Aztreoced
(Aztreonam 500mg/1gm/2gm Injection)
- Aztreonam offers greater flexibility of treatment options and reduce the selective pressure from the use of Carbapenems, Piperacillin/Tazobactam, Aminoglycosides and third-generation Cephalosporins.
- Aztreonam has clinically useful potency against aerobic Gram-negative bacteria, including those expressing Ambler class B metallo-b-lactamases (MBLs).2
INDICATIONS
- Complicated and Uncomplicated Urinary Tract Infections (pyelonephritis and cystitis caused by E.coli, K.pneumoniae, P.mirabilis, Paeruginosa, E.cloacae, K. oxytoca, Citrobacterspp, and S. Marcescens)
- Lower Respiratory Tract Infections (pneumonia and bronchitis caused by E.coli, K.pneumoniae, Pmirabilis, Paeruginosa, H.influenzae, Enterobacter spp, and S. Marcescens)
- Septicemia (E.coli, K.pneumoniae, Paeruginosa, P.mirabilis, S. marcescens, and Enterobacter spp)
- Skin and Skin-Structure Infections (those associated with postoperative wounds, ulcers, and burns, caused by E. coli, P. mirabilis, S. marcescens, Enterobacter spp, P. aeruginosa, K. pneumoniae, and Citrobacter spp)
- Intra-abdominal Infections (peritonitis caused by E. coli, K. pneumoniae, Enterobacter spp, P. aeruginosa, Citrobacter spp and Serratia spp)
- Gynecologic Infections (endometritis and pelvic cellulitis caused by E.coli, K. pneumoniae, Enterobacter spp and P. Mirabilis)
ADMINISTRATION AND DOSAGE
- Route of administration and Dosage should be determined by susceptibility of the causative organisms, severity and site of infection, and the condition of the patient.
- Administered IV (Bolus Injection & Infusion) or by IM.
Dosage Guidelines for Adults
| Type of Infections | Dose | Frequency (hours) |
|---|---|---|
| Urinary Tract Infections | 500 mg or 1 g | 8 or 12 |
| Moderately severe systemic infections | 1 gor 2 g | 8 or 12 |
| Severe systemic or life-threatening infections | 2g | 6 or 8 |
- IV is recommended for patients ts requiring single doses greater than 1 or those with bacterial septicemia, localized parenchymal abscess (eg, intra-abdominal abscess) peritonitis, or other severe systemic or life-threatening infections
- Maximum recommended dose is 8 g per day.
Pyelonephritis Treatment Guideline
| Inpatient Treatment | Second-line therapy (preferred if patient is critically ill or pregnant) |
|---|---|
| Patients with Pyelonephritis who require hospitali- zation should be treated with IV antimicrobial regimens. Therapy should be given for 24-48 h or until severe symptoms improve. Duration of therapy should be 10-14 d, inclusive of initial IV therapy | Monobactam (Penicillin allergy): Aztreonam 2g IV q6h |
The treatment of choice should be based on local resistance data, and the drug regimen should be tailored according to susceptibility results.
Empiric Treatment of Complicated Intra-abdominal Infection
| Antibiotic | Adult dosage |
|---|---|
| Aztreonam | 1-2 g every 6-8 h |
Dosages are based on normal renal and hepatic function.
- J Antimicrob Chemother 2015
- J Antimicrob Chemother 2016: 71: 2704-2712
- Medscape, Updated: Dec 01, 2015
- Complicated Intra-abdominal Infection Guidelines: CID 2010:50 (15 January)
IDSA and ATS 2016 guidelines - Management of Adults With Hospital-acquired Pneumonia (HAP) and Ventilator-associated Pneumonia (VAP)
Empiric Treatment Option for Clinically Suspected VAP in Units Where Antipseudomonal / Gram-Negative Coverage is Appropriate
| Gram-Negative Antibiotics With Antipseudomonal Activity: ẞ-Lactam-Based Agent |
|---|
| Monobactam - Aztreonam 2 g IV q8h |
In the absence of other options, it is acceptable to use Aztreonam as an adjunctive agent with another ẞ-lactam-based agent because it has different targets within the bacterial cell wall
Recommended Initial Empiric Antibiotic Therapy for HAP (Non-VAP)
| Not at High Risk of Mortality but With Factors Increasing the Likelihood of MRSA | Aztreonam 2 g IV q8h |
| Plus: Vancomycin 15mg/kg IV q8-12h with goal to target 15-20 15-20 mg/mL mg/mL trough trough level (consider a loading dose of 25-30 mg/kg x 1 for severe illness) OR Linezolid 600 mg IV q12h | |
| Not at High Risk of Mortality but With Factors Increasing the Likelihood of MRSA | Aztreonam 2 g IV q8h |
| Plus: Vancomycin 15mg/kg IV q8-12h with goal to target 15-20 15-20 mg/mL mg/mL trough trough level (consider a loading dose of 25-30 mg/kg x 1 for severe illness) OR Linezolid 600 mg IV q12h |
- Risk factors for mortality include need for ventilatory support due to pneumonia and septic shock.
- Indications for MRSA coverage include intravenous antibiotic treatment during the prior 90 days, and treatment in a unit where the prevalence of MRSA among S. aureus isolates is not known or is >20%. Prior detection of MRSA by culture or non-culture screening may also increase the risk of MRSA. The 20% threshold was chosen to balance the need for effective initial antibiotic therapy against the risks of excessive antibiotic use; hence, individual units can elect to adjust the threshold in accordance with local values and preferences. IfMRSA coverage is omitted, the antibiotic regimen should include coverage for MSSA.
- If patient has factors increasing the likelihood of gram-negative infection, 2 antipseudomonal agents are recommended. If patient has structural lung disease increasing the risk of gram negative infection (ie, bronchiectasis or cystic fibrosis), 2 antipseudomonal agents are recommended. A high-quality Gram stain from a respiratory specimen with numerous and predominant gram-negative bacilli provides further support for the diagnosis of a gram-negative pneumonia, including fermenting and non-glucose- fermenting microorganisms.