Ceftazidime is a beta-lactam, third-generation broad-spectrum semisynthetic, bactericidal activity with antibacterial cephaloridine and used especially for Pseudomonas and other gram-negative infections in debilitated patients. Ceftazidime binds to and inactivates penicillin-binding proteins (PBP) located on the inner membrane of the bacterial cell wall. PBPs participate in the terminal stages of assembling the bacterial cell wall, and in reshaping the cell wall during cell division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis. Compared to the second and first generation cephalosporins, ceftazidime is more active against gram-negative bacteria and less active against gram-positive bacteria. Ceftazidine also crosses the blood-brain barrier and reaches therapeutic concentrations in the central nervous system (CNS).
Mechanism of Action of Ceftazidime
The bactericidal activity of ceftazidime results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs).Ceftazidime is a semisynthetic, broad-spectrum, beta-lactam antibiotic for parenteral administration. Ceftazidime is bactericidal in action exerting its effect by inhibition of enzymes responsible for cell-wall synthesis, primarily penicillin binding protein 3 (PBP3). A wide range of gram-negative organisms is susceptible to ceftazidime in vitro, including strains resistant to gentamicin and other aminoglycosides. In addition, ceftazidime has been shown to be active against gram-positive organisms. It is highly stable to most clinically important beta-lactamases, plasmid or chromosomal, which are produced by both gram-negative and gram-positive organisms and, consequently, is active against many strains resistant to ampicillin and other cephalosporins. Ceftazidime has activity against the gram-negative organisms Pseudomonas and Enterobacteriaceae. Its activity against Pseudomonas is a distinguishing feature of ceftazidime among the cephalosporins.
Indications of Ceftazidime
- Bacterial infections
- Bloodstream infections
- Bone and joint infections
- Central nervous system infections
- Complicated urinary tract infections caused by susceptible Gram-negative microorganisms
- Meningitis
- Sepsis
- Endocarditis
- Endometritis
- Febrile neutropenia
- Intraabdominal infection
- Melioidosis
- Osteomyelitis
- Otitis externa
- Otitis media
- Pelvic inflammatory disease
- Peritonitis
- Pneumonia
- Pneumonia with cystic fibrosis
- Pyelonephritis
- Sinusitis
- Skin or soft tissue infection
- Cystitis
- Urinary tract infection
- Lower respiratory tract infection
- Skin structures and soft tissue infections
- Urinary tract infections
- Ventilator-associated bacterial pneumonia caused by susceptible Gram-negative microorganisms
- Hospital-acquired bacterial pneumonia caused by susceptible Gram-negative microorganisms
- Susceptible intra-abdominal infection caused by the susceptible Gram-negative microorganism
Contra-Indications of Ceftazidime
- Liver problems
- Interstitial nephritis
- Subacute cutaneous lupus erythematosus
- Systemic lupus erythematosus
- Allergies cephalosporins & beta-lactams
Dosage of Ceftazidime
Strengths: 500 mg; 1 g; 2 g; 6 g; 1 g/50 mL; 2 g/50 mL;
Osteomyelitis
- 2 g IV every 8 hours
- Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection.
Meningitis
- 2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection
Sepsis
- 2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection
Endocarditis
- 2 g IV every 8 hours
- Treatment may be required for 6 weeks or more, depending on the nature and severity of the infection.
Joint Infection
- 2 g IV every 8 hours
- Therapy should be continued for approximately 3 to 4 weeks, depending on the nature and severity of the infection.
- Longer therapy, 6 weeks or more, may be required for prosthetic joint infections.
Intra abdominal Infection
- 2 g IV every 8 hours for 7 to 14 days, depending on the nature and severity of the infection
Otitis Media
- Otitis media in hospitalized intubated patients: 2 g IV every 8 hours
Pelvic Inflammatory Disease
- 2 g IV or IM every 8 hours
- Therapy should be continued for at least 48 hours after clinical improvement is demonstrated.
- Oral therapy should then be continued to complete a 14-day course of treatment.
