Dosing and uses of Fortaz, Tazicef (ceftazidime)
Adult dosage forms and strengths
injectable solution
- 20mg/mL
- 40mg/mL
powder for injection
- 500mg
- 1g
- 2g
- 6g
Bone & Joint Infections
2 g IV q12hr
Gynecologic & Intra-abdominal Infections
2 g IV q8hr for 4-7 days
Pulmonary Infections
Infections caused by Pseudomonas spp in patients with cystic fibrosis who have healthy renal function
30-50 mg/kg IV q8hr; not to exceed 6 g/day
Meningitis
2 g IV q8hr
Pneumonia
Uncomplicated: 0.5-1 g IV q8hr
Complicated: 2 g IV q8hr
Mild Skin/Skin Structure Infections
0.5-1 g IV or IM q8hr
Urinary Tract Infections
Complicated: 500 mg IV or IM q8-12hr
Uncomplicated: 250 mg IV or IM q12hr
Life-Threatening Infections
Especially in immunocompromised patients
2 g IV q8hr
Dosing Modifications
Renal impairment
- Modifications based on 1-g dose
- CrCl 31-50 mL/min: 1 g q12hr
- CrCl 16-30 mL/min: 1 g q24hr
- CrCl 6-15 mL/min: 500 mg q24hr
- CrCl <5 mL/min: 500 mg q48hr
Dosing Considerations
Susceptible organisms
- Citrobacter spp, Clostridium spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Neisseria meningitidis, Proteus mirabilis, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes
Pediatric dosage forms and strengths
injectable solution
- 20mg/mL
- 40mg/mL
powder for injection
- 500mg
- 1g
- 2g
- 6g
Infections Caused by Susceptible Organisms
<1 month: Safety and efficacy not established
1 month-12 years: 30-50 mg/kg IV q8hr; not to exceed 6 g/day (higher end of dosing range reserved for patietns with immunocompromise, meningitis, or cystic fibrosis)
>12 years: 1-2 g IV q8hr
Dosing Considerations
Use sodium carbonate preparation
Usual dosing range for neonates (per manufacturer)
- <28 days: 30 mg/kg IV q12hr
Usual dosing range for neonates (per American Academy of Pediatrics)
- 7-28 days: 50 mg/kg IV q8hr
- <7 days, <2 kg: 50 mg/kg IV q12hr
- <7 days, >2 kg: 50 mg/kg IV q8-12hr
Fortaz, Tazicef (ceftazidime) adverse (side) effects
1-10%
Transient increases in transaminases (3-9%)
Eosinophilia (<7%)
Diarrhea (<2%)
Immune hypersensitivity reaction (2%)
Phlebitis (<2%)
Rash (maculopapular or erythematous) (2%)
Thrombocytosis (2%)
Injection site pain (1%)
<1%
Abdominal pain
Agranulocytosis
Angioedema
Asterixis
Coma
Dizziness
Encephalopathy
Fever
Hallucinations
Increased serum concentrations of bilirubin
Leukopenia
Lymphocytosis
Metallic taste
Myoclonia
Nausea or vomiting
Neuromuscular excitability
Neutropenia
Paresthesia
Photosensitivity
Pruritus
Seizures
Thrombocytopenia
Transient increases in blood urea nitrogen (BUN) or serum creatinine
Urticaria
Warnings
Contraindications
Documented hypersensitivity to drug or components
Cautions
High serum concentrations may result in serious adverse nervous system effects
Elevated international normalized ratio (INR) has reported in patients with nutritional deficiency, prolonged treatment, or renal or hepatic disease
Use with caution in patients with history of seizure disorder (especially in renal impairment, where drug levels may increase significantly)
Modify dose in renal impairment
Use with caution in patients with history of penicillin allergy
Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Pregnancy and lactation
Pregnancy category: B
Lactation: Drug excreted in breast milk; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Fortaz, Tazicef (ceftazidime)
Mechanism of action
Third-generation cephalosporin with broad-spectrum gram-negative activity, including Pseudomonas; has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms; arrests bacterial growth by binding to 1 or more penicillin-binding proteins, thereby, in turn, inhibiting final transpeptidation step of peptidoglycan synthesis in bacterial cell-wall synthesis and inhibiting cell-wall biosynthesis
Absorption
Peak plasma time: IM, 1 hr
Distribution
Widely distributed to body tissues and fluids, including aqueous humor, ascitic and prostatic fluids, and bone; penetrates CSF when meninges are inflamed
Protein bound: 5-24%
Metabolism
Not metabolized
Elimination
Half-life: 1-2 hr
Dialyzable: Hemodialysis, yes; peritoneal dialysis, yes
Excretion: Urine (80-90% as unchanged drug)
Administration
IV Incompatibilities
Additive: Amikacin, aminophylline, ciprofloxacin, gentamicin, ranitidine
Y-site: Amiodarone, amphotericin B cholesteryl complex, azithromycin, amsacrine, clarithromycin, cisatracurium(?), doxorubicin liposome, erythromycin lactobionate, fluconazole(?), idarubucin, midazolam, nicardipine (incompatible at ceftazidime 125 mg/mL but compatible at ceftazidime 10 mg/mL), pentamidine, propofol (incompatible at ceftazidime 125 mg/mL but compatible at ceftazidime 40 mg/mL), sagramostim(?), vancomycin(?), warfarin
IV/IM Administration
IV
- Direct injection: Inject over 3-5 minutes directly into vein or through tubing of running compatible infusion solution
- Infusion: Infuse intermittently over 15-30 minutes
Im
- Inject deeply
Storage
Store intact vials at room temperature, protected from light
