Fourth-Generation Cephalosporin
Methicillin-susceptible Staphylococcus aureus (MSSA), Coagulase negative Staphylococci, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, E. Coli, P. aeruginosa
Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.
Cephalosporins exhibit time-dependent killing (T > MIC)
Dose of 1g: Cmax: 66-82 mcg/L; Half-life: 2-2.3 hours; Volume of distribution: 20.5L; Table 11
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
IV: 500mg, 1g, 2g
Febrile neutropenia: 2g IV q8h x 7 days or until resolution of neutropenia
Intra-abdominal infection: 2g IV q12h x 7-10 days
Pneumonia: 1-2 g IV q12h x 10 days
Meningitis: 2g IV q12h
UTI: 0.5-1g IV/IM q12h x 7-10 days
See Table 12
Renal failure: CrCl > 60mL/min: standard dosing
CrCl 30-60mL/min: 1-2g q24h
CrCl 11-29mL/min: 0.5-1g q24h
CrCl < 10mL/min: 0.25-0.5g q24h
Hepatic failure: No dosing changes recommended at this time.
CVVH (Continuous venovenous hemofiltration): 1-2g IV q12h
CVVHD (Continuous venovenous hemodialysis): 2g IV q12h
CVVHDF (Continuous venovenous hemodiafiltration) 2g IV q12h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment, risk factors for altered prothrombin time (renal or hepatic impairment, poor nutritional status, prolonged course of antibiotic therapy)
Chloramphenicol: decreased ceftazidime effectiveness
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count
Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.
Maxpime Ò/Bristol-Myers Squibb