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Ceftazidime

Pharmacology

Third-Generation Cephalosporin Antibiotic

Regulatory Class

Ceftazidime is a semisynthetic, broad-spectrum, third-generation cephalosporin antibiotic that is bactericidal through inhibiting enzymes responsible for cell-wall synthesis, primarily penicillin-binding protein 3 (PBP3). Ceftazidime has predictable activity against many gram-negative bacilli and is considered more active against Pseudomonas aeruginosa than other third-generation cephalosporins.

Antibiotic Classification(s)

  • EMA: B (Restrict) (EMA, 2024)

  • WHO: Tier 2 (Abdelsalam Elshenawy et al., 2023; WHO, 2023)

  • ARAV: Tier 2 (Divers et al., 2017; Divers and Burgess, 2023)

  • BSAVA: Second Line (Hedley et al., 2021)b


Pharmacodynamics

Pharmacokinetics

Mechanism of Action

Ceftazidime is a time-dependent bactericidal antibiotic. Its bactericidal activity is through the inhibition of enzymes responsible for cell wall synthesis, primarily penicillin-binding protein 3 (PBP3).

Clinical Applications

Ceftazidime has predictable activity against many gram-negative bacilli and is considered more active against Pseudomonas aeruginosa than other third-generation cephalosporins.

AMR Presentation Criteria

  • Sensitive Infections

  • Severe infections with a documented lack of susceptibility to other, less toxic antibiotics

  • Immediate treatment of a presumed gram-negative infection before appropriate culture and susceptibility results are reported

Suitable Infections

  • Gram-Negative Bacteria:

  • Gram-Positive Bacteria:

  • Mycobacteria:

Pharmacodynamics

Administration

  • Veterinary Use: Ceftazidime is administered parenterally (IV, IM, SC). It is not available in an oral formulation because it is not absorbed from the gastrointestinal tract.

Distribution

  • Broad: In all veterinary species, Ceftazidime appears widely distributed throughout the body, including bone and cerebrospinal fluid (CSF) (Innis et al., 2017).

Biotransformation

  • Minimal: Ceftazidime is excreted primarily unchanged.

  • Renal:  In mammals, Ceftazidime is excreted primarily unchanged by the kidneys via glomerular filtration.

Pharmacokinetics

Precautions

Significant Adverse Effects

The most common adverse reactions in humans are eosinophilia, thrombocytosis, phlebitis or thrombophlebitis with intravenous administration, diarrhoea, transient increases in hepatic enzymes, maculopapular or urticarial rash, pain and/or inflammation following intramuscular injection, anaemia and other blood derrangements and a false positive Coomb's test (EMC, 2024a, 2024b, 2024c, 2024d, 2024e, 2024f, 2024g).


Cats and Dogs: Available data is limited.  No meaningful adverse effects profile can be assimilated from the literature; the following potential adverse effects should be considered.


  • Hypersensitivity: As seen in humans. Hypersensitivity to beta-lactams, penicillin, or cephalosporins may manifest in various ways.

  • Enteric signs: As seen in humans. Nausea, vomiting, hyporexia and enteritis may be associated with using any antibacterial agent.

  • Injection site pain: As seen in humans.

  • Dysbiosis and superinfection: Non-sensitive superinfection (e.g. Enterococci, fungi) and dysbiosis may occur with any antibacterial agent.

  • Excessive dosing: Renal compromise and neurological signs may indicate excessive dosing

  • Inadequate dosing: lack of efficacy and resistance when treating infection 


Reptiles: No meaningful adverse effects profile can be assimilated from the literature, but the literature suggests that ceftazadime is generally well tolerated.; Non-sensitive superinfection (e.g. Enterococci, fungi), dysbiosis, lack of efficacy, and resistance via subtherapeutic dosing are the most likely undesirable effects. 

Significant Therapeutic Considerations

  • Nephrotoxicity: Cephalosporin nephrotoxicity may adversely affect renal function, especially when concurrent treatment is given with cephalosporins and nephrotoxic medicinal products such as aminoglycosides or potent diuretics (e.g., furosemide).

  • Reduced Renal Function: Ceftazidime is eliminated through the kidneys, so the dose should be reduced according to renal impairment. Patients with renal impairment should be closely monitored for both safety and efficacy. Neurological sequelae have occasionally been reported when the dose has not been reduced.

