Ceftazidime dosing

To conduct retrospective DUE to determine potential cost savings of ceftazidime dosage adjustment OD None None DCA Ceftazidime dosing in elderly found to be in excess of labeled dosing because renal function not considered Input costs not considered clinical outcomes not considered... 

This patient s clearance value can be used to adjust the ceftazidime dose as described earlier. The ceftazidime clearance in a patient with normal renal function would be calculated as ... 

Gram-negative rods Tobramycin 3-14 mg/mL or Gentamicin 3-14 mg/mL or Ceftazidime SO mg/mL or Fluoroquinolones 3 mg/mL Less severe keratitis may use less frequent dosing Antibiotics may be alternated each hour for ulcers and contact lens... 

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

Dual therapy with Cefepime, ceftazidime, imipenem, meropenem, Gentamicin or tobramycin 2 mg/kg loading dose... 

Many dry solid parenteral products, such as the cephalosporins, are prepared by sterile crystallization techniques. Control of the crystallization process to obtain a consistent and uniform crystal form, habit, density, and size distribution is particularly critical for drug substances to be utilized in sterile suspensions. For example, when the crystallization process for sterile ceftazidime pentahydrate was modified to increase the density and reduce the volume of the fill dose, the rate of dissolution increased significantly. 

For severe and/or septicemic disease, administer antibiotics as follows Ceftazidime, 120 mg/kg/day in three divided doses, combined with TMP/sulfa (TMP, eight mg per kg per day/sulfa, 40 mg per kg per day in four divided doses). Initially, administer parental therapy for two weeks, followed by oral therapy for six months. 

Renal function Impairment- Ceftazidime is excreted by the kidneys, almost exclusively by glomerular filtration. In patients with impaired renal function (glomerular filtration rate (GFR) less than 50 mL/min), reduce dosage to compensate for slower excretion. In patients with suspected renal insufficiency, give an initial loading dose of 1 g. Estimate GFR to determine the appropriate maintenance dose. 

Ccr (mL/min) Recommended unit dose of ceftazidime Frequency of dosing... 

In patients with severe infections who normally receive 6 g 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 increased appropriately. 

Ceftazidime also can be used in patients undergoing intraperitoneal dialysis (IPD) and continuous ambulatory peritoneal dialysis (CARD). Give a loading dose of 1 g, followed by 500 mg every 24 hours. In addition to IV use, ceftazidime can be incorporated in the dialysis fluid at a concentration of 250... 

Cefotaxime can be used in infections due to beta-lactamase producing strains of H. influenzae and N. gonorrhoeae. Ceftriaxone has an antibacterial spectrum similar to that of cefotaxime but its longer half-life allows for less frequent dosing. Ceftazidime is especially effective against Pseudomonas aeruginosa. Cetixime and cefpodoxime are third-generation cephalosporins that can be administered orally. 

Broad spectrum, 4th generation cephalosporin demonstrating a low potential for resistance due to lack of p-lactamase induction and low potential for selection of resistant mutant strains as effective as ceftazidime and cefotaxime in comparative trials twice daily dosing may add economic advantage... 

Answer The patient s high serum creatinine indicates compromised renal function. The aminoglycosides can be nephrotoxic and thus the drug was not employed. However, tobramycin might have been used together with ceftazidime if the dose were adjusted for renal function. 

The correct answer is B (excretion depends on the kidney). Most of the p-lactam antibiotics depend on the kidney for excretion. Ceftazidime is predominantly eliminated by glomerular filtration. Thus in this patient the dose of ceftazidime would have to be modified due to the patient s renal status. A (effective on oral administration) is incorrect. Ceftazidime is only given par-enterally. C (interferes in vitamin K function to cause an anticoagulant effect) is incorrect. This property is peculiar to cefoperazone and cefamandole. D (causes ototoxicity at high serum levels) is not correct. E. Ceftazidine is administered IV or intramuscularly (IM). 

INDOMETACIN CEPHALOSPORINS Indometacin t ceftazidime levels in neonates Indometacin l clearance of ceftazidime 1 dose of ceftazidime... 

For Escherichia coli give cefotaxime or ceftazidime perhaps with gentamicin. For Group B streptococci give benzylpenicillin plus gentamicin. Consult a specialist text for details of doses for neonates. 

In a retrospective cost analysis, the records of 527 patients with acute leukemia were studied (11). They had been treated in a multicenter, randomized trial for febrile neutropenia with ceftazidime and amikacin plus either teicoplanin (6 mg/kg in a single dose n — 275) or vancomycin (30 mg/kg/day in 2 doses n — 252). Qinical responses were equivalent. Again the higher acquisition costs for teicoplanin were counterbalanced by the lower incidence of adverse events and easier administration, resulting in overall similar costs for both regimens. A total of 8% of patients treated with vancomycin reported adverse events compared with 3.2% of patients treated with teicoplanin. Rashes occurred in 6.0 versus 1.4% respectively. Nephrotoxicity, ototoxicity, fever, and hypotension occurred in very few patients. 

A 14-month-old girl with chronic renal insufficiency due to renal dysplasia was empirically treated with ceftazidime and vancomycin for fever. Her calculated creatinine clearance was 10 ml/minute/1.73 m. She erroneously received vancomycin 1.5 g in 3 doses 6 hours apart. Her serum creatinine concentration increased and her vancomycin concentrations remained markedly high (338 mg/1 5 hours after the third dose). The half-Ufe of vancomycin was 145 hours. Hearing loss developed. Continued charcoal hemoperfusion and hemodialysis were used to treat the disorder. Thrombocytopenia was noted as significant consequence of hemoperfusion. The patient did not fully recover her previous renal function and became dialysis dependent. The audiogram normalized by 6 months. 

The prevention of aminoglycoside-induced nephrotoxicity has received considerable attention in recent years. Alternative antibiotics should be used whenever possible and as soon as microbial sensitivities are known. Commonly used alternatives include fluoroquinolones (e.g., ciprofloxacin or levofloxacin) and third-generation cephalosporins (e.g., ceftazidime). When aminoglycosides are necessary, the specific drug used does not appear to significantly affect the risk of nephrotoxicity, and therapy should be selected to optimize antimicrobial efficacy. Furthermore, it is imperative to avoid volume depletion, limit the total aminoglycoside dose administered, and avoid concomitant therapy with other nephrotoxic drugs. 

For this patient s situation, the normal regimen of ceftazidime would be 1,000 mg (D ) every 8 hours (t ). If one wanted to maintain and extend the dosing interval, then Zf would be calculated as ... 

A recent case report exhibited favorable effects of high-dose intravenous ciprofloxacin (400 mg every 8 hours) plus intravenous ceftazidime for pseudomonal meningitis. However, this information must be evaluated in a controlled chnical trial before high-dose ciprofloxacin can be recommended for use. 

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