluconazole, furosemide, heparin, hydroxyzine, linezolid, magnesium sulfate, metoclopramide, morphine sulfate, ondansetron, propofol, sodium bicarbonate, trimethoprim-sulfamethoxazole, zidovudine

            IV Preparation

            Reconstituted solutions are colorless to light straw-yellow; may turn pink upon standing, without affecting potency

            Use reconstituted solutions and IV solutions (in NS or D5W) within 48 hours if kept at room temperature or within 7 days if kept in refrigerator

            IV/IM Administration

            IM: Inject deep into large muscle mass

            IV: Preferred for doses >1 g or in patients with severe life-threatening infections; administer drug by IV push over 3-5 minutes or by intermittent infusion over 20-60 minutes at final concentration not to exceed 20 mg/mL

            Monitor infusion/injection sites carefully; administer around-the-clock to minimize variations in peak and trough serum levels

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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