Ceftazidime overdosage has occurred in patients with renal failure. Reactions have included seizure activity, encephalopathy, asterixis, neuromuscular excitability, and coma. Patients who receive an acute overdosage should be carefully observed and given supportive treatment. In the presence of renal insufficiency, hemodialysis or peritoneal dialysis may aid in the removal of ceftazidime from the body.
CEPTAZ (ceftazidime) is contraindicated in patients who have shown hypersensitivity to ceftazidime or the cephalosporin group of antibiotics.
The following adverse effects from clinical trials were considered to be either related to ceftazidime therapy or were of uncertain etiology. The most common were local reactions following IV injection and allergic and gastrointestinal reactions. No disulfiramlike reactions were reported.
Local Effects, reported in fewer than 2% of patients, were phlebitis and inflammation at the site of injection (1 in 69 patients).
Hypersensitivity Reactions, reported in 2% of patients, were pruritus, rash, and fever. Immediate reactions, generally manifested by rash and/or pruritus, occurred in 1 in 285 patients. Toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme have also been reported with cephalosporin antibiotics, including ceftazidime. Angioedema and anaphylaxis (bronchospasm and/or hypotension) have been reported very rarely.
Gastrointestinal Symptoms, reported in fewer than 2% of patients, were diarrhea (1 in 78), nausea (1 in 156), vomiting (1 in 500), and abdominal pain (1 in 416). The onset of pseudomembranous colitis symptoms may occur during or after treatment (see WARNINGS).
Central Nervous System Reactions (fewer than 1%) included headache, dizziness, and paresthesia. Seizures have been reported with several cephalosporins, including ceftazidime. In addition, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia have been reported in renally impaired patients treated with unadjusted dosage regimens of ceftazidime (see PRECAUTIONS: General).
Less Frequent Adverse Events (fewer than 1%) were candidiasis (including oral thrush) and vaginitis.
Hematologic: Rare cases of hemolytic anemia have been reported.
Laboratory Test Changes noted during ceftazidime clinical trials were transient and included: eosinophilia (1 in 13), positive Coombs' test without hemolysis (1 in 23), thrombocytosis (1 in 45), and slight elevations in one or more of the hepatic enzymes, aspartate aminotransferase (AST, SGOT) (1 in 16), alanine aminotransferase (ALT, SGPT) (1 in 15), LDH (1 in 18), GGT (1 in 19), and alkaline phosphatase (1 in 23). As with some other cephalosporins, transient elevations of blood urea, blood urea nitrogen, and/or serum creatinine were observed occasionally. Transient leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and lymphocytosis were seen very rarely.
Postmarketing Experience With Ceptaz (ceftazidime) ProductsIn addition to the adverse events reported during clinical trials, the following events have been observed during clinical practice in patients treated with CEPTAZ (ceftazidime) and were reported spontaneously. For some of these events, data are insufficient to allow an estimate of incidence or to establish causation.
General: Anaphylaxis; allergic reactions, which, in rare instances, were severe (e.g., cardiopulmonary arrest); urticaria; pain at injection site.
Hepatobiliary Tract: Hyperbilirubinemia, jaundice.
Renal and Genitourinary: Renal impairment.
Cephalosporin-Class Adverse Reactions: In addition to the adverse reactions listed above that have been observed in patients treated with ceftazidime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics:
Adverse Reactions: Colitis, toxic nephropathy, hepatic dysfunction including cholestasis, aplastic anemia, hemorrhage.
Altered Laboratory Tests: Prolonged prothrombin time, false-positive test for urinary glucose, pancytopenia.
CEPTAZ (ceftazidime) is indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following diseases:
Specimens for bacterial cultures should be obtained before therapy in order to isolate and identify causative organisms and to determine their susceptibility to ceftazidime. Therapy may be instituted before results of susceptibility studies are known; however, once these results become available, the antibiotic treatment should be adjusted accordingly.
