Use of Ceftazidime-Avibactam in Infants and Children

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


Pediatr Pharm. 2019;25(5) 

In This Article

Spectrum of Activity

Ceftazidime-avibactam, in combination with metronidazole, is indicated for the treatment of cIAI in infants and children caused by susceptible strains of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytocia, Proteus mirabilis, Enterobacter cloacae, Citrobacter freundii complex, and P. aeruginosa. It is also approved as single-agent therapy for use in pediatric patients with cUTI due to E. coli, K. pneumoniae, Enterobacter cloacae, Citrobacter freundii complex, Proteus mirabilis, and P. aeruginosa.[2]

The International Network for Optimal Resistance Monitoring (INFORM) surveillance program has provided a useful overview of the real-world experience with ceftazidime-avibactam.[5] In a recent paper from INFORM data collected from 26 medical centers in six countries in Latin America between 2012 to 2015, Enterobacteriaceae isolates were highly susceptible to ceftazidime-avibactam, with inhibition of 99.6% to 100% of isolates carrying serine beta-lactamases (ESBLs, AmpC cephalosporinases, and carbapenemases including KPC). Ceftazidime-avibactam inhibited 87.4% of all P. aeruginosa isolates, including 89.5% of carbapenem non-susceptible strains in which no beta-lactamase could be identified.

A recent assessment of INFORM surveillance data from 82 medical centers in the United States gathered from 2011 to 2015 included 53,381 Gram-negative organisms that had been tested against ceftazidime-avibactam, including 8,461 isolates from children.[6] Ceftazidime-avibactam inhibited more than 99.9% of all Enterobacteriaceae at the ≤ 8 mcg/mL break point and was highly active against ESBL-positive strains of E. coli and K. pneumonia. Only one isolate was non-susceptible, an isolate of Enterobacter aerogenes with an MIC value of 16 mcg/mL. Ceftazidime-avibactam inhibited 99% of P. aeruginosa isolates, including the few strains that were non-susceptible to ceftazidime alone, meropenem, or piperacillin-tazobactam. This level of activity did not vary among the age groups tested or over time.