Ceftazidime

Ceftazidime is a 3rd generation cephalosporin; this substance has the highest antibacterial effect against Pseudomonas aeruginosa and pathogens of hospital infections. At the same time, having a wide range of medicinal activity, it is used for severe infections in situations where the pathogen has not yet been detected. It is recommended to administer this drug for nosocomial lesions.

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Indications Ceftazidime

It is used in cases of severe stages of infectious and inflammatory pathologies that arise due to the activity of bacteria sensitive to drugs:

• lesions affecting organs in the pelvic area;
• sepsis, peritonitis or cholangitis;
• pneumonia;
• empyema affecting the gallbladder;
• infections of the epidermis, bones, subcutaneous tissues and joints;
• lung abscess;
• pleural empyema;
• pyelonephritis;
• renal abscess;
• infected wounds or burns.

Along with this, the medication is prescribed for severe stages of infectious and inflammatory diseases in people with weakened immunity and for infections that appear during hemodialysis or peritoneal dialysis.

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Release form

The medicinal substance is released in the form of a lyophilisate for intramuscular and intravenous injections. Inside the box there are 10 or 50 vials with powder.

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Pharmacodynamics

The drug exhibits a bactericidal effect by destroying the binding of the cell wall components, causing the membranes to lose their stability and the microbial cell to die. Ceftazidime exhibits resistance to most β-lactamases.

The following microbial strains are sensitive to the drug: influenza bacilli, Klebsiella, Escherichia coli with Neisseria, Proteus, Acinetobacter with Citrobacter, Salmonella, Enterobacter, Providencia and Serratia, as well as Morganella, Shigella, Haemophilus parainfluenzae with Staphylococci (including Staphylococcus aureus) and Yersinia. In addition, the list includes Bacteroides, Clostridia, Streptococci with Peptococci, as well as Micrococci, Peptostreptococci with Propionibacteria and Hemolytic Streptococci of subcategory A.

Resistance is demonstrated by: enterococci, chlamydia, epidermal staphylococci, capillobacteria with bacteroides fragilis, faecal streptococci, listeria, Staphylococcus aureus (resistant to methicillin) and Clostridium difficile.

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Pharmacokinetics

When the drug is administered intramuscularly in a dose of 0.5 and 1 g, its Cmax level is 17 and 39 mg/l, respectively. It reaches TCmax values after 1 hour. In the case of intravenous administration of the same dosages, the Cmax values are 42 and 69 mg/l, respectively.

Effective medicinal values of the drug inside the serum during parenteral injection are maintained within 8-12 hours. The synthesis rate with proteins is less than 10%.

The drug level, exceeding the minimum inhibitory values for most pathogenic bacteria sensitive to the drug, is observed in bile, sputum, bone and cardiac tissue, synovium, pleural, peritoneal and intraocular fluids.

Without complications, it crosses the placenta and is found in mother's milk. If there is no inflammation, it will be difficult for the drug to pass through the BBB.

In the cerebrospinal fluid, the drug indicators for meningitis reach medicinally effective levels and are 4-20 mg/l or higher. The half-life term in an adult is 1.9 hours. In newborns, it is three to four times longer. In the case of hemodialysis, this indicator is 3-5 hours. It does not participate in intrahepatic metabolic processes.

It is excreted through the kidneys per day, with the help of CF. In this case, 80-90% of the substance is excreted unchanged. Even less than 1% is excreted with bile.

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Dosing and administration

Ceftazidime may only be administered intramuscularly or intravenously.

For adults, 1 g of the substance is administered at 8-12-hour intervals. A regimen can be used in which 2 g of the drug is administered at 12-hour intervals. In severe stages of infection, especially with weakened immunity (including persons with neutropenia), 2 g of the drug is administered at 8-hour intervals.

In case of damage to the urethra, 0.25 g of the medication is administered 2 times a day.

For cystic fibrosis and respiratory infections caused by pseudomonas, 30-50 mg/kg of the drug should be administered at 8-hour intervals.

In case of operations performed on the prostate, 1 g of Ceftazidime is used as a preventive measure before the administration of anesthesia, duplicating this injection after removing the catheter.

Elderly people can be administered a maximum of 3 g of the drug per day.

Infants over 2 months of age should be given 30-50 mg/kg per day, divided into 3 injections. A maximum of 6 g of the substance can be administered per day.

Children with weakened immunity, as well as with cystic fibrosis or meningitis, are administered 0.15 g/kg per day, divided into 3 injections. A maximum of 6 g of the drug is allowed per day.

For newborns under 2 months of age, a dose of 30 mg/kg is administered per day, divided into 2 injections (used with extreme caution).

