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Generic Name: Aztreonam
Class: Monobactams
Chemical Name: [2S - [2α,3β(Z)]] - 2 - [[[1 - (2 - Amino - 4 - thiazolyl) - 2 - [2 - methyl - 4 - oxo - 1 - sulfo - 3 - azetidinyl)amino] - 2 - oxoethylidene]amino]oxy] - 2 - methylpropanoic acid
CAS Number: 78110-38-0

Introduction

Antibacterial; monocyclic β-lactam antibiotic; monobactam.1 42 43 44 246

Uses for Azactam

Bone and Joint Infections

Has been used for treatment of bone and joint infections (including osteomyelitis or septic arthritis) caused by susceptible Enterobacter, Escherichia coli, Haemophilus influenzae, Klebsiella, Proteus mirabilis, Pseudomonas aeruginosa, or Serratia marcescens.48 166 172 173 177 178 220 267 268 282

If gram-positive bacteria are known or suspected to also be present, an antistaphylococcal anti-infective (e.g., penicillinase-resistant penicillin, vancomycin) should be used concomitantly.177

Gynecologic Infections

Treatment of gynecologic infections (including endometritis and pelvic cellulitis) caused by susceptible Enterobacter (including E. cloacae), E. coli, K. pneumoniae, or P. mirabilis.a 171 173 183 192 211

Should not be used alone for empiric treatment of gynecologic infections since these usually are polymicrobial and frequently are mixed aerobic-anaerobic bacterial infections.171 173 183 211 Clindamycin or metronidazole generally used concomitantly if aztreonam is used for initial treatment of gynecologic infections.171 173 177 183 211 213 214 267

Intra-abdominal Infections

Treatment of intra-abdominal infections (including peritonitis) caused by susceptible Citrobacter (including C. freundii), Enterobacter (including E. cloacae), E. coli, Klebsiella (including K. pneumoniae), Ps. aeruginosa, or Serratia (including S. marcescens).a 173 177 213 214

Should not be used alone for empiric treatment of intra-abdominal infections since these infections usually are polymicrobial and frequently are mixed aerobic-anaerobic bacterial infections.173 213 214 Clindamycin or metronidazole generally used concomitantly if aztreonam is used for initial treatment of intra-abdominal infections.173 177 213 214

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Respiratory Tract Infections

Treatment of lower respiratory tract infections (including pneumonia and bronchitis) caused by susceptible Enterobacter, E. coli, H. influenzae, K. pneumoniae, Ps. aeruginosa, P. mirabilis, or S. marcescens.a 165 167 168 169 173 176 177 192 206 208 222

Also has been used for treatment of lower respiratory tract infections caused by susceptible Citrobacter,167 168 176 206 208 264 267 Hafnia,264 K. oxytoca,168 Morganella,206 208 264 P. vulgaris,165 P. stuartii,192 or Moraxella catarrhalis.165 208 264

Should not be used alone for empiric treatment of lower respiratory tract infections since these infections frequently are caused by gram-positive and/or anaerobic bacteria.1 48 164 165 176 186 202 206 208 223 235 241 264 266 268

A combination regimen of clindamycin and aztreonam has been used for initial empiric treatment of lower respiratory tract infections (especially nosocomial infections).165 167 206 235 264 268 ATS has suggested a regimen of aztreonam and clindamycin as an alternative regimen for empiric treatment of nosocomial pneumonia in patients hypersensitive to β-lactam anti-infectives297 and has recommended a combination regimen of aztreonam and an aminoglycoside as one of several possible empiric regimens for patients with nosocomial pneumonia when Ps. aeruginosa or Acinetobacter may be involved (vancomycin should be added if oxacillin-resistant [methicillin-resistant] staphylococci are suspected).297

For empiric treatment of community-acquired pneumonia (CAP) in patients at risk for Ps. aeruginosa infection who are hypersensitive to β-lactam anti-infectives, ATS has suggested a regimen of aztreonam, an aminoglycoside, and an IV fluoroquinolone active against Streptococcus pneumoniae.250

Septicemia

Treatment of septicemia caused by susceptible Enterobacter, E. coli, K. pneumoniae, Ps. aeruginosa, P. mirabilis, or S. marcescens.a 173 176 177 186 192 221 222 223

Also has been used for treatment of septicemia caused by susceptible Citrobacter264 267 or H. influenzae.186 192 264

Skin and Skin Structure Infections

Treatment of skin and skin structure infections (including those associated with postoperative wounds, ulcers, and burns) caused by susceptible Citrobacter, Enterobacter, E. coli, K. pneumoniae, P. mirabilis, Ps. aeruginosa, or S. marcescens.a 173 177 192 222 223

Adjunct to surgery in management of abscesses, cutaneous infections, infections complicating hollow viscus perforations, or infections of serous surfaces caused by susceptible gram-negative aerobic bacteria.1 264

Urinary Tract Infections (UTIs)

Treatment of uncomplicated or complicated UTIs (including pyelonephritis and initial or recurrent cystitis) caused by susceptible Citrobacter, E. cloacae, E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, Ps. aeruginosa, or S. marcescens.a 90 160 162 170 175 176 177 190 192 218 219 223

Also has been used for treatment of UTIs caused by susceptible E. aerogenes,176 218 Morganella morganii,176 218 264 267 P. vulgaris,218 or Providencia.177 218 264

Has been effective for treatment of cystitis or pyelonephritis caused by gram-negative aerobic bacteria resistant to aminopenicillins, first or second generation cephalosporins, and/or aminoglycosides.170 218 264 Although aztreonam generally is associated with less toxicity than aminoglycosides, colonization or superinfection with gram-positive bacteria (especially Enterococcus faecalis) has been reported more frequently with aztreonam than with aminoglycosides.46 90 160 164 175 188

Gonorrhea

Has been effective for treatment of uncomplicated urethral, endocervical, anorectal, and/or pharyngeal gonorrhea caused by penicillinase- or nonpenicillinase-producing Neisseria gonorrhoeae.48 101 173 197 236 Not included in current CDC recommendations for treatment of gonorrhea.284

Empiric Therapy in Febrile Neutropenic Patients

Has been used in conjunction with vancomycin (with or without amikacin) for empiric anti-infective therapy in febrile granulocytopenic adults.180 216 Because gram-positive bacteria (especially Staphylococcus epidermidis) are being reported with increasing frequency in febrile granulocytopenic patients and because aztreonam is inactive against these organisms, an anti-infective agent active against staphylococci (e.g., vancomycin) also should be used if aztreonam is used for empiric therapy in these patients.215 268 298 A regimen of aztreonam and vancomycin is considered an alternative empiric regimen in patients hypersensitive to penicillins and cephalosporins.298

