(SEF tay zi deem)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as sodium [strength expressed as base]:
Fortaz in D5W: 1 g (50 mL); 2 g (50 mL)
Tazicef: 1 g/50 mL (50 mL)
Solution Reconstituted, Injection:
Fortaz: 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea); 6 g (1 ea)
Tazicef: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea)
Generic: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea); 100 g (1 ea)
Solution Reconstituted, Injection [preservative free]:
Generic: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea)
Solution Reconstituted, Intravenous:
Fortaz: 1 g (1 ea); 2 g (1 ea)
Tazicef: 1 g (1 ea); 2 g (1 ea)
Generic: 1 g/50 mL (1 ea); 2 g/50 mL (1 ea)
Brand Names: U.S.
- Fortaz in D5W
- Antibiotic, Cephalosporin (Third Generation)
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs), which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Widely throughout the body including bone, bile, skin, CSF (higher concentrations achieved when meninges are inflamed), endometrium, heart, pleural and lymphatic fluids
Urine (80% to 90% as unchanged drug)
Time to Peak
Serum: IM: ~1 hour
1 to 2 hours, prolonged with renal impairment
Use: Labeled Indications
Bacterial septicemia: Treatment of septicemia caused by Pseudomonas aeruginosa, Klebsiella spp., Haemophilus influenzae, Escherichia coli, Serratia spp., Streptococcus pneumoniae, and Staphylococcus aureus (methicillin-susceptible strains).
Bone and joint infections: Treatment of bone and joint infections caused by Pseudomonas aeruginosa, Klebsiella spp., Enterobacter spp., and Staphylococcus aureus (methicillin-susceptible strains).
CNS infections: Treatment of meningitis caused by Haemophilus influenzae and Neisseria meningitidis. Ceftazidime has also been used successfully in cases of meningitis due to Pseudomonas aeruginosa and Streptococcus pneumoniae.
Empiric therapy in the immunocompromised patient: Empiric treatment of infections in immunocompromised patients.
Gynecologic infections: Treatment of endometritis, pelvic cellulitis, and other infections of the female genital tract caused by Escherichia coli.
Intra-abdominal infections: Treatment of peritonitis caused by Escherichia coli, Klebsiella spp., and Staphylococcus aureus (methicillin-susceptible strains) and polymicrobial intra-abdominal infections caused by aerobic and anaerobic organisms and some Bacteroides spp. (many strains of Bacteroides fragilis are resistant).
Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, caused by Pseudomonas aeruginosa and other Pseudomonas spp.; Haemophilus influenzae, including ampicillin-resistant strains; Klebsiella spp.; Enterobacter spp.; Proteus mirabilis; Escherichia coli; Serratia spp.; Citrobacter spp.; Streptococcus pneumoniae; and Staphylococcus aureus (methicillin-susceptible strains).
Skin and skin-structure infections: Treatment of skin and skin-structure infections caused by Pseudomonas aeruginosa; Klebsiella spp.; Escherichia coli; Proteus spp.; including Proteus mirabilis and indole-positive Proteus; Enterobacter spp.; Serratia spp.; Staphylococcus aureus (methicillin-susceptible strains); and Streptococcus pyogenes (group A beta-hemolytic streptococci).
Urinary tract infections (UTI): Treatment of complicated and uncomplicated UTIs caused by Pseudomonas aeruginosa; Enterobacter spp.; Proteus spp., including Proteus mirabilis and indole-positive Proteus; Klebsiella spp.; and Escherichia coli.
Off Label Uses
Data from a randomized trial of immediate vitrectomy and intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis supports the use of ceftazidime in this condition [Kelsey 1995]. Additional data may be necessary to further define the role of ceftazidime in this condition.
Catheter-related bloodstream infections (children/adolescents)
A third-generation cephalosporin, such as ceftazidime, is recommended by IDSA clinical practice guidelines as a first-line agent for the treatment of catheter-related infections due to susceptible extended-spectrum beta-lactamase–negative E. coli and Klebsiella species in children. The recommended pediatric dosage in IDSA guidelines is slightly higher than that in the prescribing information for ceftazidime.
Melioidosis (Burkholderia pseudomallei) infection
Melioidosis is a worldwide subtropic and tropic bacterial disease due to contact with Burkholderia pseudomallei contaminated water or soil [Lipsitz 2012]. A DHHS Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei infection supports the use of ceftazidime as a first line agent for initial treatment of melioidosis [Lipsitz 2012]. Additional data may be necessary to further define the role of ceftazidime for the treatment of melioidosis.
