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Avycaz
ceftazidime/ avibactam
Adult Dosing .
Dosage forms: INJ
Special Note
- [strength clarification]
- Info: doses expressed as total ceftazidime + avibactam amt; 2.5 g ceftazidime/avibactam contains 2 g ceftazidime + 0.5 g avibactam
intra-abdominal infections, complicated
- [2.5 g IV q8h x5-14 days]
- Info: give w/ metronidazole 500 mg PO/IV q6-8h; duration varies by infection site/severity
UTI, complicated
- [2.5 g IV q8h x7-14 days]
- Info: duration varies by infection severity
pneumonia, hospital-acquired or ventilator-assoc.
- [2.5 g IV q8h x7 days]
- Info: may extend duration based on clinical response; refer to IDSA guidelines
renal dosing
- [see below]
- CrCl 31-50: 1.25 g q8h; CrCl 16-30: 0.94 g q12h; CrCl 6-15: 0.94 g q24h; CrCl <6: 0.94 g q48h
- HD: 0.94 g q48h, on dialysis days admin. after dialysis; consider supplement if next maint. dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: INJ
Special Note
- [strength clarification]
- Info: doses expressed as total ceftazidime + avibactam amt; 2.5 g ceftazidime/avibactam contains 2 g ceftazidime + 0.5 g avibactam
intra-abdominal infections, complicated
- [31 wk gestation and older, <29 days old]
- Dose: 25 mg/kg/dose IV q8h x5-14 days; Info: give w/ metronidazole 30 mg/kg/day IV divided q6-8h; duration varies by infection site/severity
- [29 days old-2 mo]
- Dose: 37.5 mg/kg/dose IV q8h x5-14 days; Info: give w/ metronidazole 30 mg/kg/day IV divided q6-8h; duration varies by infection site/severity
- [3-5 mo]
- Dose: 50 mg/kg/dose IV q8h x5-14 days; Info: give w/ metronidazole 30 mg/kg/day IV divided q6-8h; duration varies by infection site/severity
- [6 mo-1 yo]
- Dose: 62.5 mg/kg/dose IV q8h x5-14 days; Info: give w/ metronidazole 30 mg/kg/day IV divided q6-8h; duration varies by infection site/severity
- [2 yo and older]
- Dose: 62.5 mg/kg/dose IV q8h x5-14 days; Max: 2.5 g/dose; Info: give w/ metronidazole 30 mg/kg/day IV divided q6-8h; duration varies by infection site/severity
UTI, complicated
- [31 wk gestation and older, <29 days old]
- Dose: 25 mg/kg/dose IV q8h x7-14 days; Info: duration varies by infection site/severity
- [29 days old-2 mo]
- Dose: 37.5 mg/kg/dose IV q8h x7-14 days; Info: duration varies by infection site/severity
- [3-5 mo]
- Dose: 50 mg/kg/dose IV q8h x7-14 days; Info: duration varies by infection severity
- [6 mo-1 yo]
- Dose: 62.5 mg/kg/dose IV q8h x7-14 days; Info: duration varies by infection severity
- [2 yo and older]
- Dose: 62.5 mg/kg/dose IV q8h x7-14 days; Max: 2.5 g/dose; Info: duration varies by infection severity
pneumonia, hospital-acquired or ventilator-assoc.
- [31 wk gestation and older, <29 days old]
- Dose: 25 mg/kg/dose IV q8h x7-14 days
- [29 days old-2 mo]
- Dose: 37.5 mg/kg/dose IV q8h x7-14 days
- [3-5 mo]
- Dose: 50 mg/kg/dose IV q8h x7-14 days
- [6 mo-1 yo]
- Dose: 62.5 mg/kg/dose IV q8h x7-14 days
- [2 yo and older]
- Dose: 62.5 mg/kg/dose IV q8h x7-14 days; Max: 2.5 g/dose
renal dosing
- [<2 yo]
- renal impairment: not defined
- HD/PD: not defined
- [2 yo and older]
- CrCl 31-50: 31.25 mg/kg/dose q8h, max 1.25 g/dose; CrCl 16-30: 23.75 mg/kg/dose q12h, max 0.94 g/dose; CrCl 6-15: 23.75 mg/kg/dose q24h, max 0.94 g/dose; CrCl <6: 23.75 mg/kg/dose q48h, max 0.94 g/dose
- HD: 23.75 mg/kg/dose q48h, max 0.94 g/dose, on dialysis days admin. after dialysis; consider supplement if next maint. dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to aztreonam
- caution: hypersensitivity to beta-lactams
- caution: CrCl <50
- caution: abx-associated colitis hx, recent
Drug Interactions .
