Dosing & Uses
Dosage Forms & Strengths
solution, inhalation
- 75mg
powder for injection
- 1g
- 2g
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
Cystic fibrosis
75 mg via nebulizer q8hr for 28 days; at least 4 hr apart; not to be repeated for another 28 days after completion; pretreatment with broncdilator recommended
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (3)
- BCG vaccine live
aztreonam decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
aztreonam, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- typhoid vaccine live
aztreonam decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
Monitor Closely (10)
- bazedoxifene/conjugated estrogens
aztreonam will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- cefoxitin
cefoxitin decreases effects of aztreonam by pharmacodynamic antagonism. Use Caution/Monitor. Increase in production of beta-lactamases by cefoxitin can inactivate aztreonam.
- conjugated estrogens
aztreonam will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- dienogest/estradiol valerate
aztreonam will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
- digoxin
aztreonam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- estradiol
aztreonam will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estrogens conjugated synthetic
aztreonam will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estropipate
aztreonam will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- mestranol
aztreonam will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
aztreonam decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
Minor (22)
- amikacin
aztreonam, amikacin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
- amoxicillin
aztreonam, amoxicillin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- balsalazide
aztreonam will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- biotin
aztreonam will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- cefadroxil
aztreonam, cefadroxil. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- cefamandole
aztreonam, cefamandole. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- cefpirome
aztreonam, cefpirome. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- chloramphenicol
chloramphenicol decreases effects of aztreonam by pharmacodynamic antagonism. Minor/Significance Unknown.
- dicloxacillin
aztreonam, dicloxacillin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- gentamicin
aztreonam, gentamicin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
- neomycin PO
aztreonam, neomycin PO. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
- pantothenic acid
aztreonam will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- paromomycin
aztreonam, paromomycin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
- pivmecillinam
aztreonam, pivmecillinam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- probenecid
probenecid increases levels of aztreonam by decreasing elimination. Minor/Significance Unknown.
- pyridoxine
aztreonam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- pyridoxine (Antidote)
aztreonam will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- streptomycin
aztreonam, streptomycin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
- temocillin
aztreonam, temocillin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- thiamine
aztreonam will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ticarcillin
aztreonam, ticarcillin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- tobramycin
aztreonam, tobramycin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
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
Postmarketing Reports
Encephalopathy
Warnings
Contraindications
Hypersensitivity
Cautions
In patients with impaired hepatic or renal function, appropriate monitoring is recommended during therapy
If aminoglycoside is used concurrently, especially if high dosages of former are used or if therapy is prolonged, renal function should be monitored because of potential nephrotoxicity and ototoxicity of aminoglycoside antibiotics
Use of antibiotics may promote overgrowth of nonsusceptible organisms, including Gram-positive organisms (Staphylococcus aureus and Streptococcus faecalis) and fungi; take appropriate measures if superinfection occur during therapy
Rare cases of toxic epidermal necrolysis reported in association with therapy in patients undergoing bone marrow transplant with multiple risk factors including sepsis, radiation therapy, and other concomitantly administered drugs associated with toxic epidermal necrolysis
Clostridium difficile–associated diarrhea (CDAD)
- Reported with use of nearly all antibacterial agents and may range in severity from mild diarrhea to fatal colitis; treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile
- If CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated
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.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%)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| aztreonam injection - | 1 gram vial |  | |
| Azactam injection - | 2 gram vial |  | |
| Azactam injection - | 1 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
aztreonam injection
AZTREONAM - INJECTION
(az-TREE-oh-nam)
COMMON BRAND NAME(S): Azactam
USES: Aztreonam is used to treat a wide variety of bacterial infections. This medication is an antibiotic that works by stopping the growth of bacteria.
HOW TO USE: This medication is usually given by injection into a vein or a muscle as directed by your doctor. The dosage is based on your medical condition and response to therapy.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use aztreonam until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a relapse of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Diarrhea, nausea, vomiting, dizziness, headache, blurred vision, or redness/discomfort/pain/swelling at the injection site may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: nausea or vomiting that doesn't stop, fast/irregular heartbeat, confusion, easy bruising/bleeding, ringing in the ears, seizures, chest pain, yellowing eyes or skin, dark urine, severe stomach/abdominal pain, unusual fatigue, signs of ongoing infection (such as fever, sore throat).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool..If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection), or a new type of bacterial infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using aztreonam, tell your doctor or pharmacist if you are allergic to it; or to penicillins, cephalosporins, or certain other antibiotics (such as imipenem, meropenem); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease.This drug may rarely make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Aztreonam may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using aztreonam before having any immunizations/vaccinations.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: cefoxitin, imipenem.Aztreonam may cause false positive results with some diabetic urine testing products (cupric sulfate-type). Consult your doctor or pharmacist for recommendations. Make sure laboratory personnel and your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Laboratory and/or medical tests may be performed to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2021. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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