II. Indications
- Aerobic Gram Negative Bacterial infections (esp. hospital acquired, multi-drug resistant)
- Urinary Tract Infections
- Intraabdominal and gynecologic infections
- Pseudomonas Aeruginosa infections
- Cystic Fibrosis respiratory symptoms (nebulized Cayston)
III. Mechanism
- See Beta Lactam
- Aztreonam is classified as a Monobactam
- Like other Beta Lactams, it has a lactam 4 member ring (3 Carbons and 1 Nitrogen)
- However, unlike other Beta Lactams, Aztreonam lacks a second 5-member ring
- Monocyclic beta-lactam Antibiotic originally isolated from Chromobacterium violaceum
- Binds to and inactivates Penicillin-binding Protein-3 (PBP-3)
- Inhibits cross-linking of Bacterial cell wall components (similar to Carbapenems)
- Activity only against Gram Negative Bacteria (including Pseudomonas Aeruginosa)
- Aztreonam binds only the transpeptidase of aerobic, Gram Negative Bacteria
- No significant Gram Positive activity
- Wide tissue distribution (includes joints, CNS and urine)
IV. Dosing: Adult
-
Urinary Tract Infection
- Give 0.5 to 1 gram IM or IV every 8 to 12 hours
- Moderate Gram Negative Infections (e.g. intraabdominal, gynecologic)
- Give 1 to 2 grams IM or IV every 8 to 12 hours
- Severe Gram Negative Infections or Pseudomonas Infections
- Give 2 grams IV every 6 to 8 hours
-
Cystic Fibrosis Respiratory Symptoms
- Nebulize 1 Cayston vial (75 mg) three times daily for 28 days (then hold for at least 28 days)
- Given only with Altera nebulizer, after both Bronchodilator and mucolytic
- Administer after Bronchodilator - short acting (15 min to 4 h) or long-acting (30 min to 12 h)
-
Renal Dosing (eGFR <30 ml/min)
- eGFR 10 to 30 ml/min: Give 1 to 2 g IV load, then give 50% of typical dose
- eGFR <10: Give 0.5 to 2 g IV load, then give 25% of typical dose
- Hemodialysis (life threatening infections)
- Give 12.5% of typical dose after each Hemodialysis run
V. Dosing: Child
-
Gram Negative Infections
- Give 30 mg/kg IV every 6 to 8 hours
-
Cystic Fibrosis Respiratory Symptoms (age >= 7 years old)
- Nebulize 1 Cayston vial (75 mg) three times daily for 28 days (then hold for at least 28 days)
- Given only with Altera nebulizer, after both Bronchodilator and mucolytic
- Administer after Bronchodilator - short acting (15 min to 4 h) or long-acting (30 min to 12 h)
-
Pseudomonas respiratory infection in Cystic Fibrosis (not FDA approved)
- Give 50 mg/kg IV every 6 to 8 hours
VI. Adverse Effects
- Intravenous formulation
- Hypersensitivity
- Gastrointestinal upset
- Seizures
- Hepatitis
- Gastrointestinal upset
- Nebulized Formulation
- Bronchospasm
- Cough
- Nasal congestion
- Wheezing
- Pharyngitis
- Chest Pain
- Vomiting
- Serious
VII. Safety
- Pregnancy Category B
- Safe in Lactation
VIII. Resources
- Aztreonam (DailyMed)
- Cayston Aztreonam Nebulizer Solution (DailyMed)
IX. References
- (2010) Med Lett Drugs Ther 52(1344): 63-4
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI) | A monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum with bactericidal activity. Aztreonam preferentially binds to and inactivates penicillin-binding protein-3 (PBP-3), which is involved in bacterial cell wall synthesis, thereby inhibiting bacterial cell wall integrity and leading to cell lysis and death. This agent differs from other beta-lactam antibiotics because it is resistant to beta-lactamase hydrolysis, and it is usually used to treat infections caused by gram-negative aerobic microorganisms. |
