Aztreonam (aztreonam)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Aztreonam is a synthetic monocyclic beta-lactam (i.e., monobactam) antibiotic.
Aztreonam is a synthetic monobactam antibiotic.
Like bicyclic beta-lactam antibiotics, the antibacterial activity of aztreonam results from inhibition of mucopeptide synthesis in the bacterial cell wall. Aztreonam has a high affinity for and preferentially binds to penicillin-binding protein 3 (PBP 3) of susceptible gram-negative bacteria. The drug also has some affinity for PBP 1a of these bacteria, but little or no affinity for PBPs 1b, 2, 4, 5, or 6.
Because PBP 3 is involved in septation, aztreonam causes the formation of abnormally elongated or filamentous forms in susceptible gram-negative bacteria. As a consequence, cell division is inhibited and breakage of the cell wall occurs resulting in lysis and death. Studies using Staphylococcus aureus indicate that aztreonam does not bind to the essential PBPs of gram-positive bacteria.
Aztreonam also has poor affinity for the PBPs of anaerobic bacteria. The drug, therefore, generally is inactive against these organisms.
Aztreonam usually is bactericidal in action. Since aztreonam has poor affinity for PBPs 1a and 1b of susceptible gram-negative bacteria, it is not as rapidly bactericidal as some other beta-lactam antibiotics (e.g., imipenem, cefotaxime, cefoxitin, ceftriaxone) against these organisms. For most susceptible Enterobacteriaceae, the minimum bactericidal concentration (MBC) of aztreonam is equal to or only 2-4 times higher than the minimum inhibitory concentration (MIC) of the drug.
For Pseudomonas aeruginosa, the MBC of aztreonam is usually only 2 times higher than the MIC, but may be up to 125 times higher than the MIC for some strains of the organism.
Aztreonam is used for the treatment of infections caused by susceptible gram-negative pathogens including Pseudomonas aeruginosa; such infections include intra-abdominal infections (e.g., peritonitis), gynecologic infections (e.g., endometritis, pelvic cellulitis), lower respiratory tract infections (e.g., pneumonia, bronchitis), septicemia, skin and skin structure infections (including those associated with postoperative wounds or ulcers and burns), and complicated and uncomplicated urinary tract infections (e.g., pyelonephritis, cystitis).
Generic name: aztreonam
Pronunciation: (az-TREE-oh-nam)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Aztreonam
Indications
The following indications are listed for Aztreonam:
- Aerobic Gram-Negative Bacteremia
- Bacterial Urinary Tract Infection
- Citrobacter Peritonitis
- Citrobacter Urinary Tract Infection
- E. Coli Bronchitis
- E. Coli Endometritis
- E. Coli Pelvic Inflammatory Disease
- E. Coli Peritonitis
- E. Coli Septicemia
- E. Coli Urinary Tract Infection
- Endometritis
- Enterobacter Cloacae Bronchitis
- Enterobacter Cloacae Urinary Tract Infection
- Enterobacter Endometritis
- Enterobacter Pelvic Inflammatory Disease
- Enterobacter Peritonitis
- Enterobacter Pneumonia
- Escherichia Coli Pneumonia
- Female Genital Tract Infection
- Gram-Negative Aerobic Bacillary Pneumonia
- Haemophilus Influenzae Bronchitis
- Haemophilus Influenzae Pneumonia
- Infectious Disease Of Abdomen
- Inflammatory Disease Of Female Pelvic Organs
- Klebsiella Endometritis
- Klebsiella Pelvic Inflammatory Disease
- Klebsiella Pneumonia
- Klebsiella Pneumoniae Bronchitis
- Klebsiella Pneumoniae Peritonitis
- Klebsiella Pneumoniae Septicemia
- Klebsiella Urinary Tract Infection
- Lower Respiratory Infection