Significant Contraindications

  • Cephalosporin Hypersensitivity:  Hypersensitivity to the active substance, to any other cephalosporin (EMC, 2024a, 2024b, 2024c, 2024d, 2024e, 2024f, 2024g)

  • Beta-Lactam Hypersensitivity: Hypersensitivity (e.g. anaphylactic reaction) to any other beta-lactam antibacterial agent (penicillins, monobactams and carbapenems) (EMC, 2024a, 2024b, 2024c, 2024d, 2024e, 2024f, 2024g).

Potentially Significant Interactions

  • Nephrotoxic Medicines: Concurrent use of nephrotoxic medicinal products ( e.g. Furosemide) may adversely affect renal function (EMC, 2024a, 2024b, 2024c, 2024d, 2024e, 2024f, 2024g).

  • Chloramphenicol: Chloramphenicol is antagonistic in vitro with Ceftazidime and other cephalosporins. The clinical relevance of this finding is unknown, but if concurrent administration of ceftazidime with chloramphenicol is proposed, the possibility of antagonism should be considered (EMC, 2024a, 2024b, 2024c, 2024d, 2024e, 2024f, 2024g).

Reproductive Safety

  • Pregnancy: Animal studies do not indicate direct or indirect harmful effects on pregnancy embryonal/foetal development, parturition or postnatal development

  • Lactation: Ceftazidime is excreted in human milk in small quantities, but no effects on the breastfed infant are anticipated at therapeutic doses. Ceftazidime can be used during breastfeeding.

  • Male Fertility: No data are available.

  • Female Fertility: No data are available.

  • Carcinogenicity & Mutagenicity: No data are available.

Overdose Information

No animal data is available. Human data is as follows. 


  • Effects: Overdose with ceftazidime can lead to neurological sequelae, including encephalopathy, convulsions and coma, due to the ceftazidime component.

  • Clinical Response: Active fluid therapy/haemodilution, haemodialysis or peritoneal dialysis can reduce serum levels of ceftazidime



. 

Precautions

Availability

United Kingdom | (Human) SPCs

  1. Ceftazidime 1g Powder for Solution for Injection or Infusion - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/6346/smpc (accessed 12.28.24).

  2. Ceftazidime 2g Powder for solution for injection or infusion - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/6347/smpc (accessed 12.28.24).

  3. Ceftazidime 3 g Powder for solution for injection or infusion - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/13783/smpc (accessed 12.28.24).

  4. Ceftazidime 500mg powder for solution for injection vials - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/8764/smpc (accessed 12.28.24).

  5. Ceftazidime Venus Pharma 1 g powder for solution for injection/infusion - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/15079/smpc (accessed 12.28.24).

  6. Ceftazidime Venus Pharma 2 g powder for solution for injection/infusion - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/15076/smpc (accessed 12.28.24).

  7. Zavicefta 2 g/0.5g powder for concentrate for solution for infusion - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/2465/smpc (accessed 12.28.24).


Availability

Identifiers

Ceftazidime

  • MeSH Terms: Ceftazidime, Ceftazidime Anhydrous, Ceftazidime Pentahydrate, Fortaz, Ceftazidime Anhydrous, Ceftazidime Pentahydrate, Fortaz, Fortum, GR 20263, GR-20263, GR20263, LY139381, Pyridinium, 1-((7-(((2-amino-4-thiazolyl)((1-carboxy-1-methylethoxy)imino)acetyl)amino)-2-carboxy-8-oxo-5-thia-1-azabicyclo(4.2.0)oct-2-en-3-yl)methyl)-, inner salt, pentahydrate, (6R-(6alpha,7beta(Z)))-, Tazidime

  • IUPAC Name: (6R,7R)-7-[[(2Z)-2-(2-amino-1,3-thiazol-4-yl)-2-(2-carboxypropan-2-yloxyimino)acetyl]amino]-8-oxo-3-(pyridin-1-ium-1-ylmethyl)-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylate

  • Molecular Formula: C22 H22 N6 O7 S2

  • Pharmacotherapeutic group: J - Antiinfectives for systemic use, Antibacterials for systemic use, Other beta-lactam antibacterials, Third-generation cephalosporin

  • ATC Code(s): J01DD02 - Ceftazidime

  • ATC Vet Code: QJ01DD02 - Ceftazidime


Identifiers

Evidence-Base

Ceftazidime Pharmacology

  1. Abd El-Aty, A.M., Goudah, A., Abo El Sooud, K., 2001. Pharmacokinetics, intramuscular bioavailability and tissue residue profiles of ceftazidime in a rabbit model. Dtsch Tierarztl Wochenschr 108, 168–171.