Non–cystic fibrosis bronchiectasis (aerosolized ceftazidime)
According to international guidelines and a national consensus summary, aerosolized ceftazidime is not recommended for first-line treatment of non–cystic fibrosis bronchiectasis. Aerosolized ceftazidime may be considered for long-term therapy in patients who have 3 or more exacerbations requiring antibiotic therapy per year, patients who have fewer than 3 exacerbations causing significant morbidity per year, or patients who are chronically colonized with P. aeruginosa. However, aerosolized antibiotic choice should be guided by antibiotic sensitivity results.
Clinically significant hypersensitivity to ceftazidime, other cephalosporins, penicillins, other beta-lactam antibiotics, or any component of the formulation
Cystic fibrosis: IV:
Manufacturer’s labeling: 90 to 150 mg/kg/day every 8 hours (maximum: 6 g daily)
Alternative recommendations: Intermittent IV infusion: 200 to 400 mg/kg/day divided every 6 to 8 hours (maximum: 8 to 12 g daily); or by continuous IV infusion: 100 to 200 mg/kg/day (maximum: 12 g daily) (Zobell, 2013)
Empiric therapy in immunocompromised patients: IV: 2 g every 8 hours
Endophthalmitis, bacterial (off-label use): Intravitreal: 2 to 2.25 mg/0.1 mL NS in combination with vancomycin (Jackson, 2003; Roth, 1997)
Intra-abdominal infection, severe (in combination with metronidazole): IV: 2 g every 8 hours for 4 to 7 days (provided source controlled). Not recommended for hospital-acquired intra-abdominal infections (IAI) associated with multidrug-resistant gram negative organisms or in mild-to-moderate community-acquired IAIs due to risk of toxicity and the development of resistant organisms (Solomkin, 2010).
Melioidosis (off-label use): IV: Note: Switching to meropenem therapy is indicated if patient condition worsens (eg, organ failure, new infection focus development, repeat blood cultures remained positive). Oral eradication therapy is recommended after the intensive (acute) phase treatment is complete (Lipsitz, 2012).
Severe, acute phase: 50 mg/kg/dose every 8 hours (maximum dose: 2 g) or 2 g for one dose, followed by 6 g daily by continuous infusion for ≥10 days with or without TMP/SMX (Lipsitz, 2012).
Non-cystic fibrosis bronchiectasis (off-label use/route): Inhalation for nebulization: 250 to 1,000 mg every 12 hours or 500 mg every 6 hours for up to 12 months (Le 2010, Orriols 1999)
Osteomyelitis, native vertebral due to P. aeruginosa (alternative therapy) (off-label dose): IV: 2 g every 8 hours for 6 weeks Note: Double coverage may be considered (ie, ceftazidime plus an aminoglycoside or ciprofloxacin) (IDSA [Berbari 2015])
Peritonitis (CAPD) (off-label route; Li, 2010): Intraperitoneal:
Intermittent: 1 to 1.5 g every 24 hours per exchange in the long dwell (≥6 hours)
Continuous (per liter exchange): Loading dose: 500 mg; maintenance dose: 125 mg. Note: If patient has residual renal function (eg, >100 mL/day urine output), empirically increase each dose by 25%.
Uncomplicated: IM, IV: 500 mg to 1 g every 8 hours
Hospital-acquired or ventilator-associated (off-label): IV: 2 g every 8 hours for 7 days; may consider shorter or longer duration depending on rate of clinical improvement. When used as empiric therapy, use in combination with an agent active against S. aureus with or without an additional antipseudomonal agent (dependent on patient and institution-specific risk factors) (Kalil 2016)
Prosthetic joint infection, Pseudomonas aeruginosa (alternative to cefepime or meropenem): IV: 2 g every 8 hours for 4 to 6 weeks (consider addition of an aminoglycoside) (Osmon, 2013)
Skin and soft tissue infections: IV, IM: 500 mg to 1 g every 8 hours
Severe infections, including meningitis, CNS infection, osteomyelitis, gynecological: IV: 2 g every 8 hours
Urinary tract infections:
Manufacturer’s labeling: IV, IM:
Uncomplicated: 250 mg every 12 hours
Complicated: 500 mg every 8 to 12 hours
Alternative recommendations: IV: Complicated: 1 to 2 g every 8 to 12 hours (Hoepelman 1993; Norrby 1992).
Refer to adult dosing.
