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Pharmacologic class: Third-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.
Powder for injection: 500 mg, 1 g, 2 g, 6 g
Premixed containers: 1 g/50 ml, 2 g/50 ml
Indications and dosages
➣ Skin infections; bone and joint infections; urinary tract and gynecologic infections, including gonorrhea; respiratory tract infections; intraabdominal infections; septicemia
Adults and children ages 12 and older: For most infections, 500 mg to 2 g I.V. or I.M. q 8 to 12 hours. For pneumonia and skin infections, 0.5 to 1 g I.V. or I.M. q 8 to 12 hours. For bone and joint infections, 2 g I.V. or I.M. q 12 hours. For severe and life-threatening infections, 2 g I.V. q 8 hours. For complicated urinary tract infections (UTIs), 500 mg q 8 to 12 hours. For uncomplicated UTIs, 250 mg I.M. or I.V. q 12 hours.
Children ages 1 month to 12 years: 30 to 50 mg/kg I.V. q 8 hours
Neonates younger than 4 weeks: 30 mg/kg I.V. q 12 hours
• Renal impairment
• Febrile neutropenia
• Prophylaxis of perinatal infections
• Hypersensitivity to cephalosporins or penicillins
Use cautiously in:
• renal impairment, hepatic disease, biliary obstruction, phenylketonuria
• history of GI disease
• elderly patients
• pregnant or breastfeeding patients
• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Reconstitute powder for injection with sterile water, following manufacturer's directions for amount of diluent to use.
• For I.V. injection, dilute in sterile water as directed, and give single dose over 3 to 5 minutes. Inject into large vein; rotate injection sites.
• For intermittent I.V. infusion, dilute further with 100 ml of sterile water or another compatible fluid, such as normal saline solution or dextrose 5% in water. Infuse over 30 minutes.
• Don't dilute with sodium bicarbonate.
• For I.M. injection, reconstitute with sterile water, bacteriostatic water, or 0.5% or 1% lidocaine hydrochloride.
• When giving I.M., inject deep into large muscle mass.
CNS: headache, confusion, hemiparesis, lethargy, paresthesia, syncope, asterixis, neuromuscular excitability (with increased drug blood levels in renally impaired patients), seizures, encephalopathy
CV: hypotension, palpitations, chest pain, vasodilation
EENT: hearing loss
GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
GU: vaginal candidiasis, nephrotoxicity
Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
Hepatic: hepatic failure, hepatomegaly
Skin: urticaria, maculopapular or erythematous rash
Other: chills, fever, superinfection, I.M. site pain, anaphylaxis, serum sickness
Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity
Chloramphenicol: antagonism of ceftazidime's effects
Probenecid: decreased excretion and increased blood level of ceftazidime
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Hemoglobin, platelets, white blood cells: decreased values
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results
Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding
Monitor for extreme confusion, tonic-clonic seizures, and mild hemiparesis when giving high doses.
• Assess CBC and kidney and liver function test results.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.
• Instruct patient to report reduced urine output, persistent diarrhea, bruising, and bleeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.