az·tre·o·nam ( z-tr   -nm )n. A synthetic bactericidal antibiotic that acts against a wide spectrum of gram-negative aerobic pathogens. |
aztreonam
Azactam
Pharmacologic class: Monobactam
Therapeutic class: Anti-infective
Pregnancy risk category B
Action
Inhibits bacterial cell-wall synthesis during active multiplication by binding with penicillin-binding protein 3, resulting in cell-wall destruction
Availability
Powder for injection: 500-mg vial, 1-g vial, 2-g vial, 1 g/50-ml I.V. bag, 2 g/50-ml I.V. bag
⊘Indications and dosages
➣ Infections caused by susceptible gram-negative organisms
Adults: For urinary tract infections, 500 mg or 1 g I.M. or I.V. q 8 or 12 hours; for moderately severe systemic infections, 1 or 2 g I.M. or I.V. q 8 or 12 hours; for severe or life-threatening infections, 2 g I.M. or I.V. q 6 or 8 hours. Maximum dosage is 8 g/day.
Children: For mild to moderate infections, 30 mg/kg I.M. or I.V. q 8 hours; for moderate to severe infections, 30 mg/kg I.M. or I.V. q 6 or 8 hours. Maximum dosage is 120 mg/kg/day.
Dosage adjustment
• Severe renal failure
Contraindications
• Hypersensitivity to drug or its components
Precautions
Use cautiously in:
• renal or hepatic impairment
• elderly patients
• pregnant or breastfeeding patients.
Administration
• Flush I.V. tubing with compatible solution before and after giving drug.
• Compatible solutions include 0.9% sodium chloride injection, 5% or 10% dextrose injection, Ringer's or lactated Ringer's injection, 5% dextrose and 0.9% sodium chloride injection, and 5% dextrose and 0.45% sodium chloride injection.
• After adding diluent to vial or infusion bottle, shake immediately and vigorously.
• For I.V. bolus injection, reconstitute powder for injection by adding 6 to 10 ml of sterile water for injection. Inject prescribed dosage into tubing of compatible I.V. solution slowly over 3 to 5 minutes.
• For intermittent I.V. infusion, reconstitute powder for injection by adding compatible I.V. solution to yield a concentration not exceeding 20 mg/ml. Administer prescribed dosage over 20 to 60 minutes.
☞ Thaw commercially available frozen drug at room temperature and give by intermittent I.V. infusion only.
• For I.M. injection, reconstitute powder for injection by adding 3 ml of sterile water for injection or 0.9% sodium chloride injection.
• Give I.M. injection deep into large muscle mass.
| Route | Onset | Peak | Duration |
| I.V., I.M. | Organism & dose dependent | 1 hr | 4-12 hr |
Adverse reactions
CV: phlebitis, thrombophlebitis
GI: nausea, vomiting, diarrhea (including diarrhea associated with Clostridium difficile), pseudomembranous colitis
Hematologic: neutropenia
Respiratory: bronchospasm
Skin: rash, toxic epidermal necrolysis
Other: angioedema, anaphylaxis
Interactions
Drug-diagnostic tests. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, eosinophils, platelets, prothrombin time (PT), partial thromboplastin time (PTT): increased values
Coombs' test: positive result
Neutrophils: decreased count
Patient monitoring
☞ Assess patient closely for signs and symptoms of pseudomembranous colitis.
☞ Monitor patient carefully for hypersensitivity reaction, especially if he's allergic to penicillin, carbapenems, or cephalosporins.
• Monitor CBC with differential, AST, ALT, PT, PTT, and serum creatinine values.
• Monitor renal and hepatic function.
Patient teaching
☞ Instruct patient to immediately report severe diarrhea or signs or symptoms of hypersensitivity reaction, such as rash or difficulty breathing.
• Tell female patient to notify prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.
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