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aztreonam, aztreonam lysine
Pharmacologic class: Monobactam
Therapeutic class: Anti-infective
Pregnancy risk category B
Inhibits bacterial cell-wall synthesis during active multiplication by binding with penicillin-binding protein 3, resulting in cell-wall destruction
Inhalation solution: 75-mg single-use vial
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
➣ Cystic fibrosis in patients with Pseudomonas aeruginosa
Adults and children age 7 and older: 75 mg t.i.d. at least 4 hours apart for 28-day course, followed by 28 days off
➣ 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.
• Severe renal failure
• Hypersensitivity to drug or its components
Use cautiously in:
• renal or hepatic impairment
• elderly patients
• pregnant or breastfeeding patients.
• 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.
• Reconstitute inhalation solution with 1 ml sterile diluent supplied and administer only with nebulizer supplied. Don't reconstitute until ready to administer.
• Know that patient should use a bronchodilator as prescribed before using inhalation solution.
CNS: dizziness, confusion, seizures
CV: phlebitis, thrombophlebitis
EENT: diplopia, tinnitus
GI: nausea, vomiting, diarrhea (including diarrhea associated with Clostridium difficile), pseudomembranous colitis
Hematologic: neutropenia, pancytopenia
Skin: rash, toxic epidermal necrolysis
Other: altered taste, angioedema, anaphylaxis
Drug-drug.Aminoglycosides: increased risk of nephrotoxicity and ototoxicity
Beta-lactamase-inducing antibiotics (such as cefoxitin, imipenem): antagonism with aztreonam
Furosemide, probenecid: increased aztreonam levels
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
☞ 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.
• Show patient how to reconstitute inhalation solution using diluent supplied and tell patient not to reconstitute until ready to use. Advise patient to use only the nebulizer supplied and to use a bronchodilator as prescribed before using inhalation solution.
☞ 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.
ClassificationTherapeutic: anti infectives
- Skin and skin structure infections,
- Intra-abdominal infections,
- Gynecologic infections,
- Respiratory tract infections,
- Urinary tract infections.
- Escherichia coli,
- Klebsiella oxytoca or pneumoniae,
- Proteus mirabilis,
- Pseudomonas aeruginosa,
- Haemophilus influenzae.
- Staphylococcus aureus,
- Bacteroides fragilis,
Time/action profile (blood levels)
|IM||rapid||60 min||6–8 hr|
|IV||rapid||end of infusion||6–8 hr|
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
Ear, Eye, Nose, Throat
- nasal congestion (inhalation) (most frequent)
- nasopharyngeal pain (inhalation) (most frequent)
- chest discomfort (inhalation)
- pseudomembranous colitis (life-threatening)
- abdominal pain (inhalation) (most frequent)
- altered taste
- cough (inhalation) (most frequent)
- wheezing (inhalation) (most frequent)
- bronchospasm (inhalation)
- pain at IM site
- phlebitis at IV site
- allergic reactions including anaphylaxis (life-threatening)
- fever (inhalation) (most frequent)
Drug-Drug interactionSerum levels may be ↑ by furosemide or probenecid.
Renal ImpairmentIntravenous (Adults) CCr 10–30 mL/min—1–2 g initially, then 50% of usual dosage at usual interval; CCr <10 mL/min—500 mg–2 g initially, then 25% of usual dosage at usual interval (1/8 of initial dose should also be given after each hemodialysis session).
Availability (generic available)
- Assess for infection (vital signs; wound appearance, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
- Obtain a history before initiating therapy to determine previous use of and reactions to penicillins and cephalosporins. Patients allergic to these drugs may exhibit hypersensitivity reactions to aztreonam. However, aztreonam can often be used in these patients.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Assess respiratory status prior to and following inhalation therapy.
- Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify the health care professional immediately if these occur.
