Aztreonam: Difference between revisions
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*Mechanism of Action: Bactericidal; inhibits cell wall synthesis
*Mechanism of Action: Bactericidal; inhibits cell wall synthesis


==[[Antibacterial Spectra]] <ref>Sanford Guide to Antimicrobial Therapy 2010</ref>==
==[[Antibacterial Spectra]] <ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
{| class="wikitable"
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
|-
! [[Gram Positives]]!!Susceptibility
| Gram Positive||[[Strep. Group A, B, C, G]]||R
|-
|-
| Strep, Group A, B, C, G||0
| ||[[Strep. Pneumoniae]]||R
|-
|-
| Strep. pneumoniae||0
| ||[[Viridans strep]]||R
|-
|-
| Viridans strep||0
| ||Strep. anginosus gp||R
|-
|-
| Strep. milleri||0
| ||[[Enterococcus faecalis]]||R
|-
|-
| Enterococcus faecalis||0
| ||[[Enterococcus faecium]]||R
|-
|-
| Enterococcus faecium||0
| ||[[MSSA]]||R
|-
|-
| Staph. aureus (MSSA)||0
| ||[[MRSA]]||R
|-
|-
| Staph. aureus (MRSA)||0
| ||[[CA-MRSA]]||R
|-
|-
| Staph. aureus (CA-MRSA)||0
| ||[[Staph. Epidermidis]]||R
|-
|-
| Staph. epidermidis||0
| ||[[C. jeikeium]]||R
|-
|-
| C. jeikeium||0
| ||[[L. monocytogenes]]||R
|-
|-
| L. monocytogenes||0
| Gram Negatives||[[N. gonorrhoeae]]||'''S'''
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||'''S'''
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||X1
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||'''S'''
|-
| ||[[Citrobacter freundii]]||'''S'''
|-
| ||[[Citrobacter diversus]]||'''S'''
|-
| ||[[Citrobacter sp.]]||'''S'''
|-
| ||[[Aeromonas sp]]||'''S'''
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||'''S'''
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||R
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||R
|-
| ||[[Clostridium (not difficile)]]||R
|-
| ||[[Fusobacterium necrophorum]]||X1
|-
| ||[[Peptostreptococcus sp.]]||R
|}
|}


*'''+''' usually effective clinically or >60% susceptible
===Key===
*'''+/-''' clinical trials lacking or 30-60% susceptible
{{Template:Antibacterial Spectra Key}}
*'''0''' not effective clinically or <30% susceptible
*'''blank''' data not available


==See Also==
==See Also==

Revision as of 03:36, 24 June 2014

General

  • Type: Monobactam
  • Dosage forms: IM; IV
  • Common Trade Names: Azactam

Other

  • Antimicrobial activity more closely resembles AG's (only active against gram -)
    • Enterobacter, pseudomonas, H. influenzae, gonococci
    • Little allergic cross-reactivity with B-lactam antibiotics

Adult Dosing

General (Moderate Severe)

  • 1-2g IM/IV q8-12h
  • Max: 8g/day

General (Severe)

  • 2g IM/IV q6-8h
  • Max: 8g/day

Pediatric Dosing

General (Neonates)

  • <7 days old
    • <2000g
      • 60 mg/kg/day IV divided q12h
      • First ED Dose: 30 mg/kg x 1
    • >2000g
      • 90 mg/kg/day IV divided q8
      • First ED Dose: 30 mg/kg x 1
  • 7 days - 1 month
    • <1200g
      • 60 mg/kg/day IV divided q12h
      • First ED Dose: 30 mg/kg x 1
    • 1200-2000g
      • 90 mg/kg/day IV divided q8
      • First ED Dose: 30 mg/kg x 1
    • >2000g
      • 120 mg/kg/day IV divided q6
      • First ED Dose: 30 mg/kg x 1

General (1 Month - 9 Months)

  • General
    • 90-120 mg/kg/day IV divided q6-8h
    • First ED Dose: 40 mg/kg x 1
  • Respiratory Infections in Cystic Fibrosis
    • 200mg/kg/day IV divided q6h
    • First ED Dose: 40 mg/kg x 1
    • Max: 8g/day

General >9 Months)

  • 90-120 mg/kg/day IV divided q6-8
  • First ED Dose: 40 mg/kg x 1

Special Populations

  • Pregnancy Rating: B
  • Lactation: Safe
  • Renal
    • Adult
      • CrCl 10-30: 1-2g x1, then decrease dose 50%
      • CrCl <10: give usual dose x1, then decrease dose 75%
      • Hemodialysis: give 12.5% of initial dose as supplement
      • Peritoneal dialysis: no supplement
    • Pediatric
      • CrCl 10-30: decrease dose 50%
      • CrCl <10: decrease dose 75%
      • Hemodialysis: give supplement
      • Peritoneal dialysis: no supplement
  • Hepatic (Adult & Pediatric)
    • caution advised, but not defined

Contraindications

  • Allergy to class/drug

Adverse Drug Reactions

Serious

Common

  • Phlebitis
  • Injection site reaction
  • Diarrhea
  • Nausea/vomiting
  • Rash
  • Transaminitis
  • Elevated creatinine
  • Eosinophilia

Pharmacology

  • Half-life: 1.7h (4.7-6h ESRD)
  • Metabolism: CYP450, minimal liver
  • Excretion: Urine
  • Mechanism of Action: Bactericidal; inhibits cell wall synthesis

Antibacterial Spectra [1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G R
Strep. Pneumoniae R
Viridans strep R
Strep. anginosus gp R
Enterococcus faecalis R
Enterococcus faecium R
MSSA R
MRSA R
CA-MRSA R
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae S
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp X1
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. R
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces R
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) R
Fusobacterium necrophorum X1
Peptostreptococcus sp. R

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

Source

  • Epocrates

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
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