ceftazidime (Rx)

Brand and Other Names:Fortaz, Tazicef, more...Tazidime
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 40mg/mL

powder for injection

  • 500mg
  • 1g
  • 2g
  • 6g

Bone & Joint Infections

2 g IV q12hr

Gynecologic & Intra-abdominal Infections

2 g IV q8hr for 4-7 days

Pulmonary Infections

Infections caused by Pseudomonas spp in patients with cystic fibrosis who have healthy renal function

30-50 mg/kg IV q8hr; not to exceed 6 g/day  

Meningitis

2 g IV q8hr

Pneumonia

Uncomplicated: 0.5-1 g IV q8hr

Complicated: 2 g IV q8hr

Mild Skin/Skin Structure Infections

0.5-1 g IV or IM q8hr

Urinary Tract Infections

Complicated: 500 mg IV or IM q8-12hr

Uncomplicated: 250 mg IV or IM q12hr

Life-Threatening Infections

Especially in immunocompromised patients

2 g IV q8hr

Dosing Modifications

Renal impairment

  • Modifications based on 1-g dose
  • CrCl 31-50 mL/min: 1 g q12hr
  • CrCl 16-30 mL/min: 1 g q24hr
  • CrCl 6-15 mL/min: 500 mg q24hr
  • CrCl <5 mL/min: 500 mg q48hr

Dosing Considerations

Susceptible organisms

  • Citrobacter spp, Clostridium spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Neisseria meningitidis, Proteus mirabilis, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 40mg/mL

powder for injection

  • 500mg
  • 1g
  • 2g
  • 6g

Infections Caused by Susceptible Organisms

<1 month: Safety and efficacy not established

1 month-12 years: 30-50 mg/kg IV q8hr; not to exceed 6 g/day (higher end of dosing range reserved for patietns with immunocompromise, meningitis, or cystic fibrosis)  

>12 years: 1-2 g IV q8hr

Dosing Considerations

Use sodium carbonate preparation

Usual dosing range for neonates (per manufacturer)

  • <28 days: 30 mg/kg IV q12hr  

Usual dosing range for neonates (per American Academy of Pediatrics)

  • 7-28 days: 50 mg/kg IV q8hr
  • <7 days, <2 kg: 50 mg/kg IV q12hr
  • <7 days, >2 kg: 50 mg/kg IV q8-12hr
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Interactions

Interaction Checker

and ceftazidime

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (3)

              • BCG vaccine live

                ceftazidime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                ceftazidime, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • typhoid vaccine live

                ceftazidime decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              Monitor Closely (10)

              • bazedoxifene/conjugated estrogens

                ceftazidime will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • dienogest/estradiol valerate

                ceftazidime will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • estradiol

                ceftazidime will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                ceftazidime will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethinylestradiol

                ceftazidime will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                ceftazidime will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • probenecid

                probenecid will increase the level or effect of ceftazidime by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                ceftazidime decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • voclosporin

                voclosporin, ceftazidime. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

              • warfarin

                ceftazidime increases effects of warfarin by Other (see comment). Use Caution/Monitor. Comment: Decr vitamin K-producing intestinal flora may increase INR after a few days.

              Minor (12)

              • acyclovir

                ceftazidime will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aminohippurate sodium

                ceftazidime will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin

                ceftazidime will increase the level or effect of aspirin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin rectal

                ceftazidime will increase the level or effect of aspirin rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin/citric acid/sodium bicarbonate

                ceftazidime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chloramphenicol

                chloramphenicol decreases effects of ceftazidime by pharmacodynamic antagonism. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                ceftazidime will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • furosemide

                ceftazidime increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.

              • rose hips

                rose hips will increase the level or effect of ceftazidime by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • salicylates (non-asa)

                ceftazidime will increase the level or effect of salicylates (non-asa) by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • sulfasalazine

                ceftazidime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • willow bark

                ceftazidime will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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              Adverse Effects

              1-10%

              Transient increases in transaminases (3-9%)

              Eosinophilia (<7%)

              Diarrhea (<2%)

              Immune hypersensitivity reaction (2%)

              Phlebitis (<2%)

              Rash (maculopapular or erythematous) (2%)

              Thrombocytosis (2%)

              Injection site pain (1%)

