| Common Brands | Avycaz |
|---|---|
|
Drug Class |
Ceftazidime, Avibactam |
|
Controlled Substance Classification |
Not a controlled medication |
|
Generic Status |
Lower-cost generic available |
|
Availability |
Prescription only |
Avibactam and Ceftazidime is one of the combined antibiotic therapies which are used to treat various bacterial infections, especially those caused by multi-drug resistant bacteria.
The combination of this includes ceftazidime, a third-generation cephalosporin antibiotic, and avibactam, beta-lactamase inhibitor.
This combination operates by enhancing the effectiveness of ceftazidime, allowing it to negate bacterial resistance mechanisms, such as those beta-lactamase enzymes that hydrolyze the beta-lactam antibiotics, for example, cephalosporins.
It is known by the brand name Avycaz and is used to treat various serious infections caused by Gram-negative bacteria, including those induced by resistant organisms such as ESBL-producing and CRE.
The combination of avibactam and ceftazidime is typically given intravenously in the hospital. Dosing is dependent on the severity and type of infection and the renal function of the patient. The following is general adult dosing:
Adult Dosing: The usual dose is typically 2.5 grams (ceftazidime 2 grams + avibactam 0.5 grams) and is given every 8 hours through intravenous infusion over 2 hours
Pediatric Dosage: For pediatric patients from 3 months to 17 years of age, use the dose based on the patient’s weight and clinical condition. Adjust to the range of 50 mg/kg to 100 mg/kg of ceftazidime and avibactam every 8 hours.
Renal Insufficiency: In patients with impaired kidney function, an adjustment in the dosing interval may be necessary, and renal function should be regularly checked.
Ceftazidime: As a cephalosporin, ceftazidime works by binding to penicillin-binding proteins (PBPs) located on the bacterial cell wall. This prevents the bacteria from synthesizing the cell wall, ultimately causing the bacteria to die due to cell wall rupture.
Ceftazidime specifically targets Gram-negative bacteria, including those resistant to first- and second-generation cephalosporins.
Avibactam: Avibactam is a beta-lactamase inhibitor. Beta-lactamase enzymes are made by bacteria to destroy beta-lactam antibiotics. By binding to these enzymes, avibactam prevents them from inactivating ceftazidime and allows it to remain effective
. Avibactam is effective against a wide range of beta-lactamases, including some that break down cephalosporins and even some carbapenemases-enzymes responsible for resistance to the broad-spectrum carbapenem antibiotics.
Generally, like all antibiotics, a combination of avibactam and ceftazidime can cause side effects. The common side effects may include;
Gastrointestinal disorders; this includes diarrhea, nausea, and vomiting.
Serious side effects are rare and may include:
Allergic Reactions: Manifestations of an allergic reaction might be swelling, difficulties with breathing, or severe rash.
Clostridium difficile-associated Diarrhea (C. difficile): Like many antibiotics, ceftazidime and avibactam can disrupt the normal gut microbiota with overgrowth of C. difficile, leading to potentially severe diarrhea and colitis.
Kidney Problems: In patients with pre-existing impaired kidney conditions, ceftazidime and avibactam can at times induce injury to the kidney function.
Hematologic Effects: Hematologic effects are less frequently experienced, and may include leukopenia or thrombocytopenia.
Monitor the patient closely for signs of an allergic reaction, gastrointestinal problems, changes in kidney or liver function while receiving this drug.
Allergic Reactions: Avibactam and ceftazidime is administered with caution to those patients who have demonstrated a previous allergy to cephalosporin or other beta-lactam antibiotics.
Renal Impairment: Patients with renal impairment will require adjustments as this drug is excreted by the kidneys. Renal functions should be closely monitored during treatment.
Superinfection: Long term exposure to broad-spectrum antibiotics such as ceftazidime and avibactam has led to overgrowth of non-susceptible organisms such as C.difficile leading to severe conditions like pseudomembranous colitis.
Pregnancy and Breastfeeding: The combination of ceftazidime and avibactam have not been established as safe for pregnancy and breastfeeding. It should be administered during pregnancy only if the potential benefits justify the potential risk for the fetus.
