Ceftazidime (Fortum) is a third-generation cephalosporin with anti-pseudomonal activity. It is used to treat the following infections:

• Treatment of Bacterial septicemia caused by:
  • Pseudomonas aeruginosa,
  • Klebsiella spp.,
  • Haemophilus influenzae,
  • Escherichia coli,
  • Serratia spp.,
  • Streptococcus pneumoniae, and
  • methicillin-susceptible Staphylococcus aureus.
• Bone and joint infections caused by:
  • Pseudomonas aeruginosa,
  • Klebsiella spp.,
  • Enterobacter spp., and
  • Methicillin-susceptible Staphylococcus aureus.
• Treatment of meningitis and other CNS infections caused by:
  • Haemophilus influenzae
  • Neisseria meningitidis
  • Pseudomonas aeruginosa and
  • Streptococcus pneumoniae.
• Treatment of female genital infections, pelvic cellulitis, and endometritis caused by:
  • Escherichia coli.
• Treatment of peritonitis and other Intra-abdominal infections caused by:
  • Escherichia coli,
  • Klebsiella spp., and
  • methicillin-susceptible Staphylococcus aureus.
  • intra-abdominal infections with several microbes ( caused by aerobic and anaerobic organisms and some Bacteroides spp.)
• Treatment of Pneumonia and other Lower respiratory tract infections caused by:
  • Pseudomonas aeruginosa and other Pseudomonas spp.
  • Haemophilus influenzae
  • Enterobacter spp.
  • Proteus mirabilis
  • Escherichia coli
  • Serratia spp.
  • Citrobacter spp.
  • Streptococcus pneumoniae
  • methicillin-susceptible Staphylococcus aureus.
• Treatment of Skin and soft tissue infections caused by:
  • Pseudomonas aeruginosa
  • Klebsiella spp.
  • Escherichia coli
  • Proteus spp. (including Proteus mirabilis and indole-positive Proteus)
  • Enterobacter spp.
  • Serratia spp.
  • methicillin-susceptible Staphylococcus aureus.
  • Streptococcus pyogenes (group A beta-hemolytic streptococci).
• Complicated and uncomplicated Urinary tract infections (UTI) caused by:
  • Pseudomonas aeruginosa
  • Enterobacter spp.
  • Proteus spp. (including Proteus mirabilis and  indole positive Proteus)
  • Klebsiella spp.
  • Escherichia coli.
• Other Off-Label Uses of Ceftazidime in Adults include:
  • Bacterial endophthalmitis
  • Melioidosis ( caused by Burkholderia pseudomallei) infection
  • As aerosolized treatment of Non–cystic fibrosis bronchiectasis.

Ceftazidime Dose in Adults

Ceftazidime dose in patients with Cystic fibrosis: 

• Dose as recommended by the Manufacturer:
  • 90 to 150 mg/kg/day intravenous thrice daily to a maximum of 6 gms daily
• Alternative recommendations:
  • 200 to 400 mg/kg/day as an intermittent injection three or four times a day to a maximum dose of 8 - 12 g daily or
  • via continuous intravenous infusion, 100–200 mg/kg/day, up to a daily maximum dosage of 12 g.

Empiric treatment  of immunocompromised patients:

• 2 gms IV thrice daily

For the treatment of bacterial Endophthalmitis (off-label use):

• Vancomycin and 2 to 2.25 mg/0.1 mL NS are administered intravitreally.

Ceftazidime Use in treatment of severe Intra-abdominal infection in combination with metronidazole:

• 2 gms IV thrice daily for 4 - 7 days
• It is not recommended for mild to moderate community acquired infections and hospital-acquired intraabdominal infections caused by multidrug-resistant gram-negative organisms

Off label use in the treatment of severe & acute phase of Melioidosis:

• 50 mg/kg/dose thrice daily to a maximum dose of 2 g or
• 2 grammes as a single dosage, then 6 grammes per day by continuous intravenous infusion for at least 10 days with or without TMP/SMX.
• Patients should be switched to meropenem if the condition worsens, new foci of infections develop, and a repeat blood culture is positive

Use in treatment of bacterial Meningitis:

• For empiric or pathogen-specific therapy:
  • combined with 2 gms IV three times per day of vancomycin

As inhalational therapy in Non-cystic fibrosis bronchiectasis:

• For up to a year, take 250 to 1,000 mg twice day or 500 mg four times each day.

Off label dose as an alternative therapy in native vertebral Osteomyelitis caused by P. aeruginosa:

• 2 gms intravenous thrice daily for 6 weeks.
• Dual therapy i.e. the addition of an aminoglycoside or ciprofloxacin may be considered.

Off label use as intraperitoneal administration in Peritonitis:

• Intermittent:
  • 1 to 1.5 gm once a day per exchange in the long dwell (6 hours or more)
• Continuous (per liter exchange):
  • Loading dose of500 mg, followed by
  • Maintenance dose of 125 mg.