Consult published protocols for the treatment of infections in febrile neutropenic patients for specific recommendations regarding selection of the initial empiric regimen, when to change the initial regimen, possible subsequent regimens, and duration of therapy in these patients.299 Consultation with an infectious disease expert knowledgeable about infections in immunocompromised patients also is advised.299

Azactam Dosage and Administration

Administration

Administer by IV injection or infusion or by deep IM injection.1 Has been administered intraperitoneally in dialysis fluid.56 196 227

IV route preferred in patients with septicemia, localized parenchymal abscess (such as intra-abdominal abscess), peritonitis, or other severe systemic or life-threatening infection and when individual doses >1 g are to be administered.1

The commercially available frozen aztreonam injection in dextrose should be used only for IV infusion.287

IV Injection

Reconstitution

For direct intermittent IV injection, reconstitute vials containing 500 mg, 1 g, or 2 g by adding 6–10 mL of sterile water for injection.1 Shake immediately and vigorously following addition of the diluent.1

Rate of Administration

Inject appropriate dose of reconstituted solution slowly over a period of 3–5 minutes either directly into a vein or into the tubing of a compatible IV solution.1

IV Infusion

When given IV via a common administration tubing used to administer another drug, especially one that is incompatible with aztreonam, the tubing should be flushed before and after aztreonam administration with an IV infusion solution compatible with both drugs; the drugs should not be given simultaneously.1 264 276 When a Y-type IV administration set is used, careful attention should be given to the calculated volume of aztreonam solution to ensure that the entire dose is infused.1 264

Reconstitution and Dilution

For intermittent IV infusion, a 100-mL bottle containing 500 mg, 1 g, or 2 g of aztreonam may be reconstituted with a compatible IV infusion solution to provide a final concentration not exceeding 20 mg/mL; each g of aztreonam should be reconstituted with ≥50 mL of compatible IV infusion solution.1 Alternatively, a vial containing 500 mg, 1 g, or 2 g of aztreonam may be initially reconstituted using ≥3 mL of sterile water for injection per g of drug and then diluted further by adding the reconstituted solution to a compatible IV infusion solution1 to provide a solution with a final concentration not exceeding 20 mg/mL.1 Shake immediately and vigorously following addition of the diluent.1 A volume control IV administration set may be used to add the appropriate dose of the initially reconstituted aztreonam solution to the compatible IV infusion solution during administration; this final dilution should provide a solution with a concentration of ≤20 mg/mL.1

Thaw the commercially available injection (frozen) at room temperature or in a refrigerator; do not force thaw by immersion in a water bath or by exposure to microwave radiation.287 A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature.287 Discard thawed injection if an insoluble precipitate is present or if container seals or outlet ports are not intact.287 The injection should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.287 Manufacturer recommends that the IV administration set be replaced every 48 hours.287

Rate of Administration

Give by IV infusion over 20–60 minutes.1 160 161 164 165 175 177 186 280

IM Administration

Inject appropriate dose of reconstituted IM solution deeply into a large muscle, such as the upper outer quadrant of the gluteus maximus or lateral part of the thigh, using usual techniques and precautions.1 264

Generally well tolerated when given IM; should not be admixed with local anesthetic agents.1 264

Reconstitution

Prepare IM solutions by reconstituting vial containing 500 mg, 1 g, or 2 g with sterile water for injection, 0.9% sodium chloride injection, bacteriostatic water for injection (with benzyl alcohol or parabens), or bacteriostatic sodium chloride injection (with benzyl alcohol).1 Use ≥3 mL of diluent per g of aztreonam.1 Shake immediately and vigorously following addition of the diluent.1

Dosage

Dosage and route of administration should be determined by the type and severity of infection, susceptibility of the causative organism, and condition of the patient.1 48 Dosages lower than those usually recommended should not be used.1

Pediatric Patients

General Dosage for Neonates
IV or IM

Neonates <1 week of age: AAP recommends 30 mg/kg every 12 hours in those weighing ≤2 kg or 30 mg/kg every 8 hours in those weighing >2 kg.300

Neonates 1–4 weeks of age: AAP recommends 30 mg/kg every 12 hours in those weighing <1.2 kg, 30 mg/kg every 8 hours in those weighing 1.2–2 kg, or 30 mg/kg every 6 hours in those weighing >2 kg.300

General Pediatric Dosage
IV

Children ≥9 months of age: Manufacturer recommends 30 mg/kg every 8 hours for treatment of mild to moderate infections or 30 mg/kg every 6 or 8 hours for treatment of moderate to severe infections.1

Children >1 month of age: AAP recommends 90 mg/kg daily given in 3 divided doses for mild to moderate infections or 120 mg/kg daily given in 4 divided doses for severe infections.300

Children with cystic fibrosis: A dosage of 50 mg/kg every 6 or 8 hours (i.e., 150–200 mg/kg daily) has been suggested.269 270 275 276 280

IM

Children >1 month of age: AAP recommends 90 mg/kg daily given in 3 divided doses for mild to moderate infections or 120 mg/kg daily given in 4 divided doses for severe infections.300

Adults

General Adult Dosage
Moderately Severe Systemic Infections
IV

1 or 2 g every 8 or 12 hours.1 166 168 173 176 177 208 211 221 222 223 267

IM

1 g every 8 or 12 hours.1 166 168 173 176 177 208 211 221 222 223 267

Severe Systemic or Life-threatening Infections
IV

2 g every 6 or 8 hours.1 168 173 208 267

Urinary Tract Infections (UTIs)
IV or IM

500 mg or 1 g every 8 or 12 hours.1 160 161 162 163 164 165 177 186 190 267

Uncomplicated UTIs usually treated for 5–10 days;160 190 complicated UTIs usually treated for ≥10–18 days.160 162 164 165

Prescribing Limits

Pediatric Patients

Treatment of Infections
IV

Maximum recommended in pediatric patients ≥9 months of age is 120 mg/kg daily, but higher dosage may be warranted in those with cystic fibrosis.1

Adults

Treatment of Infections
IV or IM

Maximum 8 g daily.1

Special Populations

Hepatic Impairment

Treatment of Infections
IV or IM

Only limited experience with use of aztreonam in patients with impaired hepatic function.264

Some clinicians recommend that dosage be decreased by 20–25% in patients with alcoholic cirrhosis, especially if long-term therapy with the drug is required;32 46 47 others suggest that this decrease in dosage is unnecessary unless renal function also is impaired.276 277

Modification of usual dosage probably unnecessary in patients with stable primary biliary cirrhosis or other chronic hepatic disease unless renal function also is impaired.2 32 56 276

