Drug reference
Aztreonam is a monocyclic beta-lactam (‘monobactam’) antibiotic with an antibacterial spectrum limited to Gram-negative aerobic bacteria including Pseudomonas aeruginosa, Neisseria meningitidis, and Haemophilus influenzae; it should not be used alone for ‘blind’ treatment since it is not active against Gram- positive organisms. Aztreonam is also effective against Neisseria gonorrhoeae (but not against concurrent chlamydial infection).
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Gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria meningitidis ▶BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION ▶Adult: 1 g every 8 hours, alternatively 2 g every 12 hours, single doses over 1 g intravenous route only Severe gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, Neisseria meningitidis, and lung infections in cystic fibrosis ▶BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION ▶Adult: 2 g every 6–8 hours Gonorrhoea | Cystitis ▶BY INTRAMUSCULAR INJECTION ▶Adult: 1 g for 1 single dose Urinary-tract infections ▶BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION ▶Adult: 0.5–1 g every 8–12 hours Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis ▶BY INHALATION OF NEBULISED SOLUTION ▶Adult: 75 mg 3 times a day for 28 days, doses to be administered at least 4 hours apart, subsequent courses repeated after 28-day interval without aztreonam nebuliser solution Infection
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▶When used by inhalation Haemoptysis— risk of further haemorrhage
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Contra-indicated in aztreonam hypersensitivity. Use with caution in patients with hypersensitivity to other beta-lactam antibiotics (although aztreonam may be less likely than other beta-lactams to cause hypersensitivity in penicillin-sensitive patients).
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Scottish Medicines Consortium (SMC) decisions SMC No. 753/12 The Scottish Medicines Consortium has advised (January 2015) that aztreonam powder for nebuliser solution Infection (Cayston ®) is accepted for restricted use within NHS Scotland when inhaled colistimethate sodium and inhaled tobramycin are not tolerated or are not providing satisfactory therapeutic benefit (measured as 2% decline in forced expiratory volume in 1 second). This advice is contingent upon the continuing availability of the Patient Access Scheme in NHS Scotland or a list price that is equivalent or lower.
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GENERAL SIDE-EFFECTS ▶Common or very common Dyspnoea. respiratory disorders SPECIFIC SIDE-EFFECTS ▶Common or very common ▶When used by inhalation Cough. haemoptysis. joint disorders. laryngeal pain. nasal complaints. rash ▶Rare or very rare ▶With parenteral use Anaemia. asthenia. breast tenderness. chest pain. confusion. diplopia. dizziness. eosinophilia. haemorrhage. headache. hepatic disorders. hypotension. insomnia. leucocytosis. myalgia. nasal congestion. neutropenia. oral disorders. pancytopenia. paraesthesia. pseudomembranous enterocolitis. seizure. thrombocytopenia. thrombocytosis. tinnitus. vertigo. vulvovaginal candidiasis ▶Frequency not known ▶With parenteral use Abdominal pain. angioedema. diarrhoea. nausea. skin reactions. taste altered. toxic epidermal necrolysis. vomiting
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▶With systemic use No information available; manufacturer of injection advises avoid. ▶When used by inhalation No information available; manufacturer of powder for nebuliser solution advises avoid unless essential.
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Amount in milk probably too small to be harmful.
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▶With systemic use Manufacturer advises caution in chronic impairment with cirrhosis. Dose adjustments ▶With systemic use Manufacturer advises dose reduction of 20—25% for long term treatment of patients with chronic impairment with cirrhosis, especially in alcoholic cirrhosis and concomitant renal impairment.
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Dose adjustments ▶With systemic use If eGFR 10–30 mL/minute/1.73 m2, usual initial dose of injection, then half normal dose. If eGFR less than 10 mL/minute/1.73 m2, usual initial dose of injection, then one-quarter normal dose.
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▶When used by inhalation Measure lung function before and after initial dose of aztreonam and monitor for bronchospasm.
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▶With intravenous use For intravenous injection, give over 3–5 minutes. For intravenous infusion (Azactam ®), give intermittently in Glucose 5% or Sodium chloride 0.9%. Dissolve initially in water for injections (1 g per 3 mL) then dilute to a concentration of less than 20 mg/mL; to be given over 20–60 minutes. ▶When used by inhalation Other inhaled drugs should be administered before aztreonam; a bronchodilator should be administered before each dose.
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There can be variation in the licensing of different medicines containing the same drug. Powder and solvent for nebuliser solution ▶Cayston (Gilead Sciences International Ltd) Aztreonam (as Aztreonam lysine) 75 mg Cayston 75mg powder and solvent for nebuliser solution vials with Altera Nebuliser Handset | 84 vial P £2,181.53 DT = £2,181.53 Powder for solution for injection ▶Azactam (Bristol-Myers Squibb Pharmaceuticals Ltd) Aztreonam 1 gram Azactam 1g powder for solution for injection vials | 1 vial P £9.40 (Hospital only) Aztreonam 2 gram Azactam 2g powder for solution for injection vials | 1 vial P £18.82 (Hospital only) ANTIBACTERIALS › NITROIMIDAZOLE DERIVATIVES
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1 g every 8 hours, alternatively 2 g every
First-line fragment. Read the complete Indications and Dose section above.
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2 g every 6–8 hours
First-line fragment. Read the complete Indications and Dose section above.
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1 g for 1 single dose
First-line fragment. Read the complete Indications and Dose section above.
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0.5–1 g every 8–12 hours
First-line fragment. Read the complete Indications and Dose section above.
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75 mg 3 times a day for 28 days, doses to be
First-line fragment. Read the complete Indications and Dose section above.
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