Third-generation cephalosporin (anti-Pseudomonas)
Ceftazidime is an injectable antibiotic of the cephalosporin family (third generation), used in severe hospital-acquired infections, with important activity against Pseudomonas aeruginosa. It is only given intravenously or intramuscularly, usually in hospital.
Also known as: Ceftazidima, Fortaz
Combining Ceftazidime and Streptomycin (an aminoglycoside) increases the risk of nephrotoxicity and ototoxicity.
The ceftazidime label explicitly documents that "nephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside antibacterial drugs or potent diuretics such as furosemide", recommending that "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 aminoglycosides". The streptomycin label, in turn, classifies the combination with nephrotoxic/neurotoxic drugs (including other aminoglycosides and nephrotoxic cephalosporins) as one to avoid. The combination is used in severe infections (e.g. brucellosis, endocarditis, nosocomial pneumonia) — use with daily creatinine monitoring, dose adjustment to renal clearance and audiovestibular surveillance.
Ceftazidime + streptomycin: nephrotoxicity documented with cephalosporins plus aminoglycosides. Monitor renal function, especially with high doses or prolonged therapy.
Additive nephrotoxic and ototoxic effect of aminoglycosides and cephalosporins, especially in renal impairment or at high doses.
Creatinine/urinalysis, diuresis, hearing (tinnitus, hearing loss), balance.
Rising creatinine, oliguria/renal failure, tinnitus or hearing loss.
Monitor renal function (creatinine) and auditory function; adjust doses for creatinine clearance; avoid prolonged combination.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358 ; approved Streptomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abd1f64e-4283-4370-aae8-3666316aa36e — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Ceftazidime is given intravenously or intramuscularly; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358
No relevant pharmacokinetic interaction with ceftazidime.
Moderate alcohol intake.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358
Ceftazidime is contraindicated in patients with documented cephalosporin allergy (risk of anaphylaxis).
Confirm allergy history before administering.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358
Ceftazidime is eliminated renally; renal impairment requires dose adjustment (risk of neurotoxicity).
Adjust the dose based on renal function.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358
Data on ceftazidime in pregnancy are limited; use only if the benefit outweighs the risk.
Use only in severe infections with no safe alternative.
Present in breast milk in small amounts; generally compatible.
No specific contraception required.
DailyMed/FDA (NIH/NLM) — approved Ceftazidime label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=78982c98-7866-49f1-989f-a289c4242358
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Third-generation cephalosporin with reference antipseudomonal activity; time-dependent bactericidal, with renal excretion — requires dose adjustment in renal impairment.
Inhibits bacterial cell wall synthesis by binding to PBPs (including PBP3 of Pseudomonas aeruginosa), blocking peptidoglycan transpeptidation — bacterial lysis.
IV/IM administration (no oral absorption); serum peaks 45 and 90 mcg/mL after 500 mg and 1 g IV over 5 min; ~10% protein binding; dose-proportional concentrations; penetrates tissues well, including CSF with inflamed meninges.
Virtually no metabolism; 80-90% excreted unchanged renally (glomerular filtration and tubular secretion) within 24 h; hepatic dysfunction does not affect the pharmacokinetics.
Half-life ~1.9 h (IV) and ~2 h (IM); no accumulation with normal renal function at 1-2 g 8-hourly; the half-life is prolonged in renal impairment.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
