aztreonam lysine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
aztreonam lysine: clinical details
Prescribing considerations
- Confirm chronic Pseudomonas aeruginosa pulmonary infection and specialist cystic fibrosis oversight.
- Use cautiously with renal impairment or severe hepatic impairment because dedicated pharmacokinetic studies are unavailable.
- Assess benefit against bleeding risk in active haemoptysis.
- Efficacy is not established in patients with relatively preserved lung function; relevant studies excluded recent Burkholderia cepacia isolation.
- Consider resistance and superinfection if clinical response deteriorates.
Contraindications and cautions
- Hypersensitivity to aztreonam or any excipient.
- Use caution with previous immediate or serious allergy to penicillins, cephalosporins or carbapenems, although cross-reactivity risk is considered low.
Monitoring
- Symptoms, adherence and tolerability
- Lung function and bronchospasm, particularly around initiation or deterioration
- Haemoptysis
- Sputum microbiology and susceptibility where clinically indicated
- Rash or other evidence of hypersensitivity
- Emergence of resistant Pseudomonas or additional pathogens during repeated use
Clinical pharmacology
Aztreonam is a monobactam beta-lactam that binds bacterial penicillin-binding proteins and inhibits cell-wall synthesis. Inhalation produces high sputum exposure with low plasma concentrations; absorbed aztreonam is eliminated mainly through the kidneys.
Formulation and product differences
- The licensed inhaled product is a powder supplied with sodium chloride solvent for reconstitution.
- It must be administered with the Cayston-specific Altera handset and must not be mixed with other medicines.
- Injectable aztreonam is a different formulation containing arginine and must not be nebulised.
aztreonam lysine preparations and strengths
Inhaled preparation
Route: Inhaled
Strengths: 75 mg
aztreonam lysine interactions
Formal interaction studies have not been performed, but clinical studies did not identify interactions with several commonly used cystic fibrosis treatments. Administration compatibility remains important.
Other nebulised medicines
Do not mix them with aztreonam lysine in the Altera handset; administer inhaled treatments separately in the prescribed order.
Bronchodilators
No interaction signal was identified, but use the bronchodilator first to reduce inhalation-related bronchospasm.
Dornase alfa, azithromycin, tobramycin, pancreatic enzymes and inhaled corticosteroids
Clinical studies found no evidence of interactions when these were used alongside inhaled aztreonam.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.