CEPTAZ (ceftazidime) may be used alone in cases of confirmed or suspected sepsis. Ceftazidime has been used successfully in clinical trials as empiric therapy in cases where various concomitant therapies with other antibiotics have been used.
CEPTAZ (ceftazidime) may also be used concomitantly with other antibiotics, such as aminoglycosides, vancomycin, and clindamycin; in severe and life-threatening infections; and in the immunocompromised patient (see Compatibility And Stability). When such concomitant treatment is appropriate, prescribing information in the labeling for the other antibiotics should be followed. The dosage depends on the severity of the infection and the patient's condition.
CEPTAZ (ceftazidime) in the dry state should be stored between 15° and 30°C (59° and 86°F) and protected from light. CEPTAZ (ceftazidime) is a dry, white to off-white powder supplied in vials and infusion packs as follows:
NDC 0173-0414-00 1-g* Vial (Tray of 25)
NDC 0173-0415-00 2-g* Vial (Tray of 25)
NDC 0173-0416-00 1-g* Infusion Pack (Tray of 10)
NDC 0173-0417-00 2-g* Infusion Pack (Tray of 10)
NDC 0173-0418-00 10-g* Pharmacy Bulk Package (Tray of 6)
*Equivalent to anhydrous ceftazidime.
REFERENCES
4.Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31-41.
GlaxoSmithKline Research Triangle Park, NC 27709. CEPTAZ (ceftazidime) and ZINACEF are registered trademarks of GlaxoSmithKline. CLINITEST and CLINISTIX are registered trademarks of Ames Division, Miles Laboratories, Inc. VIAFLEX and PL 146 Plastic are registered trademarks of Baxter International Inc. April 2002. FDA Rev date: 3/29/2002
BEFORE THERAPY WITH CEPTAZ (ceftazidime) IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFTAZIDIME, CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS-HYPERSENSITIVITY AMONG BETA-LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF AN ALLERGIC REACTION TO CEPTAZ (ceftazidime) OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, IV FLUIDS, IV ANTIHISTAMINES, CORTICOSTEROIDS, PRESSOR AMINES, AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED.
Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ceftazidime, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.
Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is one primary cause of "antibiotic-associated colitis."
After the diagnosis of pseudomembranous colitis has been established, appropriate therapeutic measures should be initiated. Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibacterial drug clinically effective against Clostridium difficile colitis.
Elevated levels of ceftazidime in patients with renal insufficiency can lead to seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia (see PRECAUTIONS).
PRECAUTIONSGeneral: High and prolonged serum ceftazidime concentrations can occur from usual dosages in patients with transient or persistent reduction of urinary output because of renal insufficiency. The total daily dosage should be reduced when ceftazidime is administered to patients with renal insufficiency (see DOSAGE AND ADMINISTRATION). Elevated levels of ceftazidime in these patients can lead to seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia. Continued dosage should be determined by degree of renal impairment, severity of infection, and susceptibility of the causative organisms.
As with other antibiotics, prolonged use of CEPTAZ (ceftazidime) may result in overgrowth of nonsusceptible organisms. Repeated evaluation of the patient's condition is essential. If superinfection occurs during therapy, appropriate measures should be taken.
Inducible type I beta-lactamase resistance has been noted with some organisms (e.g., Enterobacter spp., Pseudomonas spp., and Serratia spp.). As with other extended-spectrum beta-lactam antibiotics, resistance can develop during therapy, leading to clinical failure in some cases. When treating infections caused by these organisms, periodic susceptibility testing should be performed when clinically appropriate. If patients fail to respond to monotherapy, an aminoglycoside or similar agent should be considered.
Cephalosporins may be associated with a fall in prothrombin activity. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy. Prothrombin time should be monitored in patients at risk and exogenous vitamin K administered as indicated.
CEPTAZ (ceftazidime) should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.
Arginine has been shown to alter glucose metabolism and elevate serum potassium transiently when administered at 50 times the recommended dose. The effect of lower dosing is not known.
Distal necrosis can occur after inadvertent intra-arterial administration of ceftazidime.
