Use of Ceftazidime-Avibactam in Infants and Children

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS

Disclosures

Pediatr Pharm. 2019;25(5) 

In This Article

Availability and Dosing Recommendations

Ceftazidime-avibactam (Avycaz®) is available in single-dose vials of 2.5 grams (2 grams ceftazidime and 500 mg avibactam).[2] The manufacturer's recommended dose in children 6 months up to 18 years of age with normal renal function is 62.5 mg/kg (equivalent to 50 mg/kg ceftazidime and 12.5 mg/kg avibactam), to a maximum of 2.5 grams, given every 8 hours. The dose should be infused over 2 hours. Patients 3 months up to 6 months of age should receive a dose of 50 mg/kg (40 mg/kg ceftazidime and 10 mg/kg avibactam) administered in the same manner. The recommended duration of treatment is 5 to 14 days for cIAI and 7 to 14 days for cUTI or pyelonephritis.

Dosing modifications for adults and children 2 years of age and older with renal impairment are included in prescribing information. In children with an estimated creatinine clearance of 31–50 mL/min/1.73 m2 based on the Schwartz bedside formula, a dose of 31.25 mg/kg given every 8 hours is recommended, with a maximum dose of 1.25 grams. Patients with a clearance of 16–30 mL/min/1.73 m2 should receive a dose of 23.75 mg/kg every 12 hours, with a maximum dose of 0.94 grams. Children with a clearance of 6–15 mL/min/1.73 m2 should receive a dose of 23.75 mg once daily, and those with a clearance of 5 mL/min/1.73 m2 or less should receive the same dose but given every 48 hours. Daily evaluation of serum creatinine levels should be used to identify changes in clearance to guide further dosing adjustments. Dosing adjustments are not yet available for children under 2 years of age with renal impairment. Ceftazidime-avibactam is cleared by hemodialysis and should be dosed after each hemodialysis session.

Ceftazidime-avibactam is compatible with a number of medications, including amikacin, azithromycin, aztreonam, daptomycin, dexmedetomidine, furosemide, gentamicin, heparin, magnesium sulfate, metronidazole, norepinephrine, phenylephrine, potassium phosphate, tobramycin, vasopressin, and vecuronium. More detailed information is available in the prescribing information.[2]

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