Infectious Disease Book


Third Generation Anti-Pseudomonal Cephalosporins

Aka: Third Generation Anti-Pseudomonal Cephalosporins, Ceftazidime, Fortaz, Ceftazidime-Avibactam, Zavicefta
  1. See Also
    1. Third Generation Broad-Spectrum Cephalosporins
    2. Cephalosporin
  2. Indications: Conditions
    1. Gram-Negative, Multi-drug resistant intraabdominal Infections and Urinary Tract Infections
  3. Pharmacokinetics
    1. Half-Life Ceftazidime: 2.7 hours (similar for Avibactam)
    2. Ceftazidime is excreted in urine (80-90% unchanged, avibactam is 100% unchanged on excretion)
    3. Adjust dose in Renal Failure
  4. Indications: Bacterial Coverage
    1. Pseudomonas aeruginosa (Main indication)
    2. EKP Gram Negative Bacteria (Escherichia coli, Klebsiella, Proteus)
    3. ESP Gram Negative Bacteria (Enterobacter, Serratia, Providencia)
    4. Also covers Citrobacter species
    5. Gram Positive Cocci poorly covered
    6. No Gram Negative Coccobacilli coverage
  5. Preparations
    1. Ceftazidime (Fortaz)
      1. Adult: 1-2 grams IM or IV every 8 to 12 hours
      2. Child: 30-50 mg/kg IV every 8 hours
    2. Ceftazidime-Avibactam (Zavicefta)
      1. Addition of Beta-Lactamase inhibitor (Avibactam) circumvents Beta-Lactamase resistance
      2. Ceftazidime-Avibactam (2g-0.5g) 62.5 g IV every 8 hours
      3. Urinary Tract Infections: Treated for 7-14 days
      4. Intraabdominal infections
        1. Treat for 5 to 14 days
        2. Combine with Metronidazole
  6. Precautions
    1. Avoid Avibactam in pregnancy (adverse effects in pregnancy)
    2. Ceftazidime is excreted in Breast Milk
  7. Disadvantages
    1. Most expensive
    2. Limited spectrum
  8. Adverse Effects
    1. Gastrointestinal (Nausea, Vomiting, Diarrhea, Constipation)
    2. Dizziness
    3. Anxiousness
    4. Abdominal Pain
    5. Paresthesias
  9. References
    1. Morrison and LoVecchio (2021) Crit Dec Emerg Med 35(1): 28

Ceftazidime (C0007559)

Definition (NCI) A beta-lactam, third-generation cephalosporin antibiotic with bactericidal activity. Ceftazidime binds to and inactivates penicillin-binding proteins (PBP) located on the inner membrane of the bacterial cell wall. PBPs participate in the terminal stages of assembling the bacterial cell wall, and in reshaping the cell wall during cell division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis. Compared to the second and first generation cephalosporins, ceftazidime is more active against gram-negative bacteria and less active against gram-positive bacteria. Ceftazidine also crosses the blood-brain barrier and reaches therapeutic concentrations in the central nervous system (CNS).
Definition (MSH) Semisynthetic, broad-spectrum antibacterial derived from CEPHALORIDINE and used especially for Pseudomonas and other gram-negative infections in debilitated patients.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002442
SnomedCT 323836005, 36893000, 387200005
LNC LP15242-8, MTHU003920
English Ceftazidime, Pyridinium, 1-((7-(((2-amino-4-thiazolyl)((1-carboxy-1-methylethoxy)imino)acetyl)amino)-2-carboxy-8-oxo-5-thia-1-azabicyclo(4.2.0)oct-2-en-3-yl)methyl)-, inner salt, pentahydrate, (6R-(6alpha,7beta(Z)))-, ceftazidime, ceftazidime (medication), CEFTAZIDIME, Ceftazidime [Chemical/Ingredient], cefTAZidime, CefTAZidime, Pyridinium, 1-((7-(((2-amino-4-thiazolyl)((1-carboxy-1-methylethoxy)imino)acetyl)amino)-2-carboxy-8-oxo-5-thia-1-azabicyclo(4.2.0)oct-2-en-3-yl)methyl)-, Hydroxide, Inner Salt, Pentahydrate, (6R-(6alpha,7beta(Z)))-, Ceftazidime (product), Ceftazidime (substance)
Swedish Ceftazidim
Czech ceftazidim
Finnish Keftasidiimi
Japanese セフタジジム
Polish Ceftazydym
Spanish ceftazidima (producto), ceftazidima (sustancia), ceftazidima, Ceftazidima
French Ceftazidime
German Ceftazidim
Italian Ceftazidima
Portuguese Ceftazidima
Derived from the NIH UMLS (Unified Medical Language System)

Fortaz (C0700859)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002442
English Fortaz ADD-Vantage, fortaz, Fortaz
Derived from the NIH UMLS (Unified Medical Language System)

Ceftazidime+Avibactam (C3656596)

Concepts Organic Chemical (T109) , Antibiotic (T195)
LNC LP172560-7, MTHU046357
English Ceftazidime+Avibactam
Derived from the NIH UMLS (Unified Medical Language System)

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