Carcinogenesis, Mutagenesis, Impairment of Fertility: Long-term studies in animals have not been performed to evaluate carcinogenic potential. However, a mouse Micronucleus test and an Ames test were both negative for mutagenic effects.
Pregnancy: Teratogenic Effects: Pregnancy Category B. Reproduction studies have been performed in mice and rats at doses up to 40 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus due to ceftazidime. CEPTAZ (ceftazidime) at 23 times the human dose was not teratogenic or embryotoxic in a rat reproduction study. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Nursing Mothers: Ceftazidime is excreted in human milk in low concentrations. It is not known whether the arginine component of this product is excreted in human milk. Because many drugs are excreted in human milk and because safety of the arginine component of CEPTAZ (ceftazidime) in nursing infants has not been established, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use: Safety of the arginine component of CEPTAZ (ceftazidime) in neonates, infants, and children has not been established. This product is for use in patients 12 years and older. If treatment with ceftazidime is indicated for neonates, infants, or children, a sodium carbonate formulation should be used.
Geriatric Use: Clinical studies of CEPTAZ (L-arginine formulation of ceftazidime) did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. However, of the 2,221 subjects who received ceftazidime as FORTAZ in 11 clinical studies, 824 (37%) were 65 and over while 391 (18%) were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater susceptibility of some older individuals to drug effects cannot be ruled out. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function (see DOSAGE AND ADMINISTRATION).
Dosage: The usual adult dosage is 1 gram administered intravenously or intramuscularly every 8 to 12 hours. The dosage and route should be determined by the susceptibility of the causative organisms, the severity of infection, and the condition and renal function of the patient.
The guidelines for dosage of CEPTAZ (ceftazidime) are listed in Table 3. The following dosage schedule is recommended.
Table 3. Recommended Dosage Schedule
| Dose | Frequency | |
| Patients 12 years and older* | ||
| Usual recommended dosage | 1 gram IV or IM | q8-12hr |
| Uncomplicated urinary tract infections | 250 mg IV or IM | q12hr |
| Bone and joint infections | 2 grams IV | q12hr |
| Complicated urinary tract infections | 500 mg IV or IM | q8-12hr |
| Uncomplicated pneumonia; mild skin and skin-structure infections | 500 mg-1 gram IV or IM | q8hr |
| Serious gynecologic and intra-abdominal infections | 2 grams IV | q8hr |
| Meningitis | 2 grams IV | q8hr |
| Very severe life-threatening infections, especially in immunocompromised patients | 2 grams IV | q8hr |
| Lung infections caused by Pseudomonas spp. in patients with cystic fibrosis with normal renal function† | 30-50 mg/kg IV to a maximum of 6 grams per day | q8hr |
| * This product is for use in patients 12
years and older. If treatment with ceftazidime is indicated for patients
less than 12 years old, a sodium carbonate formulation should be used. †Although clinical improvement has been shown, bacteriologic cures cannot be expected in patients with chronic respiratory disease and cystic fibrosis. |
||
Impaired Hepatic Function: No adjustment in dosage is required for patients with hepatic dysfunction.
Impaired Renal Function: Ceftazidime is excreted by the kidneys, almost exclusively by glomerular filtration. Therefore, in patients with impaired renal function (glomerular filtration rate [GFR] < 50 mL/min), it is recommended that the dosage of ceftazidime be reduced to compensate for its slower excretion. In patients with suspected renal insufficiency, an initial loading dose of 1 gram of CEPTAZ (ceftazidime) may be given. An estimate of GFR should be made to determine the appropriate maintenance dosage. The recommended dosage is presented in Table 4.
