Ceftazidime + Sulbactam

Indications

Ceftazidime + Sulbactam is used for: Indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following disease : Bone and joint infections Urinary tract infections in adult and geriatric population Lower respiratory tract infections in paediatric patients including pneumonia caused by resistant Pseudomonas

Adult Dose

Parenteral Adult: 1-2 g 8-12 hrly as deep IM inj, slow IV inj over 3-5 min or IV infusion for up to 30 min.

Child Dose

Parenteral Child: <40 kg: 100-150 mg/kg daily in 3 divided doses. Max: 6 g daily.

Renal Dose

Renal impairment: Loading dose: 1 g. Maintenance doses based on CrCl. May need to increase dose by 50% in severe infections. Peritoneal dialysis: Loading dose is followed by 500 mg 24 hrly; may add ceftazidime to the dialysis fluid (usually 125-250 mg for 2 L of dialysis fluid). Haemodialysis: Admin loading dose then 1 g after each dialysis period. CrCl (ml/min) Dosage Recommendation <5 500 mg 48 hrly. 6-15 500 mg 24 hrly. 16-30 1 g 24 hrly. 31-50 1 g 12 hrly.

Administration

Contra Indications

Hypersensitivity to ceftazidime or other cephalosporins.

Precautions

Patient w/ history of penicillin allergy, seizure disorder. Renal impairment. Pregnancy and lactation. Monitoring Parameters Monitor renal function. Observe for signs and symptoms of anaphylaxis during 1st dose.

Pregnancy-Lactation

Interactions

May increase nephrotoxicity of aminoglycosides. May diminish therapeutic effect of BCG, typhoid vaccine, Na picosulfate. May increase anticoagulant effect of vit K antagonists (e.g. warfarin). May increase serum level w/ probenecid.

Adverse Effects

Side effects of Ceftazidime + Sulbactam : Diarrhoea, nausea, vomiting, abdominal pain, metallic taste; eosinophilia, thrombocytosis; pruritus, rash (maculopapular, erythematous), urticaria, photosensitivity, angioedema, fever; transient increases in serum concentrations of AST, ALT, alkaline phosphatase, LDH, γ-glutamyltransferase, bilirubin, serum creatinine concentrations; local reactions (e.g. phlebitis, pain or inflammation at inj site), candidiasis, vaginitis. Rarely, transient leucopenia, neutropenia thrombocytopenia, agranulocytosis, lymphocytosis. Potentially Fatal: Anaphylactic reactions, Clostridium difficile-associated diarrhoea and colitis.

Mechanism of Action

Ceftazidime binds to 1 or more of the penicillin-binding proteins (PBPs) which inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.