              <1%

              Abdominal pain

              Agranulocytosis

              Angioedema

              Asterixis

              Coma

              Dizziness

              Encephalopathy

              Fever

              Hallucinations

              Increased serum concentrations of bilirubin

              Leukopenia

              Lymphocytosis

              Metallic taste

              Myoclonia

              Nausea or vomiting

              Neuromuscular excitability

              Neutropenia

              Paresthesia

              Photosensitivity

              Pruritus

              Seizures

              Thrombocytopenia

              Transient increases in blood urea nitrogen (BUN) or serum creatinine

              Urticaria

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              Warnings

              Contraindications

              Documented hypersensitivity to drug or excipients, or to cephalosporin class of antibacterial drugs, penicillins or other beta-lactam antibacterial drugs

              Cautions

              High and prolonged serum ceftazidime concentrations can occur from usual dosages in patients with transient or persistent reduction of urinary output because of renal insufficiency; elevated levels of the drug in these patients can lead to, seizures, nonconvulsive status epilepticus (NCSE), encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonus reported in patients treated with ceftazidime; adjust dosing based on creatinine clearance in patients with renal impairment

              Elevated international normalized ratio (INR) has reported in patients with nutritional deficiency, prolonged treatment, or renal or hepatic disease

              Use with caution in patients with history of seizure disorder (especially in renal impairment, where drug levels may increase significantly)

              Modify dose in renal impairment

              Use with caution in patients with history of penicillin allergy

              Prescribing the drug in the absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria

              Clostridioides difficile-associated diarrhea

              • Clostridioides difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including ceftazidime products, and may range in severity from mild diarrhea to fatal colitis; treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile
              • C. difficile produces toxins A and B, which contribute to the development of CDAD; hypertoxin- producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy
              • CDAD must be considered in all patients who present with diarrhea following antibacterial use; careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents
              • If CDAD is suspected or confirmed, ongoing antibacterial use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated
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              Pregnancy & Lactation

              Pregnancy category: B

              Lactation: Drug excreted in breast milk; use with caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Third-generation cephalosporin with broad-spectrum gram-negative activity, including Pseudomonas; has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms; arrests bacterial growth by binding to 1 or more penicillin-binding proteins, thereby, in turn, inhibiting final transpeptidation step of peptidoglycan synthesis in bacterial cell-wall synthesis and inhibiting cell-wall biosynthesis

              Absorption

              Peak plasma time: IM, 1 hr

              Distribution

              Widely distributed to body tissues and fluids, including aqueous humor, ascitic and prostatic fluids, and bone; penetrates CSF when meninges are inflamed

              Protein bound: 5-24%

              Metabolism

              Not metabolized

              Elimination

              Half-life: 1-2 hr

              Dialyzable: Hemodialysis, yes; peritoneal dialysis, yes

              Excretion: Urine (80-90% as unchanged drug)

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              Administration

              IV Incompatibilities

              Additive: Amikacin, aminophylline, ciprofloxacin, gentamicin, ranitidine

              Y-site: Amiodarone, amphotericin B cholesteryl complex, azithromycin, amsacrine, clarithromycin, cisatracurium(?), doxorubicin liposome, erythromycin lactobionate, fluconazole(?), idarubucin, midazolam, nicardipine (incompatible at ceftazidime 125 mg/mL but compatible at ceftazidime 10 mg/mL), pentamidine, propofol (incompatible at ceftazidime 125 mg/mL but compatible at ceftazidime 40 mg/mL), sagramostim(?), vancomycin(?), warfarin

              IV/IM Administration

              IV

              • Direct injection: Inject over 3-5 minutes directly into vein or through tubing of running compatible infusion solution
              • Infusion: Infuse intermittently over 15-30 minutes

              IM

              • Inject deeply

              Storage

              Store intact vials at room temperature, protected from light

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Tazicef intravenous
              -
              2 gram vial
              Tazicef intravenous
              -
              1 gram vial
              ceftazidime injection
              -
              6 gram vial
              ceftazidime injection
              -
              2 gram vial
              ceftazidime injection
              -
              1 gram vial
              ceftazidime injection
              -
              6 gram vial
              ceftazidime injection
              -
              6 gram vial
              ceftazidime injection
              -
              2 gram vial
              ceftazidime injection
              -
              1 gram vial
              Tazicef injection
              -
              6 gram vial
              Tazicef injection
              -
              1 gram vial
              Tazicef injection
              -
              2 gram vial

              Copyright © 2010 First DataBank, Inc.

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              Formulary

              FormularyPatient Discounts

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.