Antimicrobials
Aztreonam

Aztreonam

Medium
N/A
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status No

In-Hospital Cost will be updated

PharmaCare Formulary Status Yes (vial-neb) No (inj)

Special Authority Yes (vial-neb) (See below under Restricted Use Criteria)

Special Access Programme Yes (inj) (See below under Restricted Use Criteria)

PharmaCare Coverage 75mg/ml vial-neb - $44.5188/ml

Outpatient Cost 75mg/ml vial-neb - $44.52-57.38/ml

Therapy of gram negative infections including Pseudomonas, particularly in patients with penicillin and cephalosporin allergy or when there is no alternative susceptible agent.

Nebulized form used in cystic fibrosis patients.

Empiric therapy for febrile neutropenia.

Monitor liver enzymes

Special Authority Status: Yes (75mg/ml vial-neb)

Special Authority Category: Limited Coverage Drugs

Special Authority Criteria: For cyclic treatment of chronic Pseudomonas aeruginosa infections in patients with:

  • moderate to severe cystic fibrosis AND
  • deteriorating clinical condition despite treatment with inhaled tobramycin

Special Authority Approval Period: Indefinite

Special Authority Practitioner Exemptions: None

Special Authority Special Notes:

  •  cyclic treatment is measured in 28-day cycles and is defined as 28 days “on” followed by 28 days “off”
  •  may be prescribed as monotherapy or combination treatment

Special Access Programme (SAP) Status: Yes (inj)

SAP is administered by Health Canada and allows the purchase of drugs unavailable in Canada – please consult with clinical pharmacist if drug is required

Neutropenia (IV)

  •  children: 3% to 11%
  •  adults: <1%
  •  associated with immune-mediated destruction of polymorphonuclear leukocytes
  •  sx: abrupt onset of fever, rash, and eosinophilia

Thrombocytopenia (IV)

  • acute immune-mediated
  • usually platelet count normalizes within 2 weeks after discontinuation

Increase in liver enzymes (IV)

  • usually mild-to-moderate, asymptomatic, self-limited
  • does not require drug discontinuation
  • can occur at standard and high doses within 3-5 days of administration

Pulmonary infiltrate with eosinophilia (PIE) syndrome (IV)

  • sx: abrupt onset of fever, chills, dyspnea, pulmonary infiltrates and peripheral eosinophilia
  • can occur at doses of 30mg/kg IV q6-8h in children

CNS toxicity (IV)

  • sx: seizures
  • has greater convulsant properties than some cephalosporins, but less than penicillin and cefazolin
  • can occur at doses of 100-200mg/kg/day q6h
  • caused by inhibition of GABA binding, increased CNS excitation and slow clearance from the CNS

Allergic reaction (IV, IM and INH)

  • IgE-mediated
  • sx: pruritus, flushing, urticaria, angioedema, wheezing, laryngeal edema, hypotension, and/or anaphylaxis
  • sx usually appear within 4 hrs of administration but may begin within mins

Serum sickness (IV, IM and INH)

  • late allergic reaction
  • sx: fever, rash, adenopathy, arthritis and glomerulonephritis
  • associated with circulating immune complexes

Rash (IV, IM and INH)

  • includes morbilliform rash, erythema multiforme, SJS, exfoliative dermatitis, toxic epidermal necrolysis and vasculitis
  • sx: photosensitivity, skin lesions, mucosal membrane ulceration, erythema, scaling, palpable purpura and/or positive Nikolsky's sign

Other

  • Pharyngolaryngeal pain (INH) (adults: 12%)
  • Cough (INH) (adults: 54%)
  • Nasal congestion (INH) (adults: 16%)
  • Wheezing (INH) (adults: 16%)

Ceftazidime

  •  cross-reactivity between aztreonam and ceftazidime
  •  caused by identical R1 side chain group
  •  not all patients experience cross-reactivity
  •  patients who experienced immediate reactions to ceftazidime in the past and now require aztreonam should be skin tested to aztreonam (2 mg/ml)

No cross-reactivity between penicillin and aztreonam

Antimicrobial class: Monobactam

Pregnancy category: B

Average serum half life: 2.0 hr

Urine penetration: Therapeutic

Lung penetration: Therapeutic

Biliary penetration: Moderate