Overview
avibactam
beta-lactamase inhibitor
- OAT1 substrate
- OAT3 substrate
ceftazidime
cephalosporin
- alters GI flora
- anticoagulant effects
- bactericidal activity requires bacterial growth
- impairs immunomodulatory bacterial infective agent
- lowers seizure threshold
- nephrotoxicity
Avoid/Use Alternative
- aldesleukin
- amifampridine
- BCG live intravesical
- bumetanide
- cholera vaccine, live
- fecal microbiota, live
- iohexol
- methotrexate
- probenecid
- typhoid vaccine, live
Monitor/Modify Tx
- alteplase
- amikacin
- amikacin inhaled
- antithrombin
- apixaban
- argatroban
- bivalirudin
- bupropion
- dabigatran
- dalteparin
- defibrotide
- edoxaban
- enoxaparin
- ethacrynic acid
- fondaparinux
- furosemide
- gentamicin
- heparin
- iopamidol
- mycophenolate mofetil
- mycophenolic acid
- neomycin
- paromomycin
- plazomicin
- reteplase
- rifampin
- rivaroxaban
- streptomycin
- tenecteplase
- tobramycin
- tobramycin inhaled
- torsemide
- treosulfan
- warfarin
Caution Advised
- acetazolamide
- brivaracetam
- busulfan
- cabotegravir
- cannabidiol
- carbamazepine
- cenobamate
- chlorambucil
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- demeclocycline
- diazepam
- dichlorphenamide
- doxycycline
- eravacycline
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fexinidazole
- fosphenytoin
- gabapentin
- ganaxolone
- gemfibrozil
- hydroxychloroquine
- lacosamide
- lactulose
- lamotrigine
- leflunomide
- levetiracetam
- lindane topical
- lorazepam
- magnesium citrate
- meropenem
- methsuximide
- midazolam
- minocycline
- nitisinone
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- pretomanid
- primidone
- promethazine
- rufinamide
- sarecycline
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- teriflunomide
- tetracycline
- tiagabine
- topiramate
- tramadol
- trimethoprim
- vaborbactam
- vadadustat
- valproic acid
- vigabatrin
- zonisamide
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- anaphylaxis
- Stevens-Johnson syndrome
- erythema multiforme
- toxic epidermal necrolysis
- hemolytic anemia
- agranulocytosis
- pancytopenia
- neutropenia
- leukopenia
- thrombocytopenia
- cholestatic jaundice
- interstitial nephritis
- seizures
- encephalopathy
- C. difficile-assoc. diarrhea
Common Reactions
- diarrhea
- nausea
- vomiting
- rash (peds pts)
- infusion site rxn (peds pts)
- headache
- constipation
- dizziness
- abdominal pain
- pruritus
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; CBC, LFTs if prolonged tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
ceftazidime: may use during pregnancy; no human data available; no known risk of fetal harm based on animal data at 0.6x and 5x MRHD
avibactam: weigh risk/benefit during pregnancy; no human data available; no known risk of teratogenicity, though possible risk of dose-dependent delayed ossification and decr. fetal wt based on animal data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on limited human data and drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for ceftazidime: minimal; CYP450: unknown; for avibactam: none; CYP450: none
Excretion: for ceftazidime: urine 80-90% (100% unchanged); Half-life: 2.7h, 14-30h (ESRD); for avibactam: urine 97% (85% unchanged); Half-life: 2.7h
Subclass: Beta-Lactamase Inhibitors ; Beta-Lactams ; Cephalosporins, 3rd generation
Mechanism of Action
ceftazidime binds to peptidoglycan, inhibiting cell wall synthesis; avibactam inhibits beta-lactamases, preventing beta-lactam degradation
Formulary .
No Formulary Selected
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