  2. Abdelsalam Elshenawy, R., Umaru, N., Aslanpour, Z., 2023. WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance - a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic. Front Microbiol 14, 1298858. https://doi.org/10.3389/fmicb.2023.1298858

  3. Ackerman, B.H., Ross, J., Tofte, R.W., Rotschafer, J.C., 1984. Effect of decreased renal function on the pharmacokinetics of ceftazidime. Antimicrob Agents Chemother 25, 785–786. https://doi.org/10.1128/AAC.25.6.785

  4. Acred, P., 1983. Therapeutic and kinetic properties of ceftazidime in animals. Infection 11 Suppl 1, S44-48. https://doi.org/10.1007/BF01641106

  5. AVMA, 2024. AAFP/AAHA antimicrobial stewardship guidelines | American Veterinary Medical Association [WWW Document]. URL https://www.avma.org/resources-tools/avma-policies/aafpaaha-antimicrobial-stewardship-guidelines (accessed 12.23.24).

  6. Balant, L., Dayer, P., Auckenthaler, R., 1985. Clinical pharmacokinetics of the third generation cephalosporins. Clin Pharmacokinet 10, 101–143. https://doi.org/10.2165/00003088-198510020-00001

  7. Bauernfeind, A., 1981. An evaluation of the activity of cephalosporins against Pseudomonas aeruginosa. J Antimicrob Chemother 8 Suppl B, 111–117. https://doi.org/10.1093/jac/8.suppl_b.111

  8. Bayer, A.S., Crowell, D.J., Yih, J., Bradley, D.W., Norman, D.C., 1988. Comparative pharmacokinetics and pharmacodynamics of amikacin and ceftazidime in tricuspid and aortic vegetations in experimental Pseudomonas endocarditis. J Infect Dis 158, 355–359. https://doi.org/10.1093/infdis/158.2.355

  9. Bayer, A.S., Norman, D., Kim, K.S., 1985. Efficacy of amikacin and ceftazidime in experimental aortic valve endocarditis due to Pseudomonas aeruginosa. Antimicrob Agents Chemother 28, 781–785. https://doi.org/10.1128/AAC.28.6.781

  10. Bean, A., 2020. Antimicrobial Resistance and Therapy in Exotic Pet Practice.

  11. Benoni, G., Arosio, E., Raimondi, M.G., Apolloni, E., Passarella, E., Lechi, A., Velo, G.P., 1984. Distribution of ceftazidime in ascitic fluid. Antimicrob Agents Chemother 25, 760–763. https://doi.org/10.1128/AAC.25.6.760

  12. Boccazzi, A., Rizzo, M., Caccamo, M.L., Assael, B.M., 1983. Comparison of the concentrations of ceftazidime in the serum of newborn infants after intravenous and intramuscular administration. Antimicrob Agents Chemother 24, 955–956. https://doi.org/10.1128/AAC.24.6.955

  13. Bouza, E., Hellín, T., Rodríguez-Creixems, M., Martínez-Beltrán, J., Loza, E., Baquero, F., 1983. Comparison of ceftazidime concentrations in bile and serum. Antimicrob Agents Chemother 24, 104–106. https://doi.org/10.1128/AAC.24.1.104

  14. Broens, E.M., Van Geijlswijk, I.M., 2018. Prudent Use of Antimicrobials in Exotic Animal Medicine. Veterinary Clinics of North America: Exotic Animal Practice 21, 341–353. https://doi.org/10.1016/j.cvex.2018.01.014

  15. Caneschi, A., Bardhi, A., Barbarossa, A., Zaghini, A., 2023. The Use of Antibiotics and Antimicrobial Resistance in Veterinary Medicine, a Complex Phenomenon: A Narrative Review. Antibiotics 12, 487. https://doi.org/10.3390/antibiotics12030487

