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Drug dosage identifier

Ceftazadime Pentahydrate

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Dose and administration

30-50 mg/kg/dose IV infusion by syringe pump over 30 minutes, or IM.

Postmenstrual Age (weeks) Postnatal Age (days) Dosing Interval (hr)
<29 0 to 28 12
>28 8
30 to 36 0 to 14 12
>14 8
37 to 44 0 to 7 12
>7 8
>45 All 6

Indications

Infections caused by organisms resistant to other antibiotics, including aminoglycosides and many cephalosporins.

Contraindications and precautions

  • CNS infections with Streptococcal faecalis, Pseudomonas aerogenosa.
  • Caution in preterm infants, especially extreme immaturity.
  • Caution in infants with liver, renal or gastrointestinal disease.

Clinical pharmacology

Bacteriocidal third generation cephalosporin antibiotic which is resistant to most beta-lactamases and is active against a wide range of gram positive and gram negative bacteria. Inactive against Streptococcus faecalis, many staphylococci and many strains of Bacteroides fragilis. A useful anti-pseudomonal agent, especially in combination with aminoglycosides or penicillin. Active by inhibiting cell wall mucopeptide synthesis.

Poor oral absorption. Widely distributed at varying concentrations in human body tissues and fluids. Very little passes into the CSF unless the meninges are inflamed. Low binding (10%) to human plasma protein. Ceftazadime is not metabolised in the body. Excreted via the kidney. Reduction in serum concentrations can be achieved by peritoneal dialysis/haemodialysis. Serum half life in neonates is 4-10 hours.

Possible adverse effects

  • Venous irritation, soft tissue injury at IV injection site.
  • Pain, soft tissue injury at IM injection site.
  • Rash, pruritus, urticaria.
  • Gastrointestinal disturbance (nausea, vomiting and diarrhoea).
  • Neutropaenia, thrombocytopaenia, eosinophilia.
  • Positive Coombs test.
  • Transient elevation of hepatic enzymes.

Special considerations

  • Ceftazadime at high dosage should be given with caution to those infants receiving aminoglycosides or potent diuretics.
  • Adjust dose in suspected renal dysfunction (usually by lengthening the dosing interval).
  • Sodium content 2.3 mmol/gm.

Management of Ceftazadime administration

Description

  • White to pale yellow powder for reconstitution. 500 mg/vial, 1 gm/vial.
  • Reconstituted solution is clear and effervescent. May range from light yellow to amber. Potency is not affected by these colour variations.
  • No preservative.

Prescription

  • Stat dose is charted on stat page of prescription chart in mg/dose.
  • Maintenance doses are charted on the prescription chart in mg/dose.

Administration

Slow IV Infusion

  1. Reconstitute with water to 100 mg/ml. Water should be added in two stages.
      Ceftazadime 500mg Ceftazadime 1gram
    Powder space 0.5ml 1.0ml
    Water to be added 4.5ml 9.0ml
      500mg in 5.0ml 1gram in 10.0ml
  2. Shake vigorously. Allow 1-2 minutes for carbon dioxide to be released before drawing up dose. Filter prior to administration via a 0.2 micron Pall filter. Small bubbles in solution may be disregarded.
  3. Does not require further dilution.
  4. Administer by slow IV infusion over 30 minutes using a syringe pump.
  5. Compatible with D5W, D10W and NS. Do NOT mix with other drugs, IV solutions, blood, or blood products. (Incompatible with aminoglycosides, sodium bicarbonate and vancomycin).
  6. Flush line with NS before and after infusion of ceftazadime.

Nursing considerations

  • Observe site closely for extravasation during administration.
  • Observe for signs of adverse effects.
  • Observe for signs of renal, hepatic or haematological dysfunction during prolonged therapy.
  • Monitor for signs of super-infection.

Storage

  • Store at room temperature <25° C until reconstituted.
  • Protect from light.
  • Is not suitable for storage.

References

  1. Prober CG, Stevenson DK, Benitz WE. The use of antibiotics in neonates weighing less than 1200 gm. Pediatr Infec Dis J 1990; 9:111.
  2. Odio CM, Umana, MA, Saenz A, et al. Comparative efficacy of ceftazadime vers carbenacillin and amikacin for treatment of neonatal septicaemia. Pediatr Infec Dis 1987; 6:371.
  3. Low DC, Bissinden JG, Wise R. Ceftazadime in neonatal infections. Arch Dis Child 1985; 60:360.
  4. Prescribing information (product disclosure) Glaxo NZ 1990.
  5. Royal Children's Hospital, Melbourne. Paediatric Pharmacopoeia 11th Edition 1994, p28.
  6. Young TE and Mangum OB, Neofax. A manual of drugs used in neonatal care, 11th Edition 1998, p18-19.
  7. Northern Neonatal Network Neonatal Formulary. BMJ Books 2nd Edition 1998, p72.

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Document Control

  • Date last published: 30 September 1998
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years