Formulary
Aztreonam: Indications, Dosing, Side Effects and Interactions
Aztreonam is a monocyclic beta-lactam ('monobactam') antibiotic with an antibacterial spectrum limited to Gram-negative aerobic bacteria including Pseudomonas...
MedNext Academy | 4 min read
Aztreonam: Indications, Dosing, Side Effects and Interactions
Aztreonam is a monocyclic beta-lactam ('monobactam') antibiotic with an antibacterial spectrum limited to Gram-negative aerobic bacteria including Pseudomonas...
Drug action
Aztreonam is a monocyclic beta-lactam ('monobactam') antibiotic with an antibacterial spectrum limited to Gram-negative aerobic bacteria including Pseudomonas aeruginosa , Neisseria meningitidis , and Haemophilus influenzae ; it should not be used alone for 'blind' treatment since it is not active against Gram-positive organisms. Aztreonam is also effective against Neisseria gonorrhoeae (but not against concurrent chlamydial infection).
Indications and dose
**Gram-negative infections includingPseudomonas aeruginosa,Haemophilus influenzae, andNeisseria meningitidis**
- **Adult** (By Deep Intramuscular Injection, Or By Intravenous Infusion, Or By Intravenous Injection): Gram-negative infections including Pseudomonas aeruginosa , Haemophilus influenzae , and Neisseria meningitidis 1 g every 8 hours, alternatively 2 g every 12 hours, single doses over 1 g intravenous route only.
**Severe gram-negative infections includingPseudomonas aeruginosa,Haemophilus influenzae,Neisseria meningitidis, and lung infections in cystic fibrosis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): Severe gram-negative infections including Pseudomonas aeruginosa , Haemophilus influenzae , Neisseria meningitidis , and lung infections in cystic fibrosis 2 g every 6-8 hours.
**Gonorrhoea,Cystitis**
- **Adult** (By Intramuscular Injection): 1 g for 1 single dose.
**Urinary-tract infections**
- **Adult** (By Deep Intramuscular Injection, Or By Intravenous Infusion, Or By Intravenous Injection): 0.5-1 g every 8-12 hours.
**Chronic pulmonaryPseudomonas aeruginosainfection in patients with cystic fibrosis**
- **Adult** (By Inhalation Of Nebulised Solution): Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis 75 mg 3 times a day for 28 days, doses to be administered at least 4 hours apart, subsequent courses repeated after 28-day interval without aztreonam nebuliser solution.
**Gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria meningitidis for aztreonam**
- **Neonate up to 7 days** (By intravenous injection, or by intravenous infusion): 30 mg/kg every 12 hours.
- **Neonate 7 days to 28 days** (By intravenous injection, or by intravenous infusion): 30 mg/kg every 6-8 hours.
- **Child 1 month-11 years** (By intravenous injection, or by intravenous infusion): 30 mg/kg every 6-8 hours.
- **Child 12-17 years** (By intravenous injection, or by intravenous infusion): 1 g every 8 hours, alternatively 2 g every 12 hours.
**Severe gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, Neisseria meningitidis, and lung infections in cystic fibrosis for aztreonam**
- **Child 2-11 years** (By intravenous infusion, or by intravenous injection): 50 mg/kg every 6-8 hours (max. per dose 2 g 4 times a day).
- **Child 12-17 years** (By intravenous infusion, or by intravenous injection): 2 g every 6-8 hours.
**Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis for aztreonam**
- **Child 6-17 years** (By inhalation of nebulised solution): 75 mg 3 times a day for 28 days, doses to be administered at least 4 hours apart, subsequent courses repeated after 28-day interval without aztreonam nebuliser solution.
Cautions
When used by inhalation Haemoptysis- risk of further haemorrhage
Side effects
General side-effects: Common or very common Dyspnoea; respiratory disorders Specific side-effects: Common or very common When used by inhalation Cough; haemoptysis; joint disorders; laryngeal pain; nasal complaints; rash Rare or very rare With parenteral use Anaemia; asthenia; breast tenderness; chest pain; confusion; diplopia; dizziness; eosinophilia; haemorrhage; headache; hepatic disorders; hypotension; insomnia; leucocytosis; myalgia; nasal congestion; neutropenia; oral disorders; pancytopenia; paraesthesia; pseudomembranous enterocolitis; seizure; thrombocytopenia; thrombocytosis; tinnitus; vertigo; vulvovaginal candidiasis Frequency not known With parenteral use Abdominal pain; angioedema; Clostridioides difficile colitis; diarrhoea; nausea; skin reactions; taste altered; toxic epidermal necrolysis; vomiting
Interactions
**Severe interactions:**
- Concomitant administration of probenecid or furosemide and aztreonam cause clinically insignificant increases in the serum levels of aztreonam.
- Single-dose pharmacokinetic studies have not shown any significant interaction between aztreonam and gentamicin, cephradine, clindamycin or metronidazole.
**Other interactions (5):**
- Due to the induction of beta-lactamases, certain antibiotics (eg, cefoxitin, imipenem) have been found to cause antagonism with many beta-lactams, including aztreonam, for certain gram-negative...
- Appropriate monitoring should be undertaken when anticoagulants are prescribed concomitantly.
- Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation (see section 4.4 and 4.8).
- Unlike broad spectrum antibiotics, aztreonam produces no effects on the normal anaerobic intestinal flora.
- No disulfiram-like reactions with alcohol ingestion have been reported.
Pregnancy
With systemic use: No information available; manufacturer of injection advises avoid. When used by inhalation: No information available; manufacturer of powder for nebuliser solution advises avoid unless essential.
Breast feeding
Amount in milk probably too small to be harmful.
Hepatic impairment
With systemic use: Manufacturer advises caution in chronic impairment with cirrhosis. Dose adjustments With systemic use: Manufacturer advises dose reduction of 20-25% for long term treatment of patients with chronic impairment with cirrhosis, especially in alcoholic cirrhosis and concomitant renal impairment.
Renal impairment
Dose adjustments With systemic use: If eGFR 10-30 mL/minute/1.73 m 2 , usual initial dose of injection, then half normal dose. If eGFR less than 10 mL/minute/1.73 m 2 , usual initial dose of injection, then one-quarter normal dose.
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Aztreonam in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary