Names and pronunciation
(az-tree′oh-nam) Azactam, Cayston
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Drug reference
(az-tree′oh-nam) Azactam, Cayston
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Func. class.: Antibiotic—miscellaneous
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Chem. class.: Monobactam
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ACTION: Bactericidal, inhibits cell wall synthesis
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USES: UTI; septicemia; skin, muscle, bone infection; lower respiratory tract, intraabdominal infections; other infec- tions caused by gram-negative organisms
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CONTRAINDICATIONS: Hyper- sensitivity to product, severe renal disease
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SIDE EFFECTS CV: Hypotension, chest pain, thrombophlebitis CNS: Confusion, headache, insomnia, fever, seizures EENT: Nasal congestion, sore throat GI: Pseudomembranous colitis, diarrhea, abdominal pain, nausea, vomiting RESP: Cough dyspnea, bronchospasm HEMA: Anemia, thrombocytopenia, neu- tropenia, pancytopenia INTEG: Rash, injection site reactions, allergic reactions
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INTERACTIONS Increase: Synergism: aminoglycosides, monitor renal studies Increase: Antagonism: cefoxitin, imipe- nem, avoid concurrent use NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Urinary tract infections • Adult: IM/IV 500 mg-1 g q8-12hr Systemic infections • Adult: IM/IV 1-2 g q8-12hr • Child: IM/IV 90-120 mg/kg/day in divided doses q6-8hr; max 8 g/day IV Severe systemic infections • Adult: IM/IV 2 g q6-8hr; max 8 g/day; continue treatment for 48 hr after nega- tive culture or until patient is asymptom- atic Cystic fibrosis with Pseudomonas aeruginosa • Adult, adolescent, child ≥7 yr: NEB 75 mg tid × 28 days, then 28 days off; give q4hr or more; give bronchodilator before aztreonam
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Available forms: Inhalation 75-mg ampule (Cayston); injection 500 mg, 1-g, 2-g vials; injection premixed 1 g/50 mL, 2 g/50 mL
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Administer: IV Route • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solu- tion and container permit • For IV push, reconstitute each vial with 6 to 10 mL of sterile water for injection • For intermittent IV infusion, reconsti- tute with at least 3 mL of sterile water for injection per g of aztreonam. FURTHER DILUTION IS NECESSARY FOR IV INFU- SION • Shake immediately and vigorously • Storage: Use within 48 hr if kept at room temperature 59°F-98°F (15°C-30°C) or within 7 days if kept under refrigera- A tion 38°F-48°F (2°C-8°C) Intermittent IV Infusion • Further dilute the appropriate dose in a compatible IV solution • If using a volume control administra- tion set, the final dilution of aztreonam max 20 mg/mL • Shake immediately and vigorously Premixed Galaxy IV Solution • Thaw frozen containers at room tem- perature 77°F (25°C) or under refriger- ation 36°F-46°F (2°C-8°C). • Contents of the solution may precipi- tate in the frozen state and should dis- solve with little or no agitation once the solution has reached room temperature • Storage: The thawed solution is stable for 48 hr at room temperature or 14 days under refrigeration Intermittent IV Injection Route • Slowly inject directly into a vein or the tubing of a suitable administration set over 3 to 5 min Intermittent IV Infusion Route • Infuse appropriate dose IV over 20 to 60 min • For neonates, an infusion time of 15 min has been recommended • For premixed bags, do not use plastic containers in series connections, as this could result in an embolism IM Route • Reconstitute vials with at least 3 mL of an appropriate diluent per g of aztreonam • Shake immediately and vigorously • In adults, inject doses of 1 g or less deeply into a large muscle upper outer quadrant of the gluteus maximus or lat- eral part of the thigh • Do not admix with any local anesthetic agent Inhalation Route • Do not reconstitute aztreonam for in- halation until ready to use • Twist the tip off of the provided 1 mL sterile diluent (0.17% sodium chloride) ampule and squeeze contents into the aztreonam vial • Gently swirl until the contents have completely dissolved • Have patient use a bronchodilator be- fore nebulized solution. A short-acting bronchodilator can be administered 15 min to 4 hr before aztreonam. A long- acting bronchodilator can be adminis- tered 30 min to 12 hr before aztreonam. • Administer aztreonam immediately af- ter reconstitution using an Altera Nebu- lizer System only. Do not administer via any other nebulizer • Do not mix with any other drugs • Administration typically takes 2-3 min via the nebulizer mouthpiece
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Assess: • Monitor LFTs and renal function studies • Monitor for overgrowth of infection and superinfection • Monitor for allergic reactions, also those allergic to penicillin and cephalosporins • May use with other antiinfectives for coverage of gram-positive and anaerobic infections • Monitor for CDAD that can occur up to 2 mo after using
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Evaluate: • Therapeutic response: Decreased signs/symptoms of UTI or cystic fibrosis See Appendix B
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Patient and caregiver information: • That IM injection is painful • To report continuing signs/symptoms of infection • To use bronchodilator, then inhalation product • To report if pregnancy is planned or suspected or if breastfeeding
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PHARMACOKINETICS IV: onset unknown, peak immediate, duration unknown; IM: onset unknown, peak <1 hr, duration unknown; inhalation: onset unknown, 1 hr, dura- tion unknown; half-life 1½-2 hr
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• Adult: IM/IV 500 mg-1 g q8-12hr Systemic infections
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• Adult: IM/IV 1-2 g q8-12hr
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• Child: IM/IV 90-120 mg/kg/day in divided doses q6-8hr; max 8 g/day IV Severe systemic infections
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• Adult: IM/IV 2 g q6-8hr; max 8 g/day; continue treatment for 48 hr after nega- tive culture or until patient is asymptom- atic Cystic fibrosis with Pseudomonas aeruginosa
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• Adult, adolescent, child ≥7 yr: NEB 75 mg tid × 28 days, then 28 days off; give q4hr or more; give bronchodilator before aztreonam
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