Peritonitis
- 1 to 2 g IV every 8 hours for 10 to 14 days, depending on the nature and severity of the infection
- Peritoneal dialysis patients (ceftazidime sodium):
- Intermittent: 1 g/2 L dialysate intraperitoneally once daily
- Continuous: 1 g /2 L dialysate intraperitoneally, followed by 250 to 500 mg/2 L dialysate
Pneumonia
- 1 to 2 g IV or IM every 8 hours
- Therapy should be continued for 7 to 21 days, depending on the nature and severity of the infection.
Pneumonia with Cystic Fibrosis
- Lung infections caused by Pseudomonas: 30 to 50 mg/kg IV every 8 hours to a maximum of 6 g/day, in patients with normal renal function
Sinusitis
- Sinusitis in intubated patients: 2 g IV every 8 hours for 10 to 14 days, depending on the nature and severity of the infection
Skin or Soft Tissue Infection
- 1 to 2 g IV or IM every 8 hours
- Therapy should be continued for approximately 7 to 10 days, or for 3 days after the acute inflammation disappears, depending on the nature and severity of the infection.
- For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.
- Vibrio vulnificus: 1 to 2 g IV every 8 hours plus doxycycline 100 mg IV or orally every 12 hours or ciprofloxacin 400 mg IV every 12 hours.
Urinary Tract Infection
- Uncomplicated: 250 mg IV or IM every 12 hours for approximately 3 to 7 days, depending on the nature and severity of the infection
- Complicated: 500 mg IV or IM every 8 to 12 hours for 2 to 3 weeks, depending on the nature and severity of the infection
- Parenteral therapy is generally not indicated for uncomplicated infections.
Pediatric Bacteremia
- 0 to 4 weeks, birthweight 1199 g or less: 30 to 50 mg/kg IV every 12 hours
- 0 to 7 days, birthweight 1200 to 2000 g: 30 to 50 mg/kg IV every 12 hours
- 0 to 7 days, birthweight 2001 g or more: 30 to 50 mg/kg IV every 8 to 12 hours
- 7 days to 4 weeks, birthweight 1200 g or more: 30 to 50 mg/kg IV every 8 to 12 hours
- 1 month to 12 years: 30 to 50 mg/kg IV every 8 hours; maximum dose is 6 g/day13 years or older
Side Effects
The most common
- local tenderness or pain at the site of injection
- skin color change, mild diarrhea
- mild nausea
- loss of appetite
- vaginal discharge and itching
- swelling of feet or legs
- chest pain
- constipation
- a cough
- diarrhea or loose stools
- difficulty with breathing
- dizziness
- heartburn
More common
- Abdominal or stomach pain, discomfort, or tenderness
- chills or fever
- difficulty with moving
- a headache, severe and throbbing
- joint or back pain
- muscle aching or cramping
- muscle pains or stiffness
- chest pressure or squeezing pain in chest
- excessive sweating
- feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
- sudden tingling or coldness in an arm or leg
- sudden slow or difficult speech
- sudden drowsiness or need to sleep
- fast breathing
- sharp pain when taking a deep breath
- fast or slow heartbeat
- coughing up blood
- rust colored urine
- decreased amount of urine
Rare
- Anxiety
- change in vision
- seizures
- abnormal or fast heart rate
- tremors
- weight loss
- chest pain or tightness
- confusion
- a cough
- Agitation
- arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- convulsions
- extra heartbeats
- fainting
- hallucinations
- a headache
- irritability
- lightheadedness
- mood or mental changes
- muscle pain or cramps
Drug Interactions
Ceftazidime may interact with the following drugs, supplements, & may change the efficacy of drugs
- aminoglycoside antibiotics (e.g., gentamicin, tobramycin)
- probenecid
- typhoid vaccine
- cholera vaccine,
- amoxicillin
- BCG vaccine
- Aspirin Low Strength (aspirin)
- Diphenhydramine
- Rosuvastatin
- Duloxetine
- Albuterol
- Topiramate
- Carbamazepine
- Vitamin D3 (cholecalciferol)
- Alprazolam
- Cetirizine
- Phenprocoumon
- Picosulfuric acid
- Warfarin
Pregnancy Catagory
FDA Pregnancy Category B
Pregnancy
It is not known if ceftazidime is safe for use by pregnant women. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Lactation
This medication may passes into breast milk. If you are a breast-feeding mother and are taking ceftazidime it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. It is not known if ceftazidime is safe for children under 6 months of age.
References
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