Renal Impairment

Treatment of Infections
IV or IM

Doses and/or frequency of administration in adults with Clcr ≤30 mL/minute should be modified in response to the degree of renal impairment.1 2 11 30 33 46 47 48 56 203 227 256 264

Serum creatinine concentrations alone may not be sufficiently accurate to assess the degree of renal impairment, especially in geriatric adults; dosage preferably should be based on the patient’s measured or estimated Clcr.1

Adults with Clcr 10–30 mL/minute per 1.73 m2: 1- or 2-g loading dose followed by maintenance doses equal to one-half the usual dose (i.e., 250 mg, 500 mg, or 1 g) given at the usual dosage intervals.1 48 56 264

Adults with Clcr <10 mL/minute per 1.73 m2: A loading dose equal to the usual dose (i.e., 500 mg, 1 g, or 2 g) followed by maintenance doses equal to one-fourth the usual dose (i.e., 125 mg, 250 mg, or 500 mg) given at the usual dosage intervals.1 36 48 56 264

Adults undergoing hemodialysis: A loading dose equal to the usual dose (i.e., 500 mg, 1 g, or 2 g) followed by maintenance doses equal to one-fourth the usual dose (i.e., 125 mg, 250 mg, or 500 mg) given at the usual dosage intervals.1 36 48 56 264 Those with serious or life-threatening infections also should receive a supplemental dose equal to one-eighth the initial dose (i.e., 62.5 mg, 125 mg, or 250 mg) given immediately after each dialysis period.1 30 36 46 56 264 276 277

Adults undergoing CAPD: Some clinicians suggest that those with systemic infections should receive a loading dose equal to the usual dose (i.e., 500 mg, 1 g, or 2 g) followed by maintenance doses equal to one-fourth the usual dose (i.e., 125 mg, 250 mg, or 500 mg) given at the usual dosage intervals.36 46 48 227 Some clinicians suggest that adults undergoing CAPD who have peritonitis caused by susceptible organisms may receive a 1-g IV loading dose followed by maintenance doses of 500 mg given intraperitoneally in 2 L of dialysate every 6 hours.36 46 227

Data insufficient to date to make dosage recommendations for pediatric patients with impaired renal function.1

Geriatric Patients

Select dosage based on renal function.1 14 264 266 (See Renal Impairment under Dosage and Administration.)

Select dosage with caution because of age-related decreases in renal impairment.1

Cautions for Azactam

Contraindications

  • Hypersensitivity to aztreonam or any component in the formulation.1

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Colitis

Possible emergence and overgrowth of nonsusceptible bacteria (e.g., Staphylococcus aureus, Enterococcus faecalis) or fungi.1 Institute appropriate therapy if superinfection occurs.1

Treatment with anti-infectives may permit overgrowth of clostridia.1 Consider Clostridium difficile-associated diarrhea and colitis (antibiotic-associated pseudomembranous colitis) if diarrhea develops and manage accordingly.1

Some mild cases of C. difficile-associated diarrhea and colitis may respond to discontinuance alone.1 301 302 303 304 305 Manage moderate to severe cases with fluid, electrolyte, and protein supplementation; appropriate anti-infective therapy (e.g., oral metronidazole or vancomycin) recommended if colitis is severe.1 301 302 303 304 305

Sensitivity Reactions

Hypersensitivity Reactions

Immediate hypersensitivity reactions, including anaphylaxis,1 264 bronchospasm,264 generalized urticaria with or without palpebral and lingual edema and respiratory impairment,290 295 296 and a severe episode of shock, rash, and eosinophilia,175 have been reported.1 175 264

Toxic epidermal necrolysis reported rarely in patients receiving aztreonam who were undergoing bone marrow transplant and had multiple risk factors (e.g., sepsis, radiation therapy, concomitant treatment with drugs associated with toxic epidermal necrolysis).1

If hypersensitivity reaction occurs, discontinue aztreonam and initiate appropriate supportive treatment (e.g., vasopressors, antihistamines, corticosteroids, maintenance of ventilation).1 264 Serious hypersensitivity reactions may require epinephrine and other emergency measures.1 264

Cross-Hypersensitivity

Partial cross-allergenicity occurs among bicyclic β-lactam antibiotics (e.g., penicillins, cephalosporins, cephamycins).151 157 243 248 263 289 Although there appears to be little cross-allergenicity between aztreonam and bicyclic β-lactam antibiotics,1 44 45 46 47 48 151 157 173 222 241 243 248 256 264 267 274 275 289 hypersensitivity reactions to aztreonam have occurred rarely when the drug was used in patients with a history of hypersensitivity to penicillins and/or cephalosporins.1 173 192 290 296

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to β-lactam antibiotics or any allergens.1 Use with caution in patients hypersensitive to β-lactam antibiotics (e.g., penicillins, cephalosporins, cephamycins).1

General Precautions

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of aztreonam and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.a

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.a In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.a

Because aztreonam has little or no activity against gram-positive bacteria and anaerobes, concomitant use of another anti-infective may be indicated when the drug is used empirically in infections that may involve such bacteria (e.g., gynecologic, intra-abdominal, respiratory tract).171 173 183 211 213 214

Specific Populations

Pregnancy

Category B.1

Lactation

Low concentrations distributed into milk.1 Consider temporarily discontinuing breast-feeding during aztreonam therapy.1

Pediatric Use

Safety and efficacy not established in children <9 months of age.1

Use in children 9 months to 16 years of age supported by evidence from adequate and well-controlled studies in adults with additional efficacy, safety, and pharmacokinetic data from noncomparative clinical studies in pediatric patients.1 Adverse effects reported in pediatric patients similar to those reported in adults.1

Data in pediatric patients insufficient regarding treatment of septicemia or skin and skin structure infections (where the skin infection is believed or known to be caused by H. influenzae type b).1

Higher dosage may be warranted in pediatric patients with cystic fibrosis.1

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.a

Select dosage with caution because of the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly.a

Serum half-life of aztreonam slightly longer in geriatric adults than in younger adults.3 Substantially eliminated by kidneys; risk of toxicity may be greater in patients with impaired renal function.a Since geriatric patients are more likely to have renal impairment, monitor renal function and adjust dosage if needed.a

Hepatic Impairment

Monitor hepatic function.1

Renal Impairment

Monitor renal function.1

Common Adverse Effects

Local reactions at injection site (e.g., phlebitis/thrombophlebitis following IV administration or discomfort/swelling following IM administration); GI effects (diarrhea, nausea, vomiting); hypersensitivity (rash).1

Interactions for Azactam

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Aminoglycosides

In vitro evidence of additive or synergistic antibacterial effects against Ps. aeruginosa1 38 48 57 78 88 107 111 112 128 131 140 and some strains of Ps. cepacia,48 107 131 Ps. fluorescens,131 or Ps. maltophilia131

