ceftazidime
Brand: Fortaz, Tazicef
Prototype Drug
Drug Class: third-generation cephalosporin
Drug Family: antibiotic
Subclass: anti-pseudomonal third-generation cephalosporin
Organ Systems: infectious-disease
Mechanism of Action
Inhibits bacterial cell wall synthesis; uniquely active against Pseudomonas aeruginosa among third-generation cephalosporins; excellent gram-negative coverage.
penicillin-binding proteins (PBPs)
Indications
- Pseudomonas aeruginosa infections
- hospital-acquired pneumonia
- septicemia
- urinary tract infections (complicated)
- meningitis (gram-negative)
- febrile neutropenia
Contraindications
- cephalosporin hypersensitivity
Adverse Effects
Common
- injection site reactions
- diarrhea
- elevated LFTs
Serious
- anaphylaxis
- C. difficile colitis
- seizures (high doses, renal impairment)
- superinfection with resistant organisms
Pharmacokinetics (ADME)
| Absorption | IV/IM only |
| Distribution | widely distributed; good CNS penetration |
| Metabolism | not metabolized |
| Excretion | renal (unchanged >80%); dose adjustment critical in renal impairment |
| Half-life | 1.8 hours (normal renal function) |
| Onset | immediate (IV) |
| Peak | 1 hour (IM) |
| Duration | 8 hours |
| Protein Binding | 10–17% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| aminoglycosides | synergistic against Pseudomonas; additive nephrotoxicity | moderate |
| chloramphenicol | antagonism of bactericidal activity (in vitro) | moderate |
Nursing Considerations
- Dose reduction is essential in renal impairment; reduce dose and/or extend interval when CrCl is <50 mL/min; monitor for neurotoxicity (encephalopathy, seizures) with accumulation.
- Monitor cultures for resistance development; Pseudomonas aeruginosa can develop resistance during therapy via AmpC derepression.
- Administer IV over 15–30 minutes; reconstituted solutions may be used within 24 hours at room temperature.
- Monitor renal function, CBC, and LFTs during prolonged therapy.
Clinical Pearls
- Ceftazidime is one of the standard agents for Pseudomonas aeruginosa infections, with better anti-pseudomonal activity than ceftriaxone but no anaerobic coverage.
- Ceftazidime-avibactam, a newer combination, extends coverage to KPC and OXA-48 carbapenemase-producing organisms, critical for multidrug-resistant pathogens.
Safety Profile
Pregnancy generally-safe
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.