- Peritonitis
- Proteus Bronchitis
- Proteus Endometritis
- Proteus Pelvic Inflammatory Disease
- Proteus Pneumonia
- Proteus Septicemia
- Proteus Urinary Tract Infection
- Pseudomonas Aeruginosa Bronchitis
- Pseudomonas Aeruginosa Peritonitis
- Pseudomonas Aeruginosa Pneumonia
- Pseudomonas Aeruginosa Septicemia
- Pseudomonas Aeruginosa Urinary Tract Infection
- Sepsis Caused By Enterobacter
- Sepsis Caused By Serratia
- Serratia Bronchitis
- Serratia Peritonitis
- Serratia Pneumonia
- Serratia Urinary Tract Infection
- Skin And Skin Structure Citrobacter Infection
- Skin And Skin Structure E. Coli Infection
- Skin And Skin Structure Enterobacter Infection
- Skin And Skin Structure Infection
- Skin And Skin Structure Klebsiella Infection
- Skin And Skin Structure Proteus Infection
- Skin And Skin Structure Pseudomonas Aeruginosa Infection
- Skin And Skin Structure Serratia Infection
Also known as: Bronchitis Due To Aerobacter Cloacae, Bronchitis Due To Bacterium Cloacae, Bronchitis Due To E. Coli, Bronchitis Due To Enterobacter Cloacae, Bronchitis Due To Escherichia Coli, Bronchitis Due To H. Flu, Bronchitis Due To H. Influenzae, Bronchitis Due To Haemophilus Influenzae, Bronchitis Due To Hemophilus Influenzae, Bronchitis Due To Influenzae Bacillus, Bronchitis Due To Klebsiella Pneumoniae, Bronchitis Due To Pfeiffer's Bacillus, Bronchitis Due To Proteus Species, Bronchitis Due To Pseudomonas Aeruginosa, Bronchitis Due To Serratia Species, E. Coli Pneumonia, E. Coli Sepsis, E. Coli Uti, Endometritis Due To E. Coli, Endometritis Due To Enterobacter Species, Endometritis Due To Escherichia Coli, Endometritis Due To Klebsiella Species, Endometritis Due To Proteus Species, Enterobacter Sepsis, Escherichia Coli Sepsis, Escherichia Coli Septicemia, Gram-Negative Bacteremia, Gynecologic Infection, H. Flu Pneumonia, H. Influenzae Pneumonia, Hemophilus Influenzae Pneumonia, Infection Of Skin And/Or Subcutaneous Tissue, Infection Of The Lungs Due To Enterobacter, Infection Of The Lungs Due To Pseudomonas Aeruginosa, Infection Of The Lungs Due To Serratia Species, Influenza Bacillus Pneumonia, Intra-Abdominal Infection, Klebsiella Uti, Lower Respiratory Tract Infection, Pelvic Inflammatory Disease Due To Aerobacter Species, Pelvic Inflammatory Disease Due To E. Coli, Pelvic Inflammatory Disease Due To Enterobacter Species, Pelvic Inflammatory Disease Due To Escherichia Coli, Pelvic Inflammatory Disease Due To Klebsiella Species, Pelvic Inflammatory Disease Due To Proteus Species, Peritonitis Due To Aerobacter, Peritonitis Due To Citrobacter Species, Peritonitis Due To Enterobacter, Peritonitis Due To Escherichia Coli, Peritonitis Due To Klebsiella Pneumoniae, Peritonitis Due To Pseudomonas Aeruginosa, Peritonitis Due To Serratia Species, Peritonitis Due To Serratia Spp., Pfeiffer's Bacillus Pneumonia, Pid Due To Enterobacter Species, Pid Due To Escherichia Coli, Pid Due To Klebsiella Species, Pid Due To Proteus Species, Pneumonia Due To E. Coli, Pneumonia Due To Escherichia Coli, Pneumonia Due To Gram-Negative Organism, Pneumonia Due To Haemophilus Influenzae, Pneumonia Due To Klebsiella Species, Pneumonia Due To Klebsiella Spp., Pneumonia Due To Proteus Species, Pneumonia Due To Pseudomonas Aeruginosa, Pneumonia Due To Serratia Species, Pneumonia Due To Serratia Spp., Proteus Spp. Pneumonia, Sepsis Due To Aerobacter Species, Sepsis Due To Enterobacter Species, Sepsis Due To Enterobacter Spp., Sepsis Due To Klebsiella Pneumoniae, Sepsis Due To Proteus Species, Sepsis Due To Pseudomonas Aeruginosa, Sepsis Due To