In vitro evidence of synergistic antibacterial effects against Enterobacteriaceae (e.g., Enterobacter, E. coli, Klebsiella, Serratia)1 57 78 88 140

In vitro synergism reported occasionally against Acinetobacter, but usually only additive or indifferent131 264

Indifference reported against gram-positive bacteria (e.g., S. aureus, S. epidermidis, E. faecalis)88 92 131

Because of potential nephrotoxicity and ototoxicity, monitor renal function (especially if high aminoglycoside dosage is used or if therapy is prolonged)1

Chloramphenicol

In vitro studies using K. pneumoniae indicate that chloramphenicol can antagonize the bactericidal activity of aztreonam139

It has been suggested that chloramphenicol should be administered a few hours after aztreonam; the necessity of this precaution has not been established139

Clavulanic acid

In vitro evidence of synergistic effects against some β-lactamase-producing Enterobacter, Klebsiella, or B. fragilis;48 88 antagonism also may occur127 276

Concomitant use does not alter in vitro susceptibility of S. aureus to aztreonam since resistance to the drug in these organisms is intrinsic234

Clindamycin

In vitro evidence of synergistic effects against some strains of E. coli, Klebsiella, or Enterobacter, although the combination more frequently is indifferent or additive against these organisms77

Indifference or slightly additive effects reported against anaerobic bacteria38 264

Total urinary excretion of aztreonam may be increased, but other pharmacokinetic parameters not affected154

Not considered clinically important154

Furosemide

Possible increased serum aztreonam concentrations1

Not considered clinically important1

β-lactam antibiotics

In vitro evidence of additive or synergistic antibacterial effects with some β-lactams (piperacillin, cefotaxime) against some strains of Ps. aeruginosa;78 antagonism against Ps. aeruginosa reported with imipenem92

When used with some β-lactams (ampicillin, piperacillin, cefotaxime), indifference or only slightly additive effects occur against Enterobacteriaceae, including Enterobacter, E. coli, S. marcescens, or Klebsiella77 78 92

When used with cefoxitin, in vitro evidence of synergism against some strains of Enterobacter, E. coli, Klebsiella, S. marcescens, Salmonella, or Shigella;77 antagonism also reported against some Enterobacter or S. marcescens77 127

Because of the potential for antagonism, β-lactams that are potent inducers of β-lactamase production (e.g., cefoxitin, imipenem) should not be used concomitantly with aztreonam1 264

Metronidazole

Indifferent or slightly additive effects reported against anaerobic bacteria38 264

Possible decrease in peak serum concentrations of aztreonam; other pharmacokinetic parameters not affected154

Not considered clinically important154

Probenecid

Decreased rate of renal tubular secretion of aztreonam and decreased binding of aztreonam to plasma proteins1 2 34 56

Not sufficient to be of therapeutic benefit1 2 34 56

Tests for glucose

Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution240

Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)240

Azactam Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from GI tract; bioavailability is <1% following oral administration.2 8 46 47 48 56 193

Rapidly and completely absorbed following IM administration;2 6 7 29 46 47 48 56 256 peak serum concentrations generally attained within 1 hour after an IM dose.1 2 6 7 29 46

Although peak serum concentrations attained with an IM dose are slightly lower than those attained with an equivalent IV dose, serum aztreonam concentrations ≥1 hour after dosing are similar.1 2 264

Special Populations

Pharmacokinetics in pediatric patients ≥9 months of age are similar to those in adults.1

Distribution

Extent

Widely distributed into body tissues and fluids following IM or IV administration.21 46 48 264 Distributed into skeletal muscle,1 21 25 264 266 adipose tissue,1 21 264 266 skin,1 21 264 bone,1 20 25 264 gallbladder,1 21 264 liver,1 21 264 lungs,1 25 208 264 kidneys,1 2 22 264 266 atrial appendage,1 25 264 intestines,1 21 264 prostatic tissue,1 24 48 56 264 myometrium,264 266 endometrium,1 25 264 266 fallopian tubes,1 264 266 ovaries,1 264 and cervical and vaginal tissue.266 Also distributed into saliva,1 2 56 sputum,48 266 bronchial secretions,1 48 208 226 264 aqueous humor,2 6 56 and bile,1 2 7 21 31 48 56 264 and into pericardial,1 25 264 pleural,1 25 208 264 peritoneal,1 2 48 56 212 synovial,1 20 264 and blister fluids.1 2 23 46 48 56 264

Distributed into CSF following IV administration in adults and pediatric patients;1 2 15 17 18 19 46 48 56 223 264 CSF concentrations generally higher in patients with inflamed meninges than in those with uninflamed meninges.2 17 18 46 48 56

Crosses the placenta and is distributed into amniotic fluid.1 28 46 48 56 Distributed into milk in low concentrations.1 27 46 48 56 264

Plasma Protein Binding

At serum concentrations of 1–100 mcg/mL,6 10 234 46–60% bound to serum proteins in healthy adults.1 2 6 10 14 33 34 48 56 234 264 In adults with impaired renal function and decreased serum albumin concentrations, 22–49% bound to serum proteins.13 33 46 48

Elimination

Metabolism

Partially metabolized to several microbiologically inactive metabolites;2 6 7 17 33 46 48 56 264 no active metabolites have been found in serum or urine.2 6 7 17 29 48 56

Elimination Route

Eliminated principally in urine as unchanged drug1 2 4 6 7 10 23 29 34 46 48 56 212 via both glomerular filtration and tubular secretion.1 2 6 23 33 34 46 48 56 212 Partially excreted in feces,1 2 7 46 48 56 152 264 presumably via biliary elimination.2 7 23 46 48 56 264

Following IM or IV administration in adults with normal renal function, approximately 58–74% of a dose is excreted in urine unchanged,1 2 3 4 6 7 14 23 33 46 48 56 264 1–7% is excreted as SQ 26,992 (an inactive metabolite),1 2 6 7 14 23 33 48 56 264 and 3–4% is excreted as unidentified inactive metabolites.2 48

Approximately 1% of a single IV dose is excreted in feces unchanged,2 7 48 56 3% as SQ 26,992,2 7 and 7.5–10.8% as unidentified inactive metabolites.2 7

Urinary excretion of unchanged aztreonam is essentially complete 8–12 hours after a single dose of the drug,1 4 6 7 10 14 29 34 but SQ 26,992 is excreted for up to 48 hours after the dose.7 10 14

Removed by hemodialysis.2 30 36 46 47 177 203 256 Removed to a lesser extent by peritoneal dialysis.1 36 47 227