General dosing, susceptible infections: IM, IV:
Manufacturer's labeling: Infants and Children: 30 to 50 mg/kg/dose every 8 hours; maximum daily dose: 6 g/day; higher doses reserved for immunocompromised patients, cystic fibrosis, or meningitis
Alternate dosing (Red Book [AAP 2015]): Infants, Children, and Adolescents:
Mild to moderate infections: 90 to 150 mg/kg/day divided every 8 hours; maximum daily dose: 3,000 mg/day
Severe infections: 200 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day; higher doses (300 mg/kg/day) have been recommended for cystic fibrosis patients
Catheter-related blood stream infections (off-label use): Infants and Children ≤12 years: IV: 100 to 150 mg/kg/day in divided doses every 8 hours for 7 to 14 days (Maximum daily dose: 6 g daily) (Mermel 2009)
Cystic fibrosis, lung infection caused by Pseudomonas spp: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours, maximum daily dose: 6 g/day; higher doses have been used: 200 to 400 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 12 g/day (Zobell 2013)
Melioidosis (off-label use): Note: Switching to meropenem therapy is indicated if patient condition worsens (eg, organ failure, new infection focus development, repeat blood cultures remained positive). Oral eradication therapy is recommended after the intensive (acute) phase treatment is complete (Lipsitz 2012).
Severe, acute phase: Infants ≥3 months, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours for ≥10 days with or without TMP/SMX (maximum dose: 2,000 mg/dose) (Lipsitz 2012). Note: Depending on infection severity, the dose for patients ≥3 months can be ≤40 mg/kg (maximum dose: 2,000 mg/dose) (Lipsitz 2012).
Dosing: Renal Impairment
Note: If the dose recommended in the dosing section is lower than that recommended for patients with renal insufficiency as outlined below, the lower dose should be used. In severe infections, when the usual dose would be ceftazidime 6 g/day in patients without renal impairment, consider increasing the doses below by 50% or increase the dosing frequency. Further dosage adjustments should be determined by infection severity, susceptibility and patient response to therapy.
CrCl 31 to 50 mL/minute: 1 g every 12 hours
CrCl 16 to 30 mL/minute: 1 g every 24 hours
CrCl 6 to 15 mL/minute: 500 mg every 24 hours
CrCl <5 mL/minute: 500 mg every 48 hours
Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Dialyzable (50% to 100%): 500 mg to 1 g every 24 hours or 1 to 2 g every 48 to 72 hours (Heintz, 2009). Note: Dosing dependent on the assumption of 3 times per week, complete IHD sessions.
Peritoneal dialysis (PD): IV:
Intermittent: Loading dose of 1 g, followed by 500 mg every 24 hours
Continuous: Loading dose of 1 g, followed by 500 mg every 24 hours. Note: an additional 125 mg per liter of exchange fluid may be added to the dialysate if clinically warranted.
Continuous renal replacement therapy (CRRT) (Heintz, 2009; Trotman, 2005): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment:
CVVH: Loading dose of 2 g followed by 1 to 2 g every 12 hours
CVVHD/CVVHDF: Loading dose of 2 g followed by either 1 g every 8 hours or 2 g every 12 hours. Note: Dosage of 1 g every 8 hours results in similar steady-state concentrations as 2 g every 12 hours and is more cost effective. Dosage of 2 g every 8 hours may be needed for gram-negative rods with MIC ≥4 mg/L (Heintz, 2009).
Note: For patients receiving CVVHDF, some recommend giving a loading dose of 2 g followed by 3 g over 24 hours as a continuous IV infusion to maintain concentrations ≥4 times the MIC for susceptible pathogens (Heintz, 2009).
Dosing: Hepatic Impairment
No dosage adjustment necessary.
IM: Using SWFI, bacteriostatic water, lidocaine 0.5%, or lidocaine 1%, reconstitute the 500 mg vials with 1.5 mL or the 1 g vials with 3 mL; final concentration of ~280 mg/mL
IV: Reconstitute intact vials as follows (Note: After reconstitution, may dilute further with a compatible solution [eg, D5W, NS] to administer via IV infusion):
~100 mg/mL solution:
500 mg vial: 5.3 mL SWFI (withdraw 5 mL from the reconstituted vial to obtain a 500 mg dose)
1 g vial: 10 mL SWFI (withdraw 10 mL from the reconstituted vial to obtain a 1 g dose)
6 g vial: 56 mL SWFI (withdraw 10 mL from the reconstituted vial to obtain a 1 g dose)
~170 mg/mL solution: 2 g vial: 10 mL SWFI (withdraw 11.5 mL from the reconstituted vial to obtain a 2 g dose)
~200 mg/mL solution: 6 g vial: 26 mL SWFI (withdraw 5 mL from the reconstituted vial to obtain a 1 g dose)
Duplex container: Unlatch side tab, unfold, remove foil strip from drug chamber. Point set port in downward direction, fold container just below the diluent meniscus, and squeeze the diluent chamber until the seal between the diluent and drug powder opens. Agitate until dissolved.