Dose for uncomplicated, hospital-acquired, and ventilator-associated Pneumonia:

• Uncomplicated pneumonia:
  • 500 mg to 1 g IM or IV thrice daily
• Hospital-acquired or ventilator-associated as an off-label treatment:
  • 2 gms thrice daily for 7 days
  • The duration of therapy may be increased or reduced based on clinical response.

As an alternative to cefepime or meropenem in the treatment of prosthetic joint infections caused by Pseudomonas aeruginosa:

• 2 gms thrice daily for 4 to 6 weeks
• The addition of aminoglycosides may be considered

Use in treatment of Skin and soft tissue infections:

• 500 mg to 1 g IM or IV thrice daily

Use in treatment of Severe infections including osteomyelitis and gynecological infections

• 2 gms intravenous thrice daily

Use in the treatment of Urinary tract infections:

• As per the Manufacturer’s recommendations:
  • Uncomplicated UTI:
    • 250 mg IM or IV twice daily
  • Complicated UTI:
    • 500 mg IM or IV twice or thrice daily
• Alternative recommendations:
  • Complicated UTI:
    • 1 to 2 g intravenous twice or thrice daily.

Ceftazidime Dose in Childrens

Ceftazidime general dosing in susceptible infection:

• Infants, Children, and Adolescents:
  • Mild to moderate infections:
    • maximum dose of 3 gms per day (three divided doses of 90 to 150 mg/kg/day)
  • Severe infections:
    • 200 mg/kg/day in three divided doses to a maximum daily dose of 6 gms/day.
    • Patients with cystic fibrosis may require higher doses up to 300 mg/kg/day

Ceftazidime in lung infection caused by Pseudomonas spp in patients with Cystic fibrosis:

• Infants, Children, and Adolescents:
  • 150 to 200 mg/kg/day intravenous in three or four divided doses to a maximum daily dose of 6 gms per day.
  • Some experts have used higher doses in the range of 200 to 400 mg/kg/day in three or four divided doses to a maximum dose of 12 g/day

Use of Ceftazidime for the treatment of Endocarditis:

• Children and Adolescents:
  • 100 to 150 mg/kg/day intravenous in three divided doses to a maximum dose of 4000 mg//day (in combination with gentamicin or vancomycin and gentamicin depending on the cause)

Use of Ceftazidime for treatment of complicated Intra-abdominal infections:

• Infants, Children, and Adolescents:
  • 50 mg/kg/dose intravenous thrice times with metronidazole to a maximum daily dose of 6 g/day.

Use of Ceftazidime for treatment of Meningitis:

• Infants, Children, and Adolescents:
  • 150 mg/kg/day in three divided doses to a maximum dose of 6 g/day.

Use of Ceftazidime in treatment of Peritonitis in patients on peritoneal dialysis:

• Infants, Children, and Adolescents:
  • Intermittent peritoneal dialysis: 20 mg/kg/dose intraperitonally once a day in the long dwell
• Continuous peritoneal dialysis:
  • • A Loading dose of 500 mg per liter of dialysate
    • a maintenance dose of 125 mg per liter

Use of Ceftazidime for treatment of Urinary tract infection:

• Infants and Children 2 - 24 months:
  • 100 to 150 mg/kg/day intravenous in three divided doses.

Pregnancy Risk Factor B

• Ceftazidime(Fortum).Crosses the placental boundary, but there have been no adverse drug reactions when taken during pregnancy.
• It can be used to treat susceptible infections in pregnant women.

Ceftazidime(Fortum).use during breastfeeding:

• Ceftazidime can be added to breastmilk. However, it is compatible with breastfeeding.
• Because it can be taken orally, there are no systemic risks.

Ceftazidime Dose in Renal Disease:

• Ceftazidime dosage in Renal disease:
  • CrCl 31 - 50 mL/minute: 1 gm twice daily
  • CrCl 16 - 30 mL/minute: 1 gm once a day
  • CrCl 6 - 15 mL/minute: 500 mg once a day
  • CrCl less than 5 mL/minute: 500 mg every other day
  • Intermittent hemodialysis (50% to 100% dialyzable - administer the dose after hemodialysis):
    • 500 mg - 1 g once a day or
    • 1 - 2 g every second or third day.
  • Intermittent Peritoneal dialysis:
    • • • Loading dose of 1 gm IV, followed by 500 mg once a day
  • Continuous peritoneal dialysis:
    • • • Loading dose of 1 gm IV, followed by 500 mg once a day.
  • CVVH:
    • A Loading dose of 2 gms followed by 1 - 2 g twice daily
  • CVVHD/CVVHDF:
    • • A Loading dose of 2 gms followed by either 1 g thrice daily or 2 gms twice daily.

Ceftazidime Dose in Liver Disease:

Dose adjustment is not required in patients with liver disease.