| Definition (MSH) | A monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum. It is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. It may cause a superinfection with gram-positive organisms. |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D001398 |
| SnomedCT | 391808003, 387386004, 69918003 |
| LNC | LP16041-3, MTHU006798 |
| English | Az threonam, Az-threonam, Azthreonam, Aztreonam, Propanoic acid, 2-(((1-(2-amino-4-thiazolyl)-2-((2-methyl-4-oxo-1-sulfo-3-azetidinyl)amino)-2-oxoethylidene)amino)oxy)-2-methyl-, (2S-(2alpha,3beta(Z)))-, aztreonam, aztreonam (medication), Aztreonam [Chemical/Ingredient], AZTREONAM, Aztreonam - chemical, Aztreonam - chemical (substance), Aztreonam (product), Aztreonam (substance) |
| Swedish | Aztreonam |
| Czech | aztreonam |
| Finnish | Atstreonaami |
| Italian | Az-treonam, Aztreonam |
| Russian | AZTREONAM, АЗТРЕОНАМ |
| Japanese | アズトレオナム |
| French | Aztréonam |
| Polish | Aztreonam |
| Spanish | aztreonam (producto), aztreonam (sustancia), aztreonam, Aztreonam |
| German | Aztreonam |
| Portuguese | Aztreonam |
Ontology: Monobactams (C0026458)
| Definition (NCI) | Compounds containing a four-membered ring with an amide nitrogen and a keto group. This configuration includes bacteriostatic, cell-wall inhibiting antibiotics, such as penicillins and cephalosporins, their analogs and derivatives, such as the penem (or penam) compounds, clavulanic acids, and monobactams. They are substrates for and may act as inhibitors of bacterial beta-lactamases. (MeSH) |
| Definition (MSH) | Monocyclic, bacterially produced or semisynthetic beta-lactam antibiotics. They lack the double ring construction of the traditional beta-lactam antibiotics and can be easily synthesized. |
| Definition (CSP) | group of antibiotics containing beta lactam rings which are cleaved by the beta lactamases produced by almost all gram negative bacteria. |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D008997 |
| SnomedCT | 373297006, 90614001, 409132008, 409133003 |
| English | beta Lactams, Monocyclic, beta-Lactams, Monocyclic, Monobactams, Monocyclic beta Lactams, Monocyclic beta-Lactams, beta lactam antibiotic, Antibiotics, Monobactam, Monobactam Antibiotics, Monobactams [Chemical/Ingredient], antibiotics beta lactam, lactam antibiotics, monobactam, monobactams, antibiotics lactams, Beta lactam antibiotics, beta-Lactam antibiotic (product), beta-Lactam antibiotic, Beta-lactam antibiotic (substance), Beta-lactam antibiotic, beta-Lactam antibiotic, NOS, beta-Lactam antibiotic (substance), Monobactam, Monobactam (product), Monobactam (substance), Lactam Antibiotics, Beta-Lactam Antibiotic |
| Swedish | Monobaktamer |
| Czech | monobaktamy |
| Finnish | Monobaktaamit |
| Russian | ANTIBIOTIKI MONOBAKTAMOVYE, MONOTSIKLICHESKIE BETA-LAKTAMY, MONOBAKTAMY, BETA-LAKTAMY MONOTSIKLICHESKIE, АНТИБИОТИКИ МОНОБАКТАМОВЫЕ, БЕТА-ЛАКТАМЫ МОНОЦИКЛИЧЕСКИЕ, МОНОБАКТАМЫ, МОНОЦИКЛИЧЕСКИЕ БЕТА-ЛАКТАМЫ |
| French | bêta-Lactames monocycliques, Bêtalactames monocycliques, Monobactames |
| Italian | Beta-lattami monociclici, Antibiotici monobattami, Monobattami |
| Spanish | Antibióticos Monobactámicos, beta-Lactamas Monocíclicas, Monobactamos, antibiótico betalactámico (producto), antibiótico betalactámico (sustancia), antibiótico betalactámico, monobactam (producto), monobactam (sustancia), monobactam, betalactamas Monocíclicas, Monobactamas |
| Polish | Monobaktamy, Monocykliczne beta-laktamy |
| Japanese | 抗生物質-モノバクタム系, モノバクタム, スルファゼシン系抗生物質, モノバクタム系抗生物質, 単環ベータラクタム |
| German | Beta-Lactame, monocyclische, Monobactame, Monocyclische Beta-Lactame, Antibiotika, Monobactam- |
| Portuguese | Antibióticos Monobactâmicos, beta-Lactamas Monocíclicas, Monobactamas |
