Aztreonam

General
  • Type: Monobactam antibiotic
  • Dosage forms: powder for injection
  • Dosage strengths: 1g, 2g
  • Routes of Administration: IM, IV
  • Common Trade Names: Azactam

Other
  • Antimicrobial activity more closely resembles AG's (only active against gram -)
    • Enterobacter, pseudomonas, H. influenzae, gonococci
    • Little allergic cross-reactivity with B-lactam antibiotics

Adult Dosing

General (Moderate Severe)
  • 1-2g IM/IV q8-12h
  • Max: 8g/day

General (Severe)
  • 2g IM/IV q6-8h
  • Max: 8g/day

Pediatric Dosing

General (Neonates)
  • <7 days old
    • <2000g
      • 60mg/kg/day IV divided q12h
      • First ED Dose: 30mg/kg x 1
    • >2000g
      • 90mg/kg/day IV divided q8
      • First ED Dose: 30mg/kg x 1
  • 7 days - 1 month
    • <1200g
      • 60mg/kg/day IV divided q12h
      • First ED Dose: 30mg/kg x 1
    • 1200-2000g
      • 90mg/kg/day IV divided q8
      • First ED Dose: 30mg/kg x 1
    • >2000g
      • 120mg/kg/day IV divided q6
      • First ED Dose: 30mg/kg x 1

General (1 Month - 9 Months)
  • General
    • 90-120mg/kg/day IV divided q6-8h
    • First ED Dose: 40mg/kg x 1
  • Respiratory Infections in Cystic Fibrosis
    • 200mg/kg/day IV divided q6h
    • First ED Dose: 40mg/kg x 1
    • Max: 8g/day

General >9 Months)
  • 90-120mg/kg/day IV divided q6-8
  • First ED Dose: 40mg/kg x 1

Special Populations
  • Pregnancy Rating: B
  • Lactation: Safe
  • Renal
    • Adult
      • CrCl 10-30: 1-2g x1, then decrease dose 50%
      • CrCl <10: give usual dose x1, then decrease dose 75%
      • Hemodialysis: give 12.5% of initial dose as supplement
      • Peritoneal dialysis: no supplement
    • Pediatric
      • CrCl 10-30: decrease dose 50%
      • CrCl <10: decrease dose 75%
      • Hemodialysis: give supplement
      • Peritoneal dialysis: no supplement
  • Hepatic (Adult & Pediatric)
    • caution advised, but not defined

Contraindications
  • Allergy to class/drug

Adverse Drug Reactions

Serious

Common
  • Phlebitis
  • Injection site reaction
  • Diarrhea
  • Nausea/vomiting
  • Rash
  • Transaminitis
  • Elevated creatinine
  • Eosinophilia

Pharmacology
  • Half-life: 1.7h (4.7-6h ESRD)
  • Metabolism: CYP450, minimal liver
  • Excretion: Urine
  • Mechanism of Action: Bactericidal; inhibits cell wall synthesis

Antibacterial Spectra [1]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GR
Strep. PneumoniaeR
Viridans strepR
Strep. anginosus gpR
Enterococcus faecalisR
Enterococcus faeciumR
MSSAR
MRSAR
CA-MRSAR
Staph. EpidermidisR
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeS
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spS
Serratia marcescensX1
Salmonella spX1
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaS
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesR
Bacteroides fragilisR
Prevotella melaninogenicaR
Clostridium difficileR
Clostridium (not difficile)R
Fusobacterium necrophorumX1
Peptostreptococcus sp.R

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  • Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed, Philadelphia, PA: American College of Physicians, 2007.
  • Azactam (aztreonam) injection [prescribing information]. Princeton, NJ: Bristol-Myers Squibb; September 2018.
  • Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. [PubMed 26229122]10.1093/cid/civ482
  • Bosso JA and Black PG, “The Use of Aztreonam in Pediatric Patients: A Review,” Pharmacotherapy, 1991, 11(1):20-5. [PubMed 1902290]
  • Bratzler DW, Dellinger EP, Olsen KM, et al, “Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery,” Am J Health Syst Pharm, 2013, 70(3):195-283. [PubMed 23327981]
  • Brogden RN, Heel RC. Aztreonam. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1986;31(2):96-130. [PubMed 3512234]
  1. Sanford Guide to Antimicrobial Therapy 2014
  • Epocrates

References
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