Half-life

Adults with normal renal and hepatic function: Distribution half-life averages 0.2–0.7 hours2 4 6 7 9 10 14 29 33 46 48 56 and elimination half-life averages 1.3–2.2 hours.2 4 6 7 9 10 14 23 29 33 34 46 47 48 56

Children 2 months to 12 years of age: Elimination half-life averages 1.7 hours.15

Neonates: Half-life is longer than in older children and adults and is inversely related to age and birthweight.15 In neonates <7 days of age, elimination half-life averages 5.5–9.9 hours in those weighing <2.5 kg5 15 and 2.6 hours in those weighing >2.5 kg.15 In neonates 1 week to 1 month of age, elimination half-life averages 2.4 hours.15

Special Populations

Geriatric adults: Elimination half-life is slightly longer than in younger adults1 14 90 266 and ranges from 1.7–4.3 hours in adults 64–82 years of age with renal function normal for their age.14 90 266

Cystic fibrosis patients: May eliminate aztreonam at a faster rate than healthy individuals.46 48 177 269 270 Serum half-life averaged 1–1.3 hours in several patients with cystic fibrosis.177 269 270

Patients with hepatic impairment: Half-life is only slightly prolonged since the liver is a minor elimination pathway for the drug.1 Elimination half-life in patients with cirrhosis but with normal renal function averages 2.2 hours in those with primary biliary cirrhosis and 3.2 hours in those with alcoholic cirrhosis.32

Patients with renal impairment: Serum concentrations of aztreonam are higher and the serum half-life prolonged.1 2 30 33 46 47 48 56 203 212 264 In adults with renal impairment, the elimination half-life averages 3.4–3.6, 5.3–5.9, 7.8–7.9, or 8.4–8.7 hours in adults with Clcr of 30–80, 10–29, 3–9, or <2 mL/minute, respectively.30

Stability

Storage

Parenteral

Powder for Injection or Infusion

Room temperature; avoid excessive heat.a

At a concentration of ≤20 mg/mL, aztreonam is chemically and physically stable for 48 hours at 15–30°C or for 7 days when refrigerated at 2–8°C in the following IV infusion solutions: 0.9% sodium chloride injection; 5 or 10% dextrose injection; Ringer’s; lactated Ringer’s; 5% dextrose and 0.2, 0.45, or 0.9% sodium chloride; (1/6) M sodium lactate; 5 or 10% mannitol; 5% dextrose with lactated Ringer’s; 5% dextrose with Plasma-Lyte M; 10% Travert; 10% Travert with Electrolyte No. 1, 2, or 3; Ionosol B with 5% dextrose; Isolyte E; Isolyte E with 5% dextrose; Isolyte M with 5% dextrose; Normosol-R; Normosol-R with 5% dextrose; or Normosol-M with 5% dextrose.1 264 At concentrations >20 mg/mL, aztreonam is stable for 48 hours at 2–8°C in sterile water for injection or 0.9% sodium chloride injection; solutions containing >20 mg/mL prepared using other compatible IV solutions should be used immediately.1 264 277

IM solutions prepared using sterile water for injection or 0.9% sodium chloride injection are stable for 48 hours at 15–30°C or for 7 days when refrigerated at 2–8°C.264 IM injections prepared using bacteriostatic water for injection (with benzyl alcohol or parabens) or bacteriostatic sodium chloride injection (with benzyl alcohol or parabens) should be used immediately after reconstitution.264 277

Reconstituted solutions can be frozen immediately after preparation and are stable for up to 3 months at -20°C.1 264 Frozen solutions may be thawed either at 15–30°C or by overnight refrigeration.1 264 Frozen solutions that have been thawed and stored at room temperature should be used within 24 hours, and those that have been thawed and refrigerated at 2–8°C should be used within 72 hours after removal from the freezer.1 264 Once thawed, aztreonam solutions should not be refrozen.1 264

Injection (Frozen)

-20° C or lower.287 288 292 After thawing, may store up to 48 hours at room temperature (25°C) or up to 14 days at 5° C.288 292

Do not refreeze after thawing.287

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Sodium chloride 0.9%

Drug Compatibility
Admixture CompatibilityHID

Compatible

Ampicillin sodium and sulbactam sodium

Cefazolin sodium

Ciprofloxacin

Clindamycin phosphate

Gentamicin sulfate

Linezolid

Tobramycin sulfate

Incompatible

Metronidazole

Nafcillin sodium

Variable

Ampicillin sodium

Cefoxitin sodium

Vancomycin HCl

Y-Site CompatibilityHID

Compatible

Allopurinol sodium

Amifostine

Amikacin sulfate

Aminophylline

Ampicillin sodium

Ampicillin sodium and sulbactam sodium

Bivalirudin

Bleomycin sulfate

Bumetanide

Buprenorphine HCl

Butorphanol tartrate

Calcium gluconate

Carboplatin

Carmustine

Cefazolin sodium

Cefepime HCl

Cefotaxime sodium

Cefoxitin sodium

Ceftazidime

Ceftizoxime sodium

Ceftriaxone sodium

Cefuroxime sodium

Cimetidine HCl

Ciprofloxacin

Cisplatin

Clindamycin phosphate

Co-trimoxazole

Cyclophosphamide

Cytarabine

Dacarbazine

Dactinomycin

Daptomycin

Dexamethasone sodium phosphate

Dexmedetomidine HCl

Diltiazem HCl

Diphenhydramine HCl

Dobutamine HCl

Docetaxel

Dopamine HCl

Doxorubicin HCl

Doxorubicin HCl liposome injection

Doxycycline hyclate

Droperidol

Enalaprilat

Etoposide

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Filgrastim

Floxuridine

Fluconazole

Fludarabine phosphate

Fluorouracil

Foscarnet sodium

Furosemide

Gallium nitrate

Gemcitabine HCl

Gentamicin sulfate

Granisetron HCl

Haloperidol lactate

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydrocortisone sodium phosphate

Hydrocortisone sodium succinate

Hydromorphone HCl

Hydroxyzine HCl

Idarubicin HCl

Ifosfamide

Imipenem and cilastatin sodium

Leucovorin calcium

Linezolid

Magnesium sulfate

Mannitol

Mechlorethamine HCl

Melphalan HCl

Meperidine HCl

Mesna

Methotrexate sodium

Methylprednisolone sodium succinate

Metoclopramide HCl

Morphine sulfate

Nalbuphine HCl

Nicardipine HCl

Ondansetron HCl

Pemetrexed disodium

Piperacillin sodium and tazobactam sodium

Potassium chloride

Promethazine HCl

Propofol

Quinupristin/dalfopristin

Ranitidine HCl

Remifentanil HCl

Sargramostim

Sodium bicarbonate

Teniposide

Theophylline

Thiotepa

Ticarcillin disodium and clavulanate potassium

Tobramycin sulfate

Vinblastine sulfate

Vincristine sulfate

Vinorelbine tartrate

Zidovudine

Incompatible

Acyclovir sodium

Amphotericin B

Amphotericin B cholesteryl sulfate complex

Amsacrine

Azithromycin

Chlorpromazine HCl

Daunorubicin HCl

Ganciclovir sodium

Lansoprazole

Lorazepam

Metronidazole

Mitomycin

Mitoxantrone HCl

Prochlorperazine edisylate

Streptozocin

Variable

Vancomycin HCl

Actions and Spectrum

Advice to Patients

  • Advise patients that antibacterials (including aztreonam) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).a