Table 4. Recommended Maintenance Dosages of CEPTAZ (ceftazidime) in Renal
Insufficiency NOTE: IF THE DOSE RECOMMENDED IN TABLE 3 ABOVE IS LOWER THAN THAT
RECOMMENDED FOR PATIENTS WITH RENAL INSUFFICIENCY AS OUTLINED IN TABLE 4, THE
LOWER DOSE SHOULD BE USED.
| Creatinine Clearance (mL/min) | Recommended Unit Dose of CEPTAZ | Frequency of Dosing |
| 50-31 | 1 gram | q12hr |
| 30-16 | 1 gram | q24hr |
| 15-6 | 500 mg | q24hr |
| 5 | 500 mg | q48hr |
When only serum creatinine is available, the following formula (Cockcroft's equation)4 may be used to estimate creatinine clearance. The serum creatinine should represent a steady state of renal function:
| Males: Creatinine clearance (mL/min) = | Weight (kg) x (140 - age) |
| 72 x serum creatinine (mg/dL) | |
| Females: 0.85 x male value | |
In patients with severe infections who would normally receive 6 grams of CEPTAZ (ceftazidime) daily were it not for renal insufficiency, the unit dose given in the table above may be increased by 50% or the dosing frequency may be increased appropriately. Further dosing should be determined by therapeutic monitoring, severity of the infection, and susceptibility of the causative organism.
In patients undergoing hemodialysis, a loading dose of 1 gram is recommended, followed by 1 gram after each hemodialysis period.
CEPTAZ (ceftazidime) can also be used in patients undergoing intraperitoneal dialysis and continuous ambulatory peritoneal dialysis. In such patients, a loading dose of 1 gram of CEPTAZ (ceftazidime) may be given, followed by 500 mg every 24 hours. It is not known whether or not CEPTAZ (ceftazidime) can be safely incorporated into dialysis fluid.
Note: Generally CEPTAZ (ceftazidime) should be continued for 2 days after the signs and symptoms of infection have disappeared, but in complicated infections longer therapy may be required.
Administration: CEPTAZ (ceftazidime) may be given intravenously or by deep IM injection into a large muscle mass such as the upper outer quadrant of the gluteus maximus or lateral part of the thigh. Intra-arterial administration should be avoided (see PRECAUTIONS).
Intramuscular Administration:For IM administration, CEPTAZ (ceftazidime) should be constituted with one of the following diluents: Sterile Water for Injection, Bacteriostatic Water for Injection, or 0.5% or 1% Lidocaine Hydrochloride Injection. Refer to Table 5.
Intravenous Administration: The IV route is preferable for patients with bacterial septicemia, bacterial meningitis, peritonitis, or other severe or life-threatening infections, or for patients who may be poor risks because of lowered resistance resulting from such debilitating conditions as malnutrition, trauma, surgery, diabetes, heart failure, or malignancy, particularly if shock is present or pending.
For direct intermittent IV administration, constitute CEPTAZ (ceftazidime) as directed in Table 5 with Sterile Water for Injection, 5% Dextrose Injection, or 0.9% Sodium Chloride Injection. Slowly inject directly into the vein over a period of 3 to 5 minutes or give through the tubing of an administration set while the patient is also receiving one of the compatible IV fluids (see Compatibility And Stability).
For IV infusion, constitute the 1- or 2-gram infusion pack with 100 mL of Sterile Water for Injection or one of the compatible IV fluids listed under the Compatibility And Stability section. Alternatively, constitute the 1- or 2-gram vial and add an appropriate quantity of the resulting solution to an IV container with one of the compatible IV fluids.
Intermittent IV infusion with a Y-type administration set can be accomplished with compatible solutions. However, during infusion of a solution containing ceftazidime, it is desirable to discontinue the other solution.
Table 5. Preparation of Solutions of CEPTAZ (ceftazidime)
| Size | Amount of Diluentto Be Added (mL) | Volume to BeWithdrawn (mL) | Approximate Ceftazidime Concentration (mg/mL) |
| Intramuscular | |||
| 1-gram vial | 3.0 | Total | 250 |
| Intravenous | |||
| 1-gram vial | 10.0 | Total | 90 |
| 2-gram vial | 10.0 | Total | 170 |
| Infusion pack | |||
| 1-gram vial | 100 | -- | 10 |
| 2-gram vial | 100 | -- | 20 |
| Pharmacy bulk package | |||
| 10-gram vial | 40 | Amount needed | 200 |
Solutions of CEPTAZ (ceftazidime) , like those of most beta-lactam antibiotics, should not be added to solutions of aminoglycoside antibiotics because of potential interaction.