Serratia Spp., Septicemia Due To Klebsiella Pneumoniae, Septicemia Due To Proteus Species, Septicemia Due To Proteus Spp., Septicemia Due To Pseudomonas Aeruginosa, Serratia Sepsis, Skin And Skin Soft Tissue Enterobacter Infection, Skin And Skin Soft Tissue Escherichia Coli Infection, Skin And Skin Soft Tissue Infection Due To Aerobacter, Skin And Skin Soft Tissue Infection Due To Citrobacter, Skin And Skin Soft Tissue Infection Due To Enterobacter, Skin And Skin Soft Tissue Infection Due To Klebsiella, Skin And Skin Soft Tissue Infection Due To Serratia, Skin And Skin Soft Tissue Proteus Infection, Skin And Skin Soft Tissue Pseudomonas Aeruginosa Infection, Skin And Soft Tissue Skin Infection, Urinary Tract Infection Due To Citrobacter Species, Urinary Tract Infection Due To Enterobacter Cloacae, Urinary Tract Infection Due To Escherichia Coli, Urinary Tract Infection Due To Klebsiella Species, Urinary Tract Infection Due To Proteus Species, Urinary Tract Infection Due To Pseudomonas Aeruginosa, Urinary Tract Infection Due To Serratia Species, Uti Due To Citrobacter Species, Uti Due To Enterobacter Cloacae, Uti Due To Proteus Species, Uti Due To Pseudomonas Aeruginosa, Uti Due To Serratia Species.
Dosing
Dosage and route of administration of aztreonam should be determined by the type and severity of infection, susceptibility of the causative organism, and patient condition. Do not use dosages lower than those usually recommended.
For most infections, continue parenteral aztreonam treatment for at least 48 hours after the patient becomes asymptomatic or evidence of eradication of the infection has been obtained. Persistent infections may require several weeks of treatment.
Administer aztreonam by IV injection or infusion, or by deep IM injection.
Aztreonam also is administered by oral inhalation via nebulization in patients with cystic fibrosis.
Aztreonam has been administered intraperitoneally+ in dialysis fluid.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
Drug interactions reported are based on parenteral aztreonam. Formal drug interaction studies have not been conducted to date using aztreonam administered by oral inhalation via nebulization.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*Known hypersensitivity to aztreonam or any component of the formulation.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
Adverse effects reported with IV or IM aztreonam are similar to those reported with other beta-lactam antibiotics, and the drug generally is well tolerated. Adverse effects have been reported in 7% or less of patients receiving parenteral aztreonam and have required discontinuance in about 2% of patients.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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The manufacturers state that use of IV aztreonam in children 9 months of age or older is supported by evidence from adequate and well-controlled studies in adults and additional efficacy, safety, and pharmacokinetic data from noncomparative clinical studies in pediatric patients. However, data are insufficient to date to determine safety and efficacy of IV aztreonam in pediatric patients 9 months of age or older for the treatment of septicemia or skin and skin structure infections (when skin infection suspected or known to be caused by Haemophilus influenzae type b). In addition, the manufacturers state that data are insufficient to date to evaluate IM administration of aztreonam in pediatric patients or use of the drug in pediatric patients with impaired renal function.