  • Importance of completing full course of therapy, even if feeling better after a few days.a

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with aztreonam or other antibacterials in the future.a

  • Importance of discontinuing therapy and informing clinician if an allergic reaction occurs.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Aztreonam

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection

500 mg

Azactam (with arginine)

Elan

1 g

Azactam (with arginine)

Elan

2 g

Azactam (with arginine)

Elan

For injection, for IV infusion

1 g

Azactam (with arginine)

Elan

2 g

Azactam (with arginine)

Elan

Aztreonam in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection (frozen), for IV infusion

20 mg/mL (1 g) in 3.4% Dextrose

Azactam in Iso-osmotic Dextrose Injection (Galaxy [Baxter])

Elan

40 mg/mL (2 g) in 1.4% Dextrose

Azactam in Iso-osmotic Dextrose Injection (Galaxy [Baxter])

Elan

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

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4. Swabb EA, Leitz MA, Pilkiewicz FG et al. Pharmacokinetics of the monobactam SQ 26,776 after single intravenous doses in healthy subjects. J Antimicrob Chemother. 1981; 8(Suppl E):131-40. [PubMed 7199041]

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30. Fillastre JP, Leroy A, Baudoin C et al. Pharmacokinetics of aztreonam in patients with chronic renal failure. Clin Pharmacokinet. 1985; 10:91-100. [IDIS 195801] [PubMed 4038635]

31. Martiney OV, Levi JU, Devlin RG. Biliary excretion of aztreonam in patients with biliary tract disease. Antimicrob Agents Chemother. 1984; 25:358-61. [IDIS 183094] [PubMed 6539092]

32. MacLeod CM, Bartley EA, Payne JA et al. Effects of cirrhosis on kinetics of aztreonam. Antimicrob Agents Chemother. 1984; 26:493-7. [IDIS 193523] [PubMed 6542764]

33. Mihindu JC, Scheld WM, Bolton ND et al. Pharmacokinetics of aztreonam in patients with various degrees of renal dysfunction. Antimicrob Agents Chemother. 1983; 24:252-61. [IDIS 174913] [PubMed 6685452]

34. Swabb EA, Sugerman AA, Frantz M et al. Renal handling of the monobactam azthreonam in healthy subjects. Clin Pharmacol Ther. 1983; 33:609-14. [IDIS 170492] [PubMed 6682362]

35. Pilkiewicz FG, Remsburg BJ, Fisher SM et al. High-pressure liquid chromatographic analysis of aztreonam in sera and urine. Antimicrob Agents Chemother. 1983; 23:852-6. [IDIS 172592] [PubMed 6684412]

36. Gerig JS, Bolton ND, Swabb EA et al. Effect of hemodialysis and peritoneal dialysis on aztreonam pharmacokinetics. Kidney Int. 1984; 26:308-18. [PubMed 6542606]

37. Paton TW, Cornish WR, Manuel MA et al. Drug therapy in patients undergoing peritoneal dialysis: clinical pharmacokinetic considerations. Clin Pharmacokinet. 1985; 10:404-26. [IDIS 207151] [PubMed 3899455]

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39. Ekstrom B. Basic design of beta-lactam antibiotics: penams and analogues and monocyclic beta-lactams. Scand J Infect Dis. 1984; 42(Suppl):38-49.

40. Neu HC. Trends in the development of beta-lactam antibiotics. Scand J Infect Dis. 1984; 42(Suppl):7-16.

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43. Parker WL, Cimarusti CM, Floyd DM et al. Monobactams: isolation and structure determination. J Antimicrob Chemother. 1981; 8(Suppl E):17-20. [PubMed 7199043]

44. Sykes RB, Bonner DP, Bush K et al. Monobactams—monocyclic β-lactam antibiotics produced by bacteria. J Antimicrob Chemother. 1981; 8(Suppl E):1-16. [PubMed 6976959]

45. O’sullivan J, Gillum AM, Aklonis CA et al. Biosynthesis of monobactam compounds: origin of the carbon atoms in the β-lactam ring. Antimicrob Agents Chemother. 1982; 21:558-64. [PubMed 6805424]

46. Guay DR, Koskoletos C. Aztreonam, a new monobactam antimicrobial. Clin Pharm. 1985; 4:516-26. [IDIS 205723] [PubMed 3902330]

47. Hopefl AW. Aztreonam—an overview. Drug Intell Clin Pharm. 1985; 19:171-5. [IDIS 197067] [PubMed 3884302]

48. Brogden RN, Heel RC. Aztreonam: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1986; 31:96-130. [IDIS 212455] [PubMed 3512234]

49. Marble DA, Bosso JA, Townsend RJ. Stability of clindamycin phosphate with aztreonam, ceftazidime sodium, ceftriaxone sodium, or piperacillin sodium in two intravenous solutions. Am J Hosp Pharm. 1986; 43:1732-6. [IDIS 218582] [PubMed 3529949]

50. Riley CM, Lipford LC. Interaction of aztreonam with nafcillin intravenous admixtures. Am J Hosp Pharm. 1986; 43:2221-4. [IDIS 220584] [PubMed 3766577]

51. Bell RG, Lipford LC, Massanari MJ et al. Stability of intravenous admixtures of aztreonam and cefoxitin, gentamicin, metronidazole, or tobramycin. Am J Hosp Pharm. 1986; 43:1444-53. [IDIS 216920] [PubMed 3728479]

52. Riley CM, James MJ. Stability of intravenous admixtures containing aztreonam and cefazolin. Am J Hosp Pharm. 1986; 43:925-7. [IDIS 213763] [PubMed 3706339]

53. James MJ, Riley CM. Stability of intravenous admixtures of aztreonam and clindamycin phosphate. Am J Hosp Pharm. 1985; 42:1984-6. [IDIS 205287] [PubMed 4050817]

54. James MJ, Riley CM. Stability of intravenous admixtures of aztreonam and ampicillin. Am J Hosp Pharm. 1985; 42:1095-100. [IDIS 199657] [PubMed 4039889]

55. Barry AL, Thornsberry C, Jones RN et al. Aztreonam: antibacterial activity, β-lactamase stability, and interpretive standards and quality control guidelines for disk-diffusion susceptibility tests. Rev Infect Dis. 1985; 7(Suppl 4):S594-604. [IDIS 209587] [PubMed 3909316]

56. Swabb EA. Clinical pharmacology of aztreonam in healthy recipients and patients: a review. Rev Infect Dis. 1985; 7(Suppl 4):S605-12.