Administer around-the-clock to promote less variation in peak and trough serum levels. Ceftazidime can be administered deep IM into large mass muscle, IVP over 3 to 5 minutes, or IV intermittent infusion over 15 to 30 minutes. Do not admix with aminoglycosides in same bottle/bag. Ceftazidime may be administered intravitreally as 2 to 2.25 mg/0.1 mL NS in combination with vancomycin (separate syringes) (Jackson, 2003; Roth, 1997).
Intraperitoneal administration may be used in conjunction with IV use for systemic infections if continuous peritoneal dialysis is used (added to the dialysate in each exchange). Intraperitoneal administration alone may also be used for the treatment of peritonitis and added to the dialysate in intermittent (added to the longest dwell time per day) or continuous (loading dose, followed by a maintenance dose per liter of exchange) peritoneal dialysis.
Inhalation for nebulization (off-label use/route): Use with standard jet nebulizer connected to an air compressor; administer 1,000 mg diluted in 8 mL NS with mouthpiece or face mask (Orriols 1999).
Some products may contain sodium.
Vials: Store intact vials at 20°C to 25°C (68°F to 77°F). Protect from light. Reconstituted solution and solution further diluted for IV infusion are stable for 24 weeks when immediately frozen at -20°C (-4°F). After freezing, thawed solution in NS in a Viaflex small volume container for IV administration is stable for 24 hours at room temperature or for 7 days when refrigerated. Do not refreeze the thawed solution. Ceftazidime solutions (concentrations 1 to 40 mg/mL) in NS, D5W, D5NS, LR, D10W, Ringer's injection, or SWFI are stable for 24 hours at room temperature (20°C to 25°C [68°F to 77°F]) and for 7 days if refrigerated (4°C [39°F]). Consult detailed reference regarding stability of ceftazidime in other solutions.
Duplex container: Store unactivated containers at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light. Do not freeze. Unactivated duplex containers with foil strip removed from the drug chamber must be protected from light and used within 7 days at room temperature. Once activated, must be used within 12 hours if stored at room temperature or within 3 days if stored under refrigeration.
Premixed frozen solution: Store at -20°C (-4°F). Thawed solution is stable for 8 hours at room temperature or for 3 days under refrigeration; do not refreeze.
Aminoglycosides: Cephalosporins (3rd Generation) may enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Chloramphenicol: May diminish the therapeutic effect of CefTAZidime. Management: Consider using a different combination of antimicrobials, especially if bactericidal activity is desired. If these agents are combined, monitor for reduced antimicrobial effectiveness and/or therapeutic failure. Consider therapy modification
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Probenecid: May increase the serum concentration of Cephalosporins. Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction
1% to 10%:
Cardiovascular: Phlebitis (1%)
Endocrine & metabolic: Increased lactate dehydrogenase (6%), increased gamma-glutamyl transferase (5%)
Gastrointestinal: Diarrhea (1%)
Hematologic & oncologic: Eosinophilia (8%), positive direct Coombs test (4%; without hemolysis), thrombocythemia (2%)
Hepatic: Increased serum ALT (7%), increased serum AST (6%), increased serum alkaline phosphatase (4%)
Hypersensitivity: Hypersensitivity reactions (2%)
Local: Inflammation at injection site (1%), pain at injection site (1%)
<1% (Limited to important or life-threatening): Agranulocytosis, anaphylaxis, angioedema, asterixis, brain disease, candidiasis, Clostridium difficile associated diarrhea, erythema multiforme, hemolytic anemia, hyperbilirubinemia, increased lactate dehydrogenase, leukopenia, lymphocytosis, myoclonus, nausea, neuromuscular excitability, neutropenia, paresthesia, pseudomembranous colitis, renal disease (may be severe, including renal failure), renal insufficiency, seizure, skin rash, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, vaginitis
Concerns related to adverse effects:
• Elevated INR: May be associated with increased INR, especially in nutritionally-deficient patients, prolonged treatment, hepatic or renal disease.
• Neurotoxicity: High ceftazidime levels in patients with renal insufficiency can lead to seizures, encephalopathy, coma, asterixis, myoclonia, and neuromuscular excitability. Reduce total daily dosage.
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.
• Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.
Pregnancy Risk Factor
Adverse events have not been observed in animal reproduction studies. Ceftazidime crosses the placenta and reaches the cord serum and amniotic fluid. An increase in most types of birth defects was not found following first trimester exposure to cephalosporins. Maternal peak serum concentration is unchanged in the first trimester. After the first trimester, serum concentrations decrease by approximately 50% of those in nonpregnant patients. Renal clearance is increased during pregnancy.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea. Have patient report immediately to prescriber bruising, bleeding, injection site irritation, urinary retention, change in amount of urine passed, chills, pharyngitis, seizures, severe loss of strength and energy, vaginitis, or signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
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- Drug class: third generation cephalosporins