In clinical studies evaluating parenteral aztreonam in pediatric patients, discontinuance of the drug because of adverse effects was required in less than 1% of patients. Rash, diarrhea, and fever have been reported in 1-4.3% of pediatric patients. In pediatric patients receiving IV aztreonam, pain was reported in 12% and erythema, induration, or phlebitis were reported in 0.9-2.9% of patients overall; in US patients, pain occurred in 1.5% and other local reactions occurred in about 0.5%. Eosinophilia, neutropenia, or increased platelet count has been reported in 6.3, 3.2, or 3.6% of pediatric patients, respectively, and increased serum AST, ALT, or serum creatinine has been reported in 3.8-6.5%. In US pediatric studies, neutropenia (absolute neutrophil count less than 1000/mm3) occurred in 11.3% of patients younger than 2 years of age receiving aztreonam in a dosage of 30 mg/kg every 6 hours and increased serum AST and ALT (greater than 3 times the upper limit of normal) occurred in 15-20% of patients 2 years of age or older receiving a dosage of 50 mg/kg every 6 hours. It is unclear whether the increased frequency of these adverse effects was related to increased severity of illness in the patients or aztreonam dosage administered.
Aztreonam has been used IM or IV in a limited number of neonates and infants as young as 1 month of age+ without unusual adverse effects.
Safety and efficacy of aztreonam administered by oral inhalation via nebulization have not been established in pediatric patients younger than 7 years of age. The drug has been used by oral inhalation via nebulization for the treatment of newly acquired Ps. aeruginosa respiratory tract infections in a limited number of cystic fibrosis patients 3 months through 6 years of age+ without unusual adverse effects. In clinical trials evaluating aztreonam inhalation therapy in cystic fibrosis patients 7 years of age or older, pyrexia was reported more frequently in pediatric patients than in adults.
There are no adequate and controlled studies to date using parenteral aztreonam or aztreonam administered by oral inhalation via nebulization in pregnant women. Use parenteral or orally inhaled aztreonam during pregnancy only when clearly needed. Aztreonam crosses the placenta in pregnant women and enters fetal circulation.
No evidence of embryotoxicity, fetotoxicity, or teratogenicity was found in reproduction studies in pregnant rats and rabbits using daily parenteral aztreonam dosages up to 1.8 and 1.2 g/kg, respectively; these aztreonam dosages were 2.2- and 2.9-fold greater than the maximum recommended human dosage (MRHD) based on body surface area. There was no evidence of drug-induced changes in any maternal, fetal, or neonatal parameters when parenteral aztreonam was used in a perinatal/postnatal study in rats; the highest dosage used in this study (1.8 g/kg daily) was 2.2 times the MRHD based on body surface area. However, in a 2-generation reproduction study in rats using parenteral aztreonam dosages up to 2.4 g/kg daily (2.9-fold greater than the MRHD), there was a slightly reduced survival rate during the lactation period in offspring of rats that received the highest dosage, but not in offspring of rats that received lower dosages.
Because aztreonam is distributed into milk in low (<1%) concentrations following parenteral administration and because safety of aztreonam in neonates has not been fully evaluated to date, consider temporary discontinuance of nursing if parenteral aztreonam is used in lactating women.
Aztreonam 75 mg administered by oral inhalation via nebulization in lactating women produced peak plasma concentrations approximately 1% of peak plasma concentrations reported following a 500-mg IV dose of the drug. Systemic absorption of aztreonam following inhaled administration is likely minimal, but the effects on the infant or on milk production are unknown.
Select dosage in geriatric patients with caution because of the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in these patients. Aztreonam is substantially eliminated by the kidneys and the risk of adverse reactions may be greater in patients with impaired renal function. Because geriatric patients are more likely to have renal impairment, monitor renal function and make appropriate dosage modifications if necessary.
Clinical studies evaluating IV or IM aztreonam or aztreonam administered by oral inhalation via nebulization did not include sufficient numbers of patients 65 years of age and older to determine whether they respond differently than younger patients. Other reported clinical experience with parenteral aztreonam has not identified differences in responses between geriatric patients and younger adults.
Aztreonam is substantially eliminated by the kidneys, and the risk of adverse effects may be greater in those with impaired renal function. Because geriatric patients are more likely to have reduced renal function, select IV or IM dosage of aztreonam with caution and monitor renal function.
ICD codes
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Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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