57. Sykes RB, Bonner DP. Discovery and development of the monobactams. Rev Infect Dis. 1985; 7(Suppl 4):S579-93. [IDIS 209586] [PubMed 3909315]

58. Bonner DP, Whitney RR, Baughn CO et al. In-vivo properties of SQ 26,776. J Antimicrob Chemother. 1981; 8(Suppl E):123-30. [PubMed 6976961]

59. Georgopapadakou NH, Smith SA, Sykes RB. Mode of action of azthreonam. Antimicrob Agents Chemother. 1982; 21:950-6. [IDIS 151721] [PubMed 6180685]

60. Georgopapadakou NH, Smith SA, Cimarusti CM et al. Binding of monobactams to penicillin-binding proteins of Escherichia coli and Staphylococcus aureus: relation to antibacterial activity. Antimicrob Agents Chemother. 1983; 23:98-104. [PubMed 6338822]

61. Toma EC, Morisset R, Phaneuf D et al. Aztreonam: correlation between disk diffusion and agar plate dilutions susceptibility tests. Chemotherapy. 1985; 81:451-5.

62. Stamm JM, Hanson CW, Chu DT et al. In vitro evaluation of A-56619 (difloxacin) and A-56620: new aryl-fluoroquinolones. Antimicrob Agents Chemother. 1986; 29:193-200. [IDIS 223871] [PubMed 3087274]

63. Thornsberry C. Review of in vitro activity of third-generation cephalosporins and other newer beta-lactam antibiotics against clinically important bacteria. Am J Med. 1985; 79(Suppl 2A):14-20. [IDIS 204113] [PubMed 3927723]

64. Strandberg DA, Jorgensen JH, Drutz DJ. Activities of aztreonam and new cephalosporins against infrequently isolated gram-negative bacilli. Antimicrob Agents Chemother. 1983; 24:282-6. [IDIS 174916] [PubMed 6685453]

65. Neu HC, Labthavikul P. In vitro antibacterial activity and β-lactamase stability of E-0702, a new cephalosporin. Antimicrob Agents Chemother. 1983; 24:313-20. [IDIS 175794] [PubMed 6605718]

66. Neu HC, Labthavikul P. In vitro activity and β-lactamase stability of U-63196E, a novel cephalosporin. Antimicrob Agents Chemother. 1983; 24:375-82. [IDIS 175800] [PubMed 6605719]

67. Neu HC, Labthavikul P. In vitro activity and β-lactamase stability of a monobactam, SQ 26,917, compared with those of aztreonam and other agents. Antimicrob Agents Chemother. 1983; 24:227-32. [IDIS 174910] [PubMed 6605715]

68. Henry D, Skidmore AG, Ngui-Yen J et al. In vitro activities of enoxacin, ticarcillin plus clavulanic acid, aztreonam, piperacillin, and imipenem and comparison with commonly used antimicrobial agents. Antimicrob Agents Chemother. 1985; 28:259-64. [IDIS 204287] [PubMed 3869433]

69. Benson CA, Walton FE, Trenholme GM. Antibacterial activity of Ro 17-2301 and other antimicrobial agents against cefotaxime-resistant aerobic gram-negative bacilli. Antimicrob Agents Chemother. 1986; 29:155-7. [IDIS 212945] [PubMed 3079583]

70. Fainstein V, Weaver S, Bodey GP. Comparative in vitro study of SQ 26,776. Antimicrob Agents Chemother. 1982; 21:294-8. [IDIS 146661] [PubMed 6918206]

71. Smith BR, LeFrock JL, McCloskey RV et al. Comparative in vitro antimicrobial activity of carumonam, a new monocyclic β-lactam. Antimicrob Agents Chemother. 1986; 29:346-9. [IDIS 212797] [PubMed 3087280]

72. Appelbaum PC, Tamim J, Penkuch GA et al. Susceptibility of 324 nonfermentative gram-negative rods to 6 cephalosporins and azthreonam. Chemotherapy. 1983; 29:337-44. [IDIS 175165] [PubMed 6311492]

73. Clarke AM, Zemcov SJ. Antibacterial activity of the cephamycin cefotetan: an in-vitro comparison with other β-lactam antibiotics. J Antimicrob Chemother. 1983; 11(Suppl A):67-72. [PubMed 6404881]

74. Schell RF, Francisco M, Bihl JA et al. The activity of ceftazidime compared with those of aztreonam, newer cephalosporins and Sch 29482 against nonfermentative gram-negative bacilli. Chemotherapy. 1985; 31:181-90. [IDIS 200330] [PubMed 3888543]

75. Bremner DA. Azthreonam activity against gram-negative bacilli. Chemotherapy. 1984; 30:44-8. [IDIS 181893] [PubMed 6537908]

76. Sykes RB, Bonner DP, Bush K et al. Azthreonam (SQ 26,776), a synthetic monobactam specifically active against aerobic gram-negative bacteria. Antimicrob Agents Chemother. 1982; 21:85-92. [IDIS 143688] [PubMed 6979307]

77. Stutman HR, Welch DF, Scribner RK et al. In vitro antimicrobial activity of aztreonam alone and in combination against bacterial isolates from pediatric patients. Antimicrob Agents Chemother. 1984; 25:212-5. [IDIS 181953] [PubMed 6538772]

78. Buesing MA, Jorgensen JH. In vitro activity of aztreonam in combination with newer β-lactams and amikacin against multiply resistant gram-negative bacilli. Antimicrob Agents Chemother. 1984; 25:283-5. [IDIS 181960] [PubMed 6538773]

79. Shah PM, Losert-Bruggner B, Stille W. Bactericidal activity of SQ 26776. J Antimicrob Chemother. 1981; 8(Suppl E):77-80. [PubMed 6799484]

80. Russell AD. In-vitro studies on SQ 26,776, a new monobactam antibiotic. J Antimicrob Chemother. 1981; 8(Suppl E):81-8. [PubMed 6799485]

81. Yourassowsky E, Van der Linden MP, Lismont MJ et al. Growth curve patterns of Escherichia coli and Pseudomonas aeruginosa submitted to different SQ 26,776 concentrations. J Antimicrob Chemother. 1981; 8(Suppl E):89-96. [PubMed 6799486]