People with kidney disease should start treatment with a dose of 1 g of the drug. Then a maintenance dose is used, the size of which depends on the rate of excretion of the drug:

• CC values within 50-31 ml per minute – 1 g 2 times per day;
• CC level within 30-16 ml per minute – 1 g once a day;
• the QC rate is within 15-6 ml per minute – 0.5-1 g of the substance once a day;
• the level of CC is below 5 ml per minute - 0.5-1 g with a 48-hour break.

For people with a severe stage of infection, the 1-time dose of the drug can be doubled, while monitoring its blood levels, which should be within 40 mg/l.

In case of hemodialysis, maintenance doses of the drug are used taking into account the level of CC; injections should be done after the procedure. When undergoing peritoneal dialysis sessions, in addition to intravenous injections, the drug can be included in the dialysis fluid (0.125-0.25 g of the substance per 2 liters of fluid).

For people with renal insufficiency undergoing continuous hemodialysis procedures using an AV shunt, as well as for people undergoing high-speed hemofiltration sessions, 1 g of the drug is administered over 24 hours. If hemofiltration occurs at a low speed, portions prescribed for kidney diseases are administered.

To prepare an intramuscular fluid, the lyophilisate is diluted in a solvent (1-3 ml); when preparing an intravenous fluid, 2.5-10 ml of solvent is required; for infusion - 50 ml. Small bubbles that appear in the prepared solution are carbon dioxide; they do not affect the medicinal activity of Ceftazidime (gas elimination may be necessary), as well as yellowing of the liquid. Only freshly prepared liquid can be used for administration.

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Use Ceftazidime during pregnancy

Ceftazidime may be used during pregnancy only if absolutely necessary.

You should stop breastfeeding during treatment with this medication.

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Contraindications

Contraindicated for use in individuals with a history of intolerance to drugs or other cephalosporins.

Caution is required in the following cases:

• pathologies associated with the gastrointestinal tract;
• renal failure;
• combined use with aminoglycosides or loop diuretics.

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Side effects Ceftazidime

Side effects include:

• CNS dysfunction: seizures, encephalopathy, headaches, fluttering tremors, paresthesia and dizziness;
• problems with the functioning of the urogenital system: toxic nephropathy, renal dysfunction and candidal vaginitis;
• disorders of hematopoietic processes: hemorrhages, lymphocytosis, neutro-, thrombocyto- or leukopenia and hemolytic anemia;
• gastrointestinal tract lesions: cholestasis, abdominal pain, nausea, diarrhea, oropharyngeal candidiasis, vomiting and colitis;
• local symptoms: phlebitis (in case of intravenous administration), pain, burning sensation and induration at the injection site (in case of intramuscular administration);
• signs of allergy: urticaria, SJS, Quincke's edema, eosinophilia, anaphylaxis, fever, TEN and bronchospasm;
• changes in test results: an increase in the volume of urea, PT values and liver enzyme activity, as well as hypercreatininemia or -bilirubinemia and false positive data (urine sugar test and Coombs test).

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Overdose

In case of poisoning with the drug, dizziness, paresthesia, headaches, inflammation, phlebitis and pain in the injection area may occur, as well as hyperbilirubinemia or -creatininemia, leukopenia or thrombocytopenia, eosinophilia, thrombocytosis, seizures in people with kidney disease and prolongation of the PT.

Symptomatic treatment procedures are performed; in case of renal failure, peritoneal dialysis or hemodialysis is performed.

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Interactions with other drugs

Ceftazidime cannot be combined with aminoglycosides, because this results in significant mutual inactivation of the drugs (with parallel use, injections must be given in different areas of the body).

In addition, the drug is incompatible with vancomycin (their mixing leads to the formation of sediment). If their combined use through one intravenous system is required, it must be washed between administrations of the drug.

Sodium bicarbonate should not be used as a solvent because it produces carbon dioxide, which may require gas removal.

Aminoglycosides, vancomycin with clindamycin and loop diuretics reduce the clearance rate of the drug, which increases the likelihood of nephrotoxic effects.

Chloramphenicol and other bacteriostatic antibiotics weaken the medicinal activity of Ceftazidime.

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Storage conditions

Ceftazidime should be stored at temperatures no higher than 25°C.

Shelf life

Ceftazidime can be used within a 2-year period from the date of manufacture of the medicine.

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Application for children

The drug is prescribed in pediatrics with extreme caution (especially when treating newborn babies).

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Analogues

The analogs of the drug are Cefogram, Loraxone, Ceftriaxone with Medocef, Sulperazone and Medaxone with Cefotaxime, and in addition Oframax, Torotsef, Sulcef, Cefoperazone, etc.

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Reviews

Ceftazidime receives quite different reviews, so they cannot be considered unambiguously positive or negative. For some, the medication was completely suitable, eliminating the disease, and for others it was completely useless, and even caused the appearance of negative symptoms. This can be associated with the fact that different categories of antibiotics affect only bacteria sensitive to them, so before using them, it is necessary to accurately identify the type of microbe that causes the pathology.

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