Ceftazidime Dosage

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Usual Adult Dose for Bacteremia

2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Meningitis

2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Sepsis

2 g IV every 8 hours for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for 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.

Usual Adult Dose for Endometritis

2 g IV or IM every 8 hours

Parenteral therapy should be continued for at least 24 hours after the patient has remained afebrile, pain free, and the leukocyte count has normalized. Doxycycline therapy for 14 days is recommended if concurrent chlamydial infection is present in late postpartum patients (breast-feeding should be discontinued).

Usual Adult Dose for Febrile Neutropenia

2 g IV every 8 hours

Therapy should be continued for approximately 14 days, or until more specific therapy may be substituted for a proven infection, or until the patient is afebrile for 24 hours after the absolute neutrophil count is greater than 500/mm3. The total duration of therapy depends on the nature and severity of the infection.

Usual Adult Dose for 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.

Usual Adult Dose for Intraabdominal Infection

2 g IV every 8 hours for 7 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Melioidosis

2 g IV every 8 hours

Parenteral therapy should be continued for at least 10 days, followed by doxycycline 100 mg orally twice daily plus chloramphenicol 10 mg/kg orally (not available in the United States) four times daily plus sulfamethoxazole-trimethoprim 25 mg/kg - 5 mg/kg orally twice a day. Doxycycline and sulfamethoxazole-trimethoprim should be continued for 20 weeks; chloramphenicol for the first 8 weeks.

Usual Adult Dose for Nosocomial Pneumonia

2 g IV every 8 hours

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for 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. Chronic osteomyelitis may require an additional 1 to 2 months of oral antibiotics. Surgical debridement may be helpful.

Usual Adult Dose for Otitis Externa

Malignant (necrotizing) otitis externa: 2 g IV every 8 hours

Therapy may be required for 2 to 6 weeks, depending on the nature and severity of the infection.

Usual Adult Dose for Otitis Media

Otitis media in hospitalized intubated patients: 2 g IV every 8 hours

Usual Adult Dose for 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.

Usual Adult Dose for 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

Usual Adult Dose for 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.

Usual Adult Dose for 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

Usual Adult Dose for Pyelonephritis

1 to 2 g IV or IM every 8 hours for approximately 14 days, depending on the nature and severity of the infection

Usual Adult Dose for 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

Usual Adult Dose for 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.

Usual Adult Dose for Cystitis

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.

Usual Adult Dose for 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.

Usual Pediatric Dose for 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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Cystitis

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Intraabdominal Infection

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Joint Infection

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Meningitis

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Osteomyelitis

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Peritonitis

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Pneumonia

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Pneumonia with Cystic Fibrosis

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Pyelonephritis

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Septicemia

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Urinary Tract Infection

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Skin and Structure Infection

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Usual Pediatric Dose for Nosocomial Pneumonia

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/day
13 years or older: Adult dosage

The higher dose range should be reserved for patients with meningitis, cystic fibrosis, or immunocompromised patients.

Renal Dose Adjustments

CrCl 31 to 50 mL/min: 1 g IV every 12 hours
CrCl 16 to 30 mL/min: 1 g IV every 24 hours
CrCl 6 to 15 mL/min: 500 mg IV every 24 hours
CrCl less than 5 mL/min: 500 mg IV every 48 hours

If the usual recommended dosage is less than the dosage recommended for patients with renal dysfunction, the lower dosage should be administered. In severe infections where the usual dosage is 6 g/day in patients with normal renal function, the dose listed above may be increased by 50% or the dosing frequency may be increased appropriately.

Liver Dose Adjustments

Data not available

Dose Adjustments

The dose adjustment for renal dysfunction may be increased by 50% or the dosing frequency may be increased appropriately in patients with severe infections.

Precautions

11 years or less: Safety and efficacy of the L-arginine formulation has not been established. Ceftazidime sodium is recommended for this age group.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following cephalosporin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Cephalosporins may be associated with a fall in prothrombin activity. Risk factors include renal or hepatic impairment, poor nutritional state, a protracted course of antimicrobial therapy, and chronic anticoagulation therapy. Prothrombin times should be monitored and vitamin K therapy initiated if indicated.

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Cephalosporins have been known to occasionally induce a positive direct Coombs' test and a false-positive urine glucose test (with Clinitest(R), Benedict's or Fehling's solution).

Neurotoxicity (seizures, encephalopathy, coma, myoclonia, asterixis, and neuromuscular toxicity) has been associated with elevated serum concentrations in renally impaired patients. The drug should be discontinued if seizures occur. Nephrotoxicity has occurred with concomitant cephalosporins and aminoglycosides or potent diuretics.

Distal necrosis may occur after inadvertent intra-arterial administration.

Resistance may develop during therapy; therefore, periodic susceptibility testing is recommended. Inducible type I beta-lactamase resistance has occurred with some organisms (e.g., Enterobacter, Pseudomonas, and Serratia). An additional antibiotic may be added if monotherapy fails.

Dialysis

Hemodialysis: A loading dose of 1 g IV is recommended, followed by 1 g IV after each hemodialysis.

CAVH/CVVH: Dose as for GFR 10 to 50 mL/min, or base on estimated drug clearance

Peritoneal dialysis: A loading dose of 1 g IV is recommended, followed by 500 mg IV every 24 hours. Ceftazidime sodium can be incorporated in the dialysis fluid at a concentration of 250 mg for 2 L of dialysis fluid.

Other Comments

Generally ceftazidime should be continued for 2 days after the signs and symptoms of infection have disappeared, but in complicated infections longer therapy may be required.

Doses may be administered intramuscularly; however, the intravenous route is preferred for severe or life-threatening infections such as sepsis/septicemia, bacteremia,meningitis, peritonitis, and for patients with reduced resistance (i.e., malnutrition, trauma, surgery, heart failure, malignancy, or shock).

Renal function should be monitored, especially in elderly patients.

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