- Monitor bowel function. Report diarrhea, abdominal cramping, fever, and bloody stools to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Lab Test Considerations: May cause ↑ in AST, ALT, alkaline phosphatase, LDH, and serum creatinine. May cause ↑ prothrombin and partial thromboplastin times, and positive Coombs’ test.
Potential Nursing DiagnosesRisk for infection (Indications)
Ineffective airway clearance (Indications)
- After adding diluent to vial, shake immediately and vigorously. Not for multidose use; discard unused solution. IV route is recommended if single dose > 1 g or for severe or life-threatening infection.
- Intramuscular: Use 15-mL vial and dilute each gram of aztreonam with at least 3 mL of 0.9% NaCl, or sterile or bacteriostatic water for injection. Stable at room temperature for 48 hr or 7 days if refrigerated.
- Administer into large, well-developed muscle.
- Reconstitute 15 mL vial with 6–10 mL of sterile water for injection.
- Rate: Administer slowly over 3–5 min by direct injection or into tubing of a compatible solution.
- Intermittent Infusion: Reconstitute 15 mL vial with at 3 mL of Sterile Water for Injection. Diluent: Dilute further with 0.9% NaCl, Ringer’s or LR, D5W, D10W, D5/0.9% NaCl, D5/0.45% NaCl, D5/0.2% NaCl, D5/LR, or sodium lactate.Concentration: Do not exceed 50 mg/mL. Solution is stable for 48 hr at room temperature and 7 days if refrigerated. Solutions range from colorless to light, straw yellow or may develop a pink tint upon standing; this does not affect potency.
- Rate: Infuse over 20–60 min.
- Y-Site Compatibility: alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminophylline, amphotericin B lipid complex, anadulafungin, argatroban, ascorbic acid, atracurium, atropine, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daptomycin, dexamethasone sodium phosphate, dexmedetomidine, digoxin, diltiazem, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, floxuridine, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, midazolam, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, penicillin G, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide, propofol, propranolol, protamine, pyridoxime, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: acyclovir, amphotericin B cholesteryl, amphotericin B colloidal, amphotericin B liposome, amsacrine, azathioprine, azithromycin, chlorpromazine, dantrolene, daunorubicin hydrochloride, diazepam, diazoxide, erythromycin, ganciclovir, indomethacin, lorazepam, metronidazole, mitomycin, mitoxantrone, mycophenolate, pantoprazole, papaverine, pentamidine, pentazocine, pentobarbital, phenytoin, prochlorperazine, streptozocin, trastuzumab
- Inhalation: Open glass aztreonam vial by removing metal ring and pulling tab, and removing gray rubber stopper. Twist tip of diluent ampule and squeeze contents into glass aztreonam vial. Replace rubber stopper and swirl gently until contents are completely dissolved. Administer immediately after reconstitution using Altera Nebulizer System. Pour reconstituted solution into handset of nebulizer. Turn unit on. Place mouthpiece into mouth and breathe normally only through mouth. Administration takes 2–3 min. Do not use other nebulizers or mix with other medications. Do not administer IV or IM. Refrigerate azotreonam and diluent; may be stored at room temperature for up to 28 days. Protect from light.
- Administer short-acting bronchodilator between 15 min and 4 hr or long-acting bronchodilator between 30 min and 12 hr prior to treatment. If taking multiple inhaled therapies, administer in the following order: bronchodilator, mucolytic, and lastly, aztreonam.
- Advise patient to report the signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
- Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
- Advise patient to notify health care professional if new or worsening symptoms or signs of anaphylaxis occur.
- Inhalation: Instruct patient to use aztreonam as directed for the full 28–day course, even if feeling better. If a dose is missed, take all 3 daily doses, as long as doses are at least 4 hrs apart. Skipping doses or not completing full course of therapy may decrease effectiveness and increase likelihood of bacterial resistance not treatable in the future. Inform patient of the importance of using a bronchodilator prior to treatment and in use and cleaning or nebulizer.
- Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Improvement in respiratory symptoms in patients with cystic fibrosis.