Usual Adult Dose for Bacteremia

2 g IV every 6 to 8 hours

Therapy should be continued for approximately 10 to 14 days, depending on the nature and severity of the infection.

Usual Adult Dose for Bacterial Infection

Moderately severe infections: 1 to 2 g IV or IM every 8 to 12 hours
Severe infections: 2 g IV every 6 to 8 hours (maximum, 8 g/day)

Usual Adult Dose for Cystic Fibrosis

Inhalation:
Initial dose: 75 mg via nebulizer over approximately 2 to 3 minutes 3 times a day for 28 days; doses should be at least 4 hours apart

Maintenance dose: Administer in alternating cycles of 28 days on and 28 days off.

For patients on multiple inhaled therapies, the following order of administration is recommended: bronchodilator, mucolytics, and lastly, aztreonam for inhalation.

Usual Adult Dose for Febrile Neutropenia

2 g IV every 6 to 8 hours

Therapy should be continued until the absolute neutrophil count is greater than 500/mm3 and no infection is found or until an adequate clinical response is achieved if a susceptible infection is found and the patient has been afebrile for at least 24 hours. Therapy for neutropenic patients is often required for up to 3 weeks.

Usual Adult Dose for Intraabdominal Infection

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued for approximately 10 to 14 days, depending on the nature and severity of the infection.

Usual Adult Dose for Peritonitis

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued for approximately 10 to 14 days, depending on the nature and severity of the infection.

Usual Adult Dose for Osteomyelitis

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional 2 months of oral antibiotics.

Usual Adult Dose for Pelvic Inflammatory Disease

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued until this patient is afebrile and pain-free for 24 to 36 hours.

Usual Adult Dose for Pneumonia

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued for approximately 21 days, depending on the nature and severity of the infection.

Usual Adult Dose for Pyelonephritis

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued for approximately 14 days, depending on the nature and severity of the infection.

Usual Adult Dose for Skin or Soft Tissue Infection

1 to 2 g IV every 8 or 12 hours

For severe or life-threatening infections, a dose of 2 g IV every 6 to 8 hours is recommended. Therapy should be continued for approximately 7 days or until 3 days after acute inflammation disappears. For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

Usual Adult Dose for Urinary Tract Infection

500 mg to 1 g IV or IM every 8 to 12 hours

Usual Pediatric Dose for Intraabdominal Infection

7 days or less, 2000 g or less: 30 mg/kg IV every 12 hours
7 days or less, 2001 g or more: 30 mg/kg IV every 8 hours

8 to 30 days, 1199 g or less: 30 mg/kg IV every 12 hours
8 to 30 days, 1200 to 2000 g: 30 mg/kg IV every 8 hours
8 to 30 days, 2001 g or more: 30 mg/kg IV every 6 hours

1 month to 18 years: 30 mg/kg IV every 6 to 8 hours, up to a maximum of 2 g/dose or 8 g/day

Usual Pediatric Dose for Pneumonia

7 days or less, 2000 g or less: 30 mg/kg IV every 12 hours
7 days or less, 2001 g or more: 30 mg/kg IV every 8 hours

8 to 30 days, 1199 g or less: 30 mg/kg IV every 12 hours
8 to 30 days, 1200 to 2000 g: 30 mg/kg IV every 8 hours
8 to 30 days, 2001 g or more: 30 mg/kg IV every 6 hours

1 month to 18 years: 30 mg/kg IV every 6 to 8 hours, up to a maximum of 2 g/dose or 8 g/day

Usual Pediatric Dose for Bacterial Infection

7 days or less, 2000 g or less: 30 mg/kg IV every 12 hours
7 days or less, 2001 g or more: 30 mg/kg IV every 8 hours

8 to 30 days, 1199 g or less: 30 mg/kg IV every 12 hours
8 to 30 days, 1200 to 2000 g: 30 mg/kg IV every 8 hours
8 to 30 days, 2001 g or more: 30 mg/kg IV every 6 hours

1 month to 18 years: 30 mg/kg IV every 6 to 8 hours, up to a maximum of 2 g/dose or 8 g/day

Usual Pediatric Dose for Urinary Tