avibactam sodium + ceftazidime pentahydrate: clinical use

Prescribing considerations

• Use susceptibility results and antimicrobial-stewardship principles where available.
• Provide additional anaerobic or Gram-positive cover when these organisms are known or suspected contributors.
• Assess renal function carefully because both components are cleared through the kidneys and renal function may change rapidly during acute infection.
• Review beta-lactam allergy history, total sodium exposure and concurrent nephrotoxic medicines.
• Exercise particular care when calculating administration volumes for infants.

Contraindications and cautions

• Hypersensitivity to ceftazidime, avibactam or an excipient.
• Hypersensitivity to any cephalosporin.
• Previous severe hypersensitivity, including anaphylaxis or a severe skin reaction, to another beta-lactam antibacterial.

Monitoring

• Estimated renal function before and during treatment.
• Clinical and microbiological response, including possible overgrowth by non-susceptible organisms.
• Neurological status where renal function is impaired or changing.
• Persistent diarrhoea, hypersensitivity and severe cutaneous reactions.
• Haemoglobin and evidence of haemolysis if anaemia develops; treatment can cause a positive direct antiglobulin test.

Clinical pharmacology

Ceftazidime inhibits bacterial cell-wall synthesis; avibactam inhibits selected class A, class C and some class D beta-lactamases. Both undergo little or no metabolism and are eliminated predominantly unchanged through the kidneys.

Formulation and product differences

• The selected product is a white-to-yellow powder for concentrate for intravenous infusion in a single-use vial.
• It contains anhydrous sodium carbonate and has clinically relevant sodium content.
• The reconstituted concentrate requires further dilution and should not be physically mixed with other medicines unless specified as compatible.