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Fortaz, Fortum (UK), Tazicef
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.
ClassificationTherapeutic: anti infectives
Pharmacologic: third generation cephalosporins
- Skin and skin structure infections,
- Bone and joint infections,
- Urinary tract infections,
- Gynecological infections,
- Lower respiratory tract infections,
- Intra-abdominal infections,
- Febrile neutropenia,
- Haemophilus influenzae(including β-lactamase-producing strains),
- Escherichia coli,
- Klebsiella pneumoniae,
- Neisseria meningitidis,
- Pseudomonas aeruginosa,
- Moraxella catarrhalis.
|IV||rapid||end of infusion||6–12 hr|
Adverse Reactions/Side Effects
Central nervous system
- seizures (high doses in patients with renal impairment) (life-threatening)
- pseudomembranous colitis (life-threatening)
- abdominal pain
- rashes (most frequent)
- blood dyscrasias
- hemolytic anemia
- pain at IM site (most frequent)
- phlebitis at IV site (most frequent)
- allergic reactions including anaphylaxis (life-threatening)
Drug-Drug interactionConcurrent use of loop diuretics or nephrotoxic agents includingaminoglycosides may ↑ risk of nephrotoxicity.Bactericidal activity ↓ by chloramphenicol.
Renal ImpairmentIntramuscular Intravenous (Adults) CCr 31–50 mL/min—1 g every 12 hr; CCr 16–30 mL/min—1 g every 24 hr; CCr 6–15 mL/min—500 mg every 24 hr; CCr <5 mL/min—500 mg every 48 hr.
Availability (generic available)
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
- Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported 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 positive results for Coombs' test.
- May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
- May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, and lymphocytosis.
Potential Nursing DiagnosesRisk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
- Do not confuse ceftazidime with cefazolin, cefoxitin, cefotetan, or ceftriaxone.
- Intramuscular: Reconstitute IM doses with sterile or bacteriostatic water for injection. May be diluted with lidocaine to a concentration of 280 mg/mL to minimize injection discomfort.
- Inject deep into a well-developed muscle mass; massage well.
- pH: 5.0–8.0.
- Intravenous: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis.
- If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.
- Reconstitute with 10 mL of 0.9% NaCl, D5W, or sterile water. Do not use preparations containing benzyl alcohol for neonates.
- Rate: Administer at a maximum concentration of 180 mg/mL slowly over 3–5 min.
- Intermittent Infusion: Diluent: Reconstituted solution may be further diluted with 0.9% NaCl, D5W, D10W, D5/0.25% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, or lactated Ringer's solution. Concentration: Maximum of 40 mg/mL. Dilution causes carbon dioxide to form inside vial, resulting in positive pressure; vial may require venting after dissolution to preserve sterility of vial. Solution may appear yellow to amber; darkening does not alter potency. Solution is stable for 18 hr at room temperature and 7 days if refrigerated.
- Rate: Administer over 15–30 min.
- Y-Site Compatibility: acyclovir, alfentanyl, allopurinol, amifostine, aminocaproic acid, aminophylline, amphotericin B lipid complex, anakinra, anidulafungin, argatroban, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, cefazolin, cefoperazone, cefotetan, cefoxitin, ceftriaxone, cefuroxime, ciprofloxacin, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, docetaxel, dopamine, doxacurium, doxapram, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, norepinephrine, octreotide, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, penicillin G, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium acetate, potassium chloride, procainamide, propranolol, pyridoxime, ranitidine, remifentanil, rituximab, rocuronium, sodium acetate, sodium bicarbonate, sodium citrate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, thiotepa, ticarcillin/clavulanate, tigecycline, tiriofiban, tolazoline, trastuzumab, trimetaphan, vasopressin, vecuronium, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: alemtuzumab, amiodarone, amphotericin B cholesteryl, amphotericin B liposome, amsacrine, ascorbic acid, atracurium, azathioprine, azithromycin, calcium chloride, caspofungin, cefotaxime, chloramphenicol, chlorpromazine, dantrolene, diazepam, diazoxide, diphenhydramine, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, epirubicin, ganciclovir, haloperidol, hydralazine, hydroxyzine, idarubicin, midazolam, mitoxantrone, mycophentolate, nitroprusside, papaverine, pemetrexed, pentamidine, pentazocine, phenytoin, prochlorperazine, promethazine, protamine, quinupristin/dalfopriatin, thiamine, trimethoprim/sulfamethoxazole, verapamil, warfarin
- Advise patient to report 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.
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.