Ceftazidime

ceftazidime

(sef taz' i deem)

Ceptaz, Fortaz, Tazicef, Tazidime

Pregnancy Category B

Drug classes

Antibiotic

Cephalosporin (third generation)

Therapeutic actions

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Indications

·        Lower respiratory infections caused by P. aeruginosa, other Pseudomonas, S. pneumoniae, S. aureus, Klebsiella, H. influenzae, P. mirabilis, E. coli, Enterobacter, Serratia, Citrobacter

·        UTIs caused by P. aeruginosa, Enterobacter, E. coli, Klebsiella, P. mirabilis, Proteus

·        Gynecologic infections caused by E. coli

·        Dermatologic infections caused by P. aeruginosa, S. aureus, E. coli, Serratia, Proteus, Klebsiella, Enterobacter, S. pyogenes

·        Septicemia caused by P. aeruginosa, E. coli, Klebsiella, H. influenzae, Serratia, S. pneumoniae, S. aureus

·        Intra-abdominal infections caused by E. coli, S. aureus, Bacteroides, Klebsiella

·        CNS infections caused by H. influenzae, N. meningitidis

·        Bone and joint infections caused by P. aeruginosa, Klebsiella, Enterobacter, S. aureus

Contraindications and cautions

·        Contraindicated with allergy to cephalosporins or penicillins.

·        Use cautiously with renal failure, lactation, pregnancy.

Available forms

Powder for injection—500 mg, 1, 2 g; injection—1, 2 g

Dosages

ADULTS

Usual dose, 1 g (range 250 mg–2 g) q 8–12 hr IM or IV. Do not exceed 6 g/day. Dosage will vary with infection.

UTI: 250–500 mg IV or IM q 8–12 hr.

Pneumonia, dermatologic infections: 500 mg–1 g IV or IM q 8 hr.

Bone and joint infections: 2 g IV q 12 hr.

Gynecologic, intra-abdominal, life-threatening infections, meningitis: 2 g IV q 8 hr.

PEDIATRIC PATIENTS 1 MO–12 YR

30–50 mg/kg IV q 8 hr. Do not exceed 6 g/day.

PEDIATRIC PATIENTS 0–4 WK

30 mg/kg IV q 12 hr.

GERIATRIC PATIENTS OR PATIENTS WITH REDUCED RENAL FUNCTION

Loading dose of 1 g IV, followed by:

Creatinine Clearance (mL/min)	Dosage
31–50	1 g q 12 hr
16–30	1 g q 24 hr
6–15	500 mg q 24 hr
< 5	500 mg q 48 hr

Pharmacokinetics

Route	Onset	Peak	Duration
IV	Rapid	1 hr	24–28 hr
IM	30 min	1 hr	24–28 hr

Metabolism: T_1/2: 114–120 min

Distribution: Crosses the placenta; enters breast milk

Excretion: Urine

IV facts

Preparation: Reconstitute drug for direct IV injection with sterile water for injection. Reconstituted solution is stable for 24 hr at room temperature for Fortaz and Tazidime, or 18 hr at room temperature for Ceptaz and Tazicef or 7 days if refrigerated. For 500‑mg vial, mix with 5 mL diluent; resulting concentration, 11 mg/mL. For 1-g vial, mix with 5 (10) mL diluent; resulting concentration, 180 (100) mg/mL. For 2-g vial, mix with 10 mL diluent; resulting concentration, 170–180 mg/mL.

Infusion: For IV, reconstitute 1- or 2-g infusion pack with 100 mL sterile water for injection; infuse slowly. For direct injection, slowly over 3–5 min. For infusion, over 30 min. If patient is also receiving aminoglycosides, administer at separate sites.

Incompatibilities: Do not mix with sodium bicarbonate injection and aminoglycoside solutions.

Adverse effects

·        CNS: Headache, dizziness, lethargy, paresthesias

·        GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity

·        GU: Nephrotoxicity

·        Hematologic: Bone marrow depression—decreased WBC, decreased platelets, decreased Hct

·        Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness reaction

·        Local: Pain, abscess at injection site; phlebitis, inflammation at IV site

·        Other: Superinfections, disulfiram-like reaction with alcohol

Interactions

Drug-drug

·        Increased nephrotoxicity with aminoglycosides

·        Increased bleeding effects with oral anticoagulants

Drug-lab test

·        Possibility of false results on tests of urine glucose using Benedict's solution, Fehling's solution, Clinitest tablets; urinary 17-ketosteroids; direct Coombs' test

Nursing considerations

Assessment

History: Liver and renal dysfunction, lactation, pregnancy

Physical: Skin status, LFTs, renal function tests, culture of affected area, sensitivity tests

Interventions

·        Culture infection, and arrange for sensitivity tests before and during therapy if expected response is not seen.

·        Reconstitute drug for IM use with sterile water or bacteriostatic water for injection or with 0.5% or 1% lidocaine HCl injection to reduce pain; inject deeply into large muscle group.

·        WARNING: Do not mix with aminoglycoside solutions. Administer these drugs separately.

·        Powder and reconstituted solution darken with storage.

·        Have vitamin K available in case hypoprothrombinemia occurs.

·        Discontinue if hypersensitivity reaction occurs.

Teaching points

·        Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur.

·        You may experience these side effects: Stomach upset or diarrhea.

·        Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.

Adverse effects in Italic are most common; those in Bold are life-threatening.