aztreonam (Rx)

Brand and Other Names:Azactam
  • Print

Dosing & Uses

AdultPediatric

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

Next:

Interactions

Interaction Checker

and aztreonam

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            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.

              Previous
              Next:

              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

              Previous
              Next:

              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
              Previous
              Next:

              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.

              Previous
              Next:

              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%)

              Previous
              Next:

              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

              Previous
              Next:

              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.

              Previous
              Next:

              Patient Handout

              Patient Education
              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 persists or worsens.

              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 persist or worsen, 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: fast/irregular heartbeat, confusion, easy bruising/bleeding, ringing in the ears, seizures, chest pain, yellowing eyes or skin, dark urine, severe stomach/abdominal pain, persistent nausea or vomiting, unusual fatigue, persistent signs of infection (e.g., 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 (e.g., 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 as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.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 August 2021. Copyright(c) 2021 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.

              Previous
              Next:

              Formulary

              FormularyPatient Discounts

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

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • 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.
              Additional Offers
              Email to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Email Forms to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Previous
              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.