Drug Interactions: Ceftazidime and avibactam may also interact with other drugs, such as other antibiotics, diuretics, or those that affect renal function. Patients should report all medications they are taking to their health care providers.
Probenecid: Co-administration with probenecid may increase the levels of ceftazidime by inhibiting renal excretion, which could elevate the risk of side effects like nephrotoxicity. Monitoring kidney function is recommended.
Aminoglycosides: The combination of ceftazidime/avibactam with aminoglycosides may increase the risk of nephrotoxicity, so renal function should be closely monitored.
Oral Contraceptives: Ceftazidime/avibactam does not significantly affect the efficacy of oral contraceptives, but additional contraceptive methods may be considered as a precaution.
Anticoagulants: Though no major interaction is noted, monitoring of coagulation parameters (e.g., INR) is recommended when using ceftazidime/avibactam with warfarin to avoid potential bleeding risks.
For adults with normal renal function:
Ceftazidime 2 gms + Avibactam 0.5 gms q 8 hours via IV infusion.
Dose and more frequent should be adjusted according to the degree of renal impairment.
Creatinine clearance 30–50 mL/min: Administer every 12 hours.
Creatinine clearance < 30 mL/min: Administer every 24 hours.
Avibactam with ceftazidime (Avycaz) is an Rx drug. This drug is only to be prescribed by a licensed health care professional, usually in cases of serious or complicated bacterial infections, especially ones caused by MDR organisms.
Healthcare providers will consider the susceptibility of the infection to this drug and might perform a culture and sensitivity to determine if the pathogens are susceptible to the combination before starting therapy.
Answer: Avibactam is a novel beta-lactamase inhibitor, while Ceftazidime is a third-generation cephalosporin antibiotic. Together, they form a combination used to treat infections caused by multidrug-resistant bacteria.
Answer: The combination works by utilizing Ceftazidime to disrupt bacterial cell wall synthesis while Avibactam inhibits beta-lactamase enzymes that bacteria produce to resist antibiotics.
Answer: It is primarily used to treat complicated urinary tract infections, complicated intra-abdominal infections, and infections caused by resistant Gram-negative pathogens.
Answer: Generally, candidates include patients with complicated infections caused by multi-resistant Gram-negative bacteria, especially those with limited treatment options.
Answer: The synergy lies in Avibactam’s ability to extend the spectrum of activity of Ceftazidime against beta-lactamase-producing bacteria, enhancing its effectiveness.
Answer: Common side effects include nausea, diarrhea, headache, and potential allergic reactions. Serious side effects can also occur but are less common.
Answer: The combination is usually administered intravenously, based on the severity of the infection and the patient’s health condition.
Answer: Yes, it can be used in children, but the dosage might vary based on the child’s weight and specific medical conditions.
Answer: It is contraindicated in patients with a known allergy to Ceftazidime, Avibactam, or other cephalosporin antibiotics.
Answer: Compared to other combinations, Avibactam and Ceftazidime tend to offer more efficacy against certain resistant species, particularly Pseudomonas aeruginosa and Enterobacteriaceae.
Answer: Medical professionals should monitor renal function, signs of allergic reactions, and therapeutic efficacy through clinical response.
Answer: It is typically advised to avoid alcohol during treatment, as it can exacerbate certain side effects and affect recovery.
Answer: The treatment duration generally ranges from 5 to 14 days, depending on the type and severity of the infection.
Answer: While it has a broad spectrum, it is not effective against all Gram-negative bacteria, particularly those resistant to beta-lactams that do not produce beta-lactamase.
Answer: Caution is advised in patients with liver problems, and healthcare providers may adjust the dosage based on the severity of liver impairment.
Answer: If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next dose. In that case, skip the missed dose and continue with the regular schedule.
Answer: Yes, it can interact with certain medications, such as probenecid. It’s important to discuss all medications with a healthcare provider.
Answer: The use in pregnant or breastfeeding women should be carefully considered, weighing the potential benefits against risks. Consultation with a healthcare provider is essential.
Answer: If signs of an allergic reaction occur, such as rash, itching, or difficulty breathing, immediate medical attention is necessary.
Answer: To minimize resistance, it’s crucial to use the combination judiciously, ensure accurate diagnoses, and limit its use to cases where other antibiotics are ineffective.
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