  16. Cristina, R.T., Kocsis, R., Dégi, J., Muselin, F., Dumitrescu, E., Tirziu, E., Herman, V., Darău, A.P., Oprescu, I., 2022. Pathology and Prevalence of Antibiotic-Resistant Bacteria: A Study of 398 Pet Reptiles. Animals (Basel) 12, 1279. https://doi.org/10.3390/ani12101279

  17. Divers, S.J., Burgess, B.A., 2023. ARAV Antimicrobial Stewardship Policy. Journal of Herpetological Medicine and Surgery 33. https://doi.org/10.5818/JHMS.33.1.61

  18. Divers, S.J., Sladakovic, I., Mayer, J., Sanchez, S., 2017. DEVELOPMENT OF AN ANTIBIOTIC POLICY IN A ZOOLOGICAL MEDICINE SERVICE AND APPROACH TO ANTIBIOTIC DOSING USING MIC DATA.

  19. EMA, 2024. EMA AMEG Categorisation of antibiotics for use in animals [WWW Document]. URL https://www.ema.europa.eu/en/documents/report/infographic-categorisation-antibiotics-use-animals-prudent-and-responsible-use_en.pdf

  20. Gómez, C.M., Cordingly, J.J., Palazzo, M.G., 1999. Altered pharmacokinetics of ceftazidime in critically ill patients. Antimicrob Agents Chemother 43, 1798–1802. https://doi.org/10.1128/AAC.43.7.1798

  21. Hedley, J., Whitehead, M.L., Munns, C., Pellett, S., Abou‐Zahr, T., Calvo Carrasco, D., Wissink‐Argilaga, N., 2021. Antibiotic stewardship for reptiles. J of Small Animal Practice 62, 829–839. https://doi.org/10.1111/jsap.13402

  22. Innis, C.J., Ceresia, M.L., Merigo, C., Scott Weber, E., Papich, M.G., 2012. Single-dose pharmacokinetics of ceftazidime and fluconazole during concurrent clinical use in cold-stunned Kemp’s ridley turtles (Lepidochelys kempii). J Vet Pharmacol Ther 35, 82–89. https://doi.org/10.1111/j.1365-2885.2011.01290.x

  23. Innis, C.J., Harms, C.A., Manire, C.A., 2017. Therapeutics, in: Sea Turtle Health and Rehabilitation. J. Ross Publishing, 2017.  VitalBook file.

  24. Lawrence, K., Muggleton, P.W., Needham, J.R., 1984. Preliminary study on the use of ceftazidime, a broad spectrum cephalosporin antibiotic, in snakes. Research in Veterinary Science 36, 16–20. https://doi.org/10.1016/S0034-5288(18)31994-5

  25. Mader, D., 2008. Antibiotic therapy in reptiles (Proceedings).

  26. Mariat, C., Venet, C., Jehl, F., Mwewa, S., Lazarevic, V., Diconne, E., Fonsale, N., Carricajo, A., Guyomarc’h, S., Vermesch, R., Aubert, G., Bidault, R., Bertrand, J.-C., Zeni, F., 2006. Continuous infusion of ceftazidime in critically ill patients undergoing continuous venovenous haemodiafiltration: pharmacokinetic evaluation and dose recommendation. Crit Care 10, R26. https://doi.org/10.1186/cc3993

  27. McColm, A.A., Ryan, D.M., 1986. Penetration of ceftazidime into the rabbit respiratory tract. J Antimicrob Chemother 18, 593–597. https://doi.org/10.1093/jac/18.5.593

  28. Moody, J.A., Fasching, C.E., Peterson, L.R., Gerding, D.N., 1987. Ceftazidime and amikacin alone and in combination against Pseudomonas aeruginosa and Enterobacteriaceae. Diagn Microbiol Infect Dis 6, 59–67. https://doi.org/10.1016/0732-8893(87)90115-5

  29. Petraitiene, R., Petraitis, V., Kavaliauskas, P., Maung, B.B.W., Khan, F., Naing, E., Aung, T., Zigmantaite, V., Grigaleviciute, R., Kucinskas, A., Stakauskas, R., Georgiades, B.N., Mazur, C.A., Hayden, J.A., Satlin, M.J., Walsh, T.J., 2020. Pharmacokinetics and Efficacy of Ceftazidime-Avibactam in the Treatment of Experimental Pneumonia Caused by Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae in Persistently Neutropenic Rabbits. Antimicrob Agents Chemother 64, e02157-19. https://doi.org/10.1128/AAC.02157-19

