II. Indications

  1. Gram Negative aerobic Bacterial Infections
    1. Urinary Tract Infections
    2. Intraabdominal and gynecologic infections
    3. Pseudomonas aeruginosa infections
    4. Cystic Fibrosis respiratory symptoms (nebulized Cayston)

III. Mechanism

  1. Classified as a Monobactam
  2. Monocyclic beta-lactam Antibiotic originally isolated from Chromobacterium violaceum
    1. Binds to and inactivates Penicillin-binding Protein-3 (PBP-3)
    2. Inhibits cross-linking of Bacterial cell wall components (similar to Carbapenems)
  3. Activity against Gram Negative Bacteria (including Pseudomonas aeruginosa)
  4. No significant Gram Positive activity
  5. Wide tissue distribution (includes joints, CNS and urine)

IV. Dosing: Adult

  1. Urinary Tract Infection
    1. Give 0.5 to 1 gram IM or IV every 8 to 12 hours
  2. Moderate Gram Negative Infections (e.g. intraabdominal, gynecologic)
    1. Give 1 to 2 grams IM or IV every 8 to 12 hours
  3. Severe Gram Negative Infections or Pseudomonas Infections
    1. Give 2 grams IV every 6 to 8 hours
  4. Cystic Fibrosis Respiratory Symptoms
    1. Nebulize 1 Cayston vial (75 mg) three times daily for 28 days (then hold for at least 28 days)
    2. Given only with Altera nebulizer, after both Bronchodilator and mucolytic
    3. Administer after Bronchodilator - short acting (15 min to 4 h) or long-acting (30 min to 12 h)
  5. Renal Dosing (eGFR <30 ml/min)
    1. eGFR 10 to 30 ml/min: Give 1 to 2 g IV load, then give 50% of typical dose
    2. eGFR <10: Give 0.5 to 2 g IV load, then give 25% of typical dose
    3. Hemodialysis (life threatening infections)
      1. Give 12.5% of typical dose after each Hemodialysis run

V. Dosing: Child

  1. Gram Negative Infections
    1. Give 30 mg/kg IV every 6 to 8 hours
  2. Cystic Fibrosis Respiratory Symptoms (age >= 7 years old)
    1. Nebulize 1 Cayston vial (75 mg) three times daily for 28 days (then hold for at least 28 days)
    2. Given only with Altera nebulizer, after both Bronchodilator and mucolytic
    3. Administer after Bronchodilator - short acting (15 min to 4 h) or long-acting (30 min to 12 h)
  3. Pseudomonas respiratory infection in Cystic Fibrosis (not FDA approved)
    1. Give 50 mg/kg IV every 6 to 8 hours

VI. Adverse Effects

  1. Intravenous formulation
    1. Hypersensitivity
    2. Gastrointestinal upset
    3. Seizures
    4. Hepatitis
    5. Gastrointestinal upset
  2. Nebulized Formulation
    1. Bronchospasm
    2. Cough
    3. Nasal congestion
    4. Wheezing
    5. Pharyngitis
    6. Chest Pain
    7. Vomiting
  3. Serious
    1. Neutropenia
    2. Toxic Epidermal Necrolysis

VII. Safety

  1. Pregnancy Category B
  2. Safe in Lactation

IX. References

  1. (2010) Med Lett Drugs Ther 52(1344): 63-4
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Ontology: Aztreonam (C0004521)

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