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Third Generation Anti-Pseudomonal Cephalosporins

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Third Generation Anti-Pseudomonal Cephalosporins, Ceftazidime, Fortaz, Ceftazidime-Avibactam, Zavicefta

  • See Also
  1. Third Generation Broad-Spectrum Cephalosporins
  2. Cephalosporin
  • Indications
  • Conditions
  1. Gram-Negative, Multi-drug resistant intraabdominal Infections and Urinary Tract Infections
  • 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
  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
  • 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
  • Precautions
  1. Avoid Avibactam in pregnancy (adverse effects in pregnancy)
  2. Ceftazidime is excreted in Breast Milk
  • Disadvantages
  1. Most expensive
  2. Limited spectrum
  • Adverse Effects
  1. Gastrointestinal (Nausea, Vomiting, Diarrhea, Constipation)
  2. Dizziness
  3. Anxiousness
  4. Abdominal Pain
  5. Paresthesias
  • References
  1. Morrison and LoVecchio (2021) Crit Dec Emerg Med 35(1): 28