  30. Pubmed, 2024. Ceftazidime | C22H22N6O7S2 | CID 5481173 - PubChem [WWW Document].

  31. Richards, D.M., Brogden, R.N., 1985. Ceftazidime. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 29, 105–161. https://doi.org/10.2165/00003495-198529020-00002

  32. Sakata, Y., Boccazzi, A., McCracken, G.H., 1983. Pharmacokinetics and bacteriological effect of ceftazidime in experimental Streptococcus pneumoniae, Haemophilus influenzae, and Escherichia coli meningitis. Antimicrob Agents Chemother 23, 213–217.

  33. Sakata, Y., McCracken, G.H., Thomas, M.L., Olsen, K.D., 1984. Pharmacokinetics and therapeutic efficacy of imipenem, ceftazidime, and ceftriaxone in experimental meningitis due to an ampicillin- and chloramphenicol-resistant strain of Haemophilus influenzae type b. Antimicrob Agents Chemother 25, 29–32. https://doi.org/10.1128/AAC.25.1.29

  34. Shockley, R.K., Fishman, P., Aziz, M., Yannis, R.A., Jay, W.M., 1986. Subconjunctival administration of ceftazidime in pigmented rabbit eyes. Arch Ophthalmol 104, 266–268. https://doi.org/10.1001/archopht.1986.01050140124033

  35. Stamper, M.A., Papich, M.G., Lewbart, G.A., May, S.B., Plummer, D.D., Stoskopf, M.K., 1999. Pharmacokinetics of ceftazidime in loggerhead sea turtles (Caretta caretta) after single intravenous and intramuscular injections. J Zoo Wildl Med 30, 32–35.

  36. Walstad, R.A., Blika, S., 1985. Penetration of ceftazidime into the normal rabbit and human eye. Scand J Infect Dis Suppl 44, 63–67.

  37. Weese, J.S., Giguère, S., Guardabassi, L., Morley, P.S., Papich, M., Ricciuto, D.R., Sykes, J.E., 2015. ACVIM Consensus Statement on Therapeutic Antimicrobial Use in Animals and Antimicrobial Resistance. J Vet Intern Med 29, 487–498. https://doi.org/10.1111/jvim.12562

  38. WHO, 2023. WHO AWaRe classification of antibiotics 2023 [WWW Document]. Google Docs. URL https://docs.google.com/spreadsheets/d/19ThpjtwBYcrtz1Za21IJ1qxGjPl2Jot7QIFaKCqh75E/edit?gid=0&usp=embed_facebook (accessed 12.22.24).

  39. Xiong, Y.Q., Caillon, J., Zhou, X.Y., Potel, G., Bugnon, D., Le Conte, P., Le Gallou, F., Le Floch, R., Baron, D., Drugeon, H., 1995. Treatment of experimental rabbit infective endocarditis due to a multidrug-resistant Pseudomonas aeruginosa with high-dose ceftazidime alone and combined with amikacin or sulbactam or both. J Antimicrob Chemother 35, 697–706. https://doi.org/10.1093/jac/35.5.697

  40. Yu, Y.-H., Lin, Y.-T., Hsu, Y.-H., Chou, Y.-C., Ueng, S.W.N., Liu, S.-J., 2021. Biodegradable Antimicrobial Agent/Analgesic/Bone Morphogenetic Protein-Loaded Nanofibrous Fixators for Bone Fracture Repair. Int J Nanomedicine 16, 5357–5370. https://doi.org/10.2147/IJN.S325885

  41. Zhou, J., Xu, P., Chen, H., Yu, Y., Chen, Y., 2005. [Therapeutic effect of ceftazidime in a rabbit model of peritonitis caused by Escherichia coli producing CTX-M-14 extended-spectrum beta-lactamase]. Zhonghua Jie He He Hu Xi Za Zhi 28, 689–693.


Evidence

Monograph Details

Criteria

  • Active Substance & Term: Ceftazidime | Pharmacology

Resources

Development Team

  • Monograph Author(s): S McArthur B Vet Med MRCVS (last updated 25/11/2024)

  • Monograph Editor(s): TBA (last updated DD/MM/YYYY)

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