82. Acar JF, Kitzis MD, Goldstein FW. In-vitro activity of SQ 26,776 against multiply-resistant enterobacteria—preliminary results. J Antimicrob Chemother. 1981; 8(Suppl E):97-101. [PubMed 6276355]

83. Phillips I, King A, Shannon K et al. SQ 26,776: in-vitro antibacterial activity and susceptibility to β-lactamases. J Antimicrob Chemother. 1981; 8(Suppl E):103-10. [PubMed 6976960]

84. Neu HC, Labthavikul P. Antibacterial activity of a monocyclic β-lactam SQ 26,776. J Antimicrob Chemother. 1981; 8(Suppl E):111-22. [PubMed 6799479]

85. Norrby R, Friberg K. Holm SE. In-vitro antibacterial activity of SQ 26,776. J Antimicrob Chemother. 1981; 8(Suppl E):69-76. [PubMed 7199045]

86. Reeves DS, Bywater MJ, Holt HA. Antibacterial activity of the monobactam SQ 26,776 against antibiotic resistant enterobacteria, including Serratia spp. J Antimicrob Chemother. 1981; 8(Suppl E):57-68. [PubMed 6799483]

87. Livermore DM, Williams JD. In-vitro activity of the monobactam, SQ 26,776, against gram-negative bacteria and its stability to their β-lactamases. J Antimicrob Chemother. 1981; 8(Suppl E):29-37. [PubMed 6799480]

88. Wise R, Andrews JM, Hancox J, SQ 26,776, a novel β-lactam: an in-vitro comparison with other antimicrobial agents. J Antimicrob Chemother. 1981; 8(Suppl E):39-47.

89. Percival A, Thomas E, Hart CA et al. In-vitro activity of monobactam, SQ 26,776, against gram-negative bacteria. J Antimicrob Chemother. 1981; 8(Suppl E):49-55. [PubMed 6799482]

90. Naber KG, Dette GA, Kees F et al. Pharmacokinetics, in-vitro activity, therapeutic efficacy and clinical safety of aztreonam vs. cefotaxime in the treatment of complicated urinary tract infections. J Antimicrob Chemother. 1986; 17:517-27. [PubMed 3710959]

91. Russell AD, Furr JR. Penetration of SQ 26,776, a new monobactam antibiotic, into Escherichia coli and Pseudomonas aeruginosa. J Antimicrob Chemother. 1982; 9:329-30. [PubMed 6806235]

92. Ampel NM, Moon-McDermott L, Keating M et al. In-vitro activity of aztreonam in combination with four other antibiotics against gram-negative bacilli and Staphylococcus aureus. J Antimicrob Chemother. 1984; 13:398-9. [PubMed 6539326]

93. Goosens H, Vanhoof R, De Mol P et al. In-vitro susceptibility of salmonellae to antimicrobial agents. J Antimicrob Chemother. 1984; 13:559-65. [IDIS 205466] [PubMed 6540771]

94. Aronoff SC, Klinger JD. Comparison of cefpiramide (HR-810) and four anti-pseudomonal β-lactam agents against pseudomonas isolates from children with cystic fibrosis. J Antimicrob Chemother. 1985; 15:545-9. [PubMed 3924879]

95. van Saene JJ, van Saene HK, Stoutenbeek CP et al. Influence of faeces on the activity of antimicrobial agents used for decontamination of the alimentary canal. Scand J Infect Dis. 1985; 17:295-300. [PubMed 2932792]

96. Paradelis AG, Stathopoulos GA, Salpigides GN et al. Antibacterial activity of aztreonam: a synthetic monobactam. A comparative study with thirteen other antibiotics. Methods Find Exp Clin Pharmacol. 1983; 5:375-83. [PubMed 6684718]

97. Aldridge KE, Sanders CV. Comparison of the activity of carumonam (RO 17-2301) with other broad-spectrum antibiotics: in vitro antibacterial spectrum, inoculum effect, and synergy studies. Curr Ther Res Clin Exp. 1986; 40:515-27.

98. Friis H, Prag J, Togsverda E et al. Beta-lactamase stability and in vitro activity of aztreonam, with a comparison to 9 other beta-lactam antibiotics and gentamicin. Chemotherapy. 1986; 32:329-35. [IDIS 218429] [PubMed 3488177]

99. Rolston K, Alvarez ME, Hoy JF et al. Comparative in vitro activity of cefpirome and other antimicrobial agents against isolates from cancer patients. Chemotherapy. 1986; 32:344-51. [IDIS 218431] [PubMed 3731920]

100. Angehrn P. Antibacterial properties of carumonam (Ro 17:2301, AMA-1080), a new sulfonated monocyclic β-lactam antibiotic. Chemotherapy. 1985; 31:440-50. [IDIS 211003] [PubMed 3935396]

101. Miller LK, Sanchez PL, Berg SW et al. Effectiveness of aztreonam, a new monobactam antibiotic, against penicillin-resistant gonococci. J Infect Dis. 1983; 148:6612.

102. Strandberg DA, Jorgensen JH, Drutz DJ. Activity of aztreonam and new beta-lactam antibiotics against penicillinase-producing Neisseria gonorrhoeae. Curr Ther Res Clin Exp. 1983; 34:955-9.

103. Khan MY, Gruninger RP, Nelson SM et al. Comparative in vito activity of cefodizime, ceftazidime, aztreonam, and other selected antimicrobial agents against Neisseria gonorrhoeae. Antimicrob Agents Chemother. 1983; 23:477-8. [IDIS 167348] [PubMed 6303215]

104. Bassey CM, Baltch AL, Smith RP et al. Comparative in vitro activities of enoxacin (CI-919, AT-2266) and eleven antipseudomonal agents against aminoglycoside-susceptible and -resistant Pseudomonas aeruginosa strains. Antimicrob Agents Chemother. 1984; 26:417-8. [IDIS 190371] [PubMed 6439116]

105. Garcia I. Fainstein V, LeBlanc B et al. In vitro activities of new β-lactam antibiotics against Acinetobacter spp. Antimicrob Agents Chemother. 1983; 24:297-9. [IDIS 174920] [PubMed 6638992]

106. Thompson KD, O'Keefe JP, Tatarowicz WA. In vitro comparison of amifloxacin and six other antibiotics against aminoglycoside-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1984; 26:275-6. [IDIS 189081] [PubMed 6435518]

107. Aronoff SC, Klinger JD. In vitro activities of aztreonam, piperacillin, and ticarcillin combined with amikacin against amikacin-resistant Pseudomonas aeruginosa and P. cepacia isolates from children with cystic fibrosis. Antimicrob Agents Chemother. 1984; 25:279-80. [IDIS 181959] [PubMed 6561954]

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