However, if concurrent therapy with CEPTAZ (ceftazidime) and an aminoglycoside is indicated, each of these antibiotics can be administered separately to the same patient.
Instructions for Constitution: Vials of CEPTAZ (ceftazidime) as supplied are under a slightly reduced pressure. This may assist entry of the diluent. No gas-relief needle is required when adding the diluent, except for the infusion pack where it is required during the latter stages of addition (in order to preserve product sterility, a gas-relief needle should not be inserted until an overpressure is produced in the vial). No evolution of gas occurs on constitution. When the vial contents are dissolved, vials other than infusion packs may still be under a reduced pressure. This reduced pressure is particularly noticeable for the 10-gram pharmacy bulk package.
Compatibility And StabilityIntramuscular: CEPTAZ (ceftazidime) , when constituted as directed with Sterile Water for Injection, Bacteriostatic Water for Injection, or 0.5% or 1% Lidocaine Hydrochloride Injection, maintains satisfactory potency for 18 hours at room temperature or for 7 days under refrigeration. Solutions in Sterile Water for Injection that are frozen immediately after constitution in the original container are stable for 6 months when stored at -20°C. Components of the solution may precipitate in the frozen state and will dissolve on reaching room temperature with little or no agitation. Potency is not affected. Frozen solutions should only be thawed at room temperature. Do not force thaw by immersion in water baths or by microwave irradiation. Once thawed, solutions should not be refrozen. Thawed solutions may be stored for up to 12 hours at room temperature or for 7 days in a refrigerator.
Intravenous: Ceftazidime concentration greater than 100 mg/mL (2-g vial or 10-g pharmacy bulk package): CEPTAZ (ceftazidime) , when constituted as directed with Sterile Water for Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose Injection, maintains satisfactory potency for 18 hours at room temperature or for 7 days under refrigeration. Solutions of a similar concentration in Sterile Water for Injection that are frozen immediately after constitution in the original container are stable for 6 months when stored at -20°C. Components of the solution may precipitate in the frozen state and will dissolve upon reaching room temperature with little or no agitation. Potency is not affected. Frozen solutions should only be thawed at room temperature. Do not force thaw by immersion in water baths or by microwave irradiation. Once thawed, solutions should not be refrozen. Thawed solutions may be stored for up to 12 hours at room temperature or for 7 days in a refrigerator.
Ceftazidime concentration of 100 mg/mL or less (1-g vial or infusion packs): CEPTAZ (ceftazidime) , when constituted as directed with Sterile Water for Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose Injection, maintains satisfactory potency for 24 hours at room temperature or for 7 days under refrigeration. Solutions, prepared by a pharmacist, of the approved arginine formulation of ceftazidime of a similar concentration in Sterile Water for Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose Injection in the original container or in 0.9% Sodium Chloride Injection in VIAFLEX® (PL 146® Plastic) small-volume containers that are frozen immediately after constitution by the pharmacist are stable for 6 months when stored at -20°C. Solutions in the PL 146 Plastic small-volume containers are in contact with the polyvinyl chloride layer of this container and can leach out certain chemical components of the plastic in very small amounts within the expiration period. The suitability of the plastic has been confirmed in tests in animals according to USP biological tests for plastic containers as well as by tissue culture toxicity studies. Stability of the frozen solution in other containers has not been confirmed. Frozen solutions should only be thawed at room temperature. Do not force thaw by immersion in water baths or by microwave irradiation. For the larger volumes of IV infusion solutions where it may be necessary to warm the frozen product, care should be taken to avoid heating after thawing is complete. Once thawed, solutions should not be refrozen. Thawed solutions may be stored for up to 18 hours at room temperature or for 7 days in a refrigerator.
Components of the solution may precipitate in the frozen state and will dissolve on reaching room temperature with little or no agitation. Potency is not affected. Check for minute leaks in plastic containers by squeezing bag firmly. Discard bag if leaks are found as sterility may be impaired. Do not add supplementary medication to bags. Do not use unless solution is clear and seal is intact.
Use sterile equipment.
Caution: Do not use plastic containers in series connections. Such use could result in air embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is complete.
Preparation for Administration:
CEPTAZ (ceftazidime) is compatible with the more commonly used IV infusion fluids. Solutions at concentrations between 1 and 40 mg/mL in 0.9% Sodium Chloride Injection; 1/6 M Sodium Lactate Injection; 5% Dextrose Injection; 5% Dextrose and 0.225% Sodium Chloride Injection; 5% Dextrose and 0.45% Sodium Chloride Injection; 5% Dextrose and 0.9% Sodium Chloride Injection; 10% Dextrose Injection; Ringer's Injection, USP; Lactated Ringer's Injection, USP; 10% Invert Sugar in Sterile Water for Injection; and Normosol®-M in 5% Dextrose Injection may be stored for up to 24 hours at room temperature or for 7 days if refrigerated.
CEPTAZ (ceftazidime) is less stable in Sodium Bicarbonate Injection than in other IV fluids. It is not recommended as a diluent. Solutions of CEPTAZ (ceftazidime) in 5% Dextrose Injection and 0.9% Sodium Chloride Injection are stable for at least 6 hours at room temperature in plastic tubing, drip chambers, and volume control devices of common IV infusion sets.
Ceftazidime at a concentration of 4 mg/mL has been found compatible for 24 hours at room temperature or for 7 days under refrigeration in 0.9% Sodium Chloride Injection or 5% Dextrose Injection when admixed with: cefuroxime sodium (ZINACEF®) 3 mg/mL; heparin sodium in concentrations up to 50 U/mL; or potassium chloride in concentrations up to 40 mEq/L. Ceftazidime may be constituted at a concentration of 20 mg/mL with metronidazole injection 5 mg/mL, and the resultant solution may be stored for 24 hours at room temperature or for 7 days under refrigeration. Ceftazidime at a concentration of 20 mg/mL has been found compatible for 24 hours at room temperature or for 7 days under refrigeration in 0.9% Sodium Chloride Injection or 5% Dextrose Injection when admixed with 6 mg/mL clindamycin (as clindamycin phosphate).
Vancomycin solution exhibits a physical incompatibility when mixed with a number of drugs, including ceftazidime. The likelihood of precipitation with ceftazidime is dependent on the concentrations of vancomycin and ceftazidime present. It is therefore recommended, when both drugs are to be administered by intermittent IV infusion, that they be given separately, flushing the IV lines (with one of the compatible IV fluids) between the administration of these two agents.
Note: Parenteral drug products should be inspected visually for particulate matter before administration whenever solution and container permit.
As with other cephalosporins, CEPTAZ (ceftazidime) powder as well as solutions tend to darken, depending on storage conditions; within the stated recommendations, however, product potency is not adversely affected.
Directions for Dispensing: Pharmacy Bulk Package - Not for Direct Infusion: The pharmacy bulk package is for use in a pharmacy admixture service only under a laminar flow hood. Entry into the vial must be made with a sterile transfer set or other sterile dispensing device, and the contents dispensed in aliquots using aseptic technique. The use of syringe and needle is not recommended as it may cause leakage (see DOSAGE AND ADMINISTRATION). GOOD PHARMACY PRACTICE DICTATES THAT THE CLOSURE BE PENETRATED ONLY ONE TIME AFTER CONSTITUTION. AFTER INITIAL PENETRATION OF THE CLOSURE, USE ENTIRE CONTENTS OF VIAL PROMPTLY. ANY UNUSED PORTION MUST BE DISCARDED WITHIN 18 HOURS OF CONSTITUTION.
The following adverse effects from clinical trials were considered to be either related to ceftazidime therapy or were of uncertain etiology. The most common were local reactions following IV injection and allergic and gastrointestinal reactions. No disulfiramlike reactions were reported.
Local Effects, reported in fewer than 2% of patients, were phlebitis and inflammation at the site of injection (1 in 69 patients).
Hypersensitivity Reactions, reported in 2% of patients, were pruritus, rash, and fever. Immediate reactions, generally manifested by rash and/or pruritus, occurred in 1 in 285 patients. Toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme have also been reported with cephalosporin antibiotics, including ceftazidime. Angioedema and anaphylaxis (bronchospasm and/or hypotension) have been reported very rarely.
Gastrointestinal Symptoms, reported in fewer than 2% of patients, were diarrhea (1 in 78), nausea (1 in 156), vomiting (1 in 500), and abdominal pain (1 in 416). The onset of pseudomembranous colitis symptoms may occur during or after treatment (see WARNINGS).
Central Nervous System Reactions (fewer than 1%) included headache, dizziness, and paresthesia. Seizures have been reported with several cephalosporins, including ceftazidime. In addition, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia have been reported in renally impaired patients treated with unadjusted dosage regimens of ceftazidime (see PRECAUTIONS: General).
Less Frequent Adverse Events (fewer than 1%) were candidiasis (including oral thrush) and vaginitis.
Hematologic: Rare cases of hemolytic anemia have been reported.
Laboratory Test Changes noted during ceftazidime clinical trials were transient and included: eosinophilia (1 in 13), positive Coombs' test without hemolysis (1 in 23), thrombocytosis (1 in 45), and slight elevations in one or more of the hepatic enzymes, aspartate aminotransferase (AST, SGOT) (1 in 16), alanine aminotransferase (ALT, SGPT) (1 in 15), LDH (1 in 18), GGT (1 in 19), and alkaline phosphatase (1 in 23). As with some other cephalosporins, transient elevations of blood urea, blood urea nitrogen, and/or serum creatinine were observed occasionally. Transient leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and lymphocytosis were seen very rarely.
Postmarketing Experience With Ceptaz (ceftazidime) ProductsIn addition to the adverse events reported during clinical trials, the following events have been observed during clinical practice in patients treated with CEPTAZ (ceftazidime) and were reported spontaneously. For some of these events, data are insufficient to allow an estimate of incidence or to establish causation.
General: Anaphylaxis; allergic reactions, which, in rare instances, were severe (e.g., cardiopulmonary arrest); urticaria; pain at injection site.
Hepatobiliary Tract: Hyperbilirubinemia, jaundice.
Renal and Genitourinary: Renal impairment.
Cephalosporin-Class Adverse Reactions: In addition to the adverse reactions listed above that have been observed in patients treated with ceftazidime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics:
Adverse Reactions: Colitis, toxic nephropathy, hepatic dysfunction including cholestasis, aplastic anemia, hemorrhage.
Altered Laboratory Tests: Prolonged prothrombin time, false-positive test for urinary glucose, pancytopenia.
DRUG INTERACTIONSNephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside antibiotics or potent diuretics such as furosemide. Renal function should be carefully monitored, especially if higher dosages of the aminoglycosides are to be administered or if therapy is prolonged, because of the potential nephrotoxicity and ototoxicity of aminoglycosidic antibiotics. Nephrotoxicity and ototoxicity were not noted when ceftazidime was given alone in clinical trials.
Chloramphenicol has been shown to be antagonistic to beta-lactam antibiotics, including ceftazidime, based on in vitro studies and time kill curves with enteric gram-negative bacilli. Due to the possibility of antagonism in vivo, particularly when bactericidal activity is desired, this drug combination should be avoided.
Drug/Laboratory Test Interactions: The administration of ceftazidime may result in a false-positive reaction for glucose in the urine when using CLINITEST® tablets, Benedict's solution, or Fehling's solution. It is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as CLINISTIX®) be used.