Common Side Effects of Ceftazidime Include:

• Dermatologic:
  • Pruritus
  • Skin rash
• Endocrine & metabolic:
  • Increased lactate dehydrogenase
  • Increased gamma-glutamyltransferase
• Gastrointestinal:
  • Diarrhea
• Hematologic & oncologic:
  • Eosinophilia
  • Positive direct Coombs test
  • Thrombocythemia
• Hepatic:
  • Increased serum ALT
  • Increased serum AST
  • Increased serum alkaline phosphatase
• Hypersensitivity:
  • Hypersensitivity reactions
• Local:
  • Inflammation at the injection site
  • Injection site phlebitis
• Miscellaneous:
  • Fever

Less common side effects of ceftazidime:

• Central nervous system:
  • Seizure
• Hematologic & oncologic:
  • Agranulocytosis
  • Leukopenia
  • Lymphocytosis
  • Neutropenia
  • Thrombocytopenia
• Renal:
  • Increased blood urea nitrogen
  • Increased serum creatinine

Contraindication to Ceftazidime include:

Hypersensitivity to ceftazidime or other cephalosporins or any component of this formulation

Warnings/Precautions

• Coagulopathy (Elevated iNR):
  • Ceftazidime therapy may be used to treat coagulopathy, which is a condition characterized by an increase INR. This is especially true for patients who are nutritionally poor or have hepatic impairment.
  • Patients with coagulaopathy may be given Vitamin K.​​​​​​​
• Hypersensitivity reactions
  • Ceftazidime therapy can cause severe allergic reactions, especially for penicillin- and cephalosporin-allergic patients. If allergic reactions are detected, therapy should be stopped immediately.​​​​​​​
• Neurotoxicity:
  • Seizures, myoclonia, and neuromuscular exitability can occur in patients with renal impairment and high blood levels of ceftazidime.
  • Patients should modify the dose if they have poor renal function.
• Superinfection
  • Ceftriaxone treatment for longer periods (over 2 months) can lead to superinfections, including fungal or bacterial superinfections. C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.​​​​​​​
• Gastrointestinal Disease:
  • Patients suffering from Gastrointestinal Disease, particularly colitis, should be cautious when taking the drug.​​​​​​​
• Renal impairment
  • The dose needs to be changed to prevent harmful effects in patients with reduced renal function.

Ceftazidime: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring Parameters:

Monitor the patient for features of anaphylaxis and clinical improvement/ deterioration.

Monitor renal functions and adjust the dose accordingly.

How to Administer Ceftazidime?

• Intramuscular Ceftazidime should be administered deep into a large mass muscle.
• The intravenous formulation may be infused continuously for 15 to 30 minutes, or it may be pushed into the vein over a period of 3 to 5 minutes.
• Ceftazidime can also be given intravitreally as 2 to 2.25 mg/0.1 mL NS in a separate syringe with vancomycin.
• If continuous peritoneal dialysis is performed, intraperitoneal injection may be combined with intravenous usage for systemic infections. Each exchange's dialysate may contain it. With a regular jet nebulizer coupled to an air compressor, inhalation for nebulization is another option (off-label method). Give 1,000 mg diluted in 8 mL of NS while wearing a face mask or a mouthpiece.

Mechanism of action of Ceftazidime:

• Ceftazidime blocks the formation of proteins, peptidoglycans and penicillin-binding proteins.
• This eventually leads to cell lysis through the use of autolytic enzymes.

It works wellabsorbedAfter intramuscular injection, it is widelydistributedAll over the body, including bones, bile and skin, lungs. A mere 10% of the drug's total is available.

Proteins boundIt has been ahalf-life eliminationPatients with severe renal impairment may experience a delay of 1 to 2 hours. The drug can be found in 80 to 90% of the country.excretedUse urine as an unchanged drug.

International Brands of Ceftazidime:

• Baxidyme
• Biotum
• Biozim
• Caltum
• Cef-H
• Cefa 3
• Cefadime
• Cefatum
• Cefaz
• Cefazime
• Cefdim
• Cefidime
• Cefortam
• Cefpiran
• Cefranz
• Ceftadime
• Ceftamil
• Ceftaz
• Ceftazash
• Ceftidin
• Ceftim
• Ceftum
• Celodim
• Cestazid
• Cetazine
• Cetazum
• Cezidin
• Dimcef
• Dimzef
• Elzid
• Extimon
• Fivtum
• Fortaz
• Fortum
• Fortum Pro
• Fortumset
• Forzid
• Ftazidime
• Glazidim
• Izadima
• Kefadim
• Kefazim
• Lacedim
• Lemoxol
• Maxidim
• Megacef
• Mirocef
• Negacef
• Orzid
• Parzidim
• Pharodime
• Romacef
• Septax
• Spectrum
• Starcef
• Tagal
• Tazicef
• Tazidan
• Tazidem
• Thidim
• Tinacef
• Trizidim
• UIzadima
• Xtrazidime
• Zadolina
• Zeptrigen
• Zibac
• Zidimax
• Zidmbiotic
• Zitadim
• Zitum
• Zytaz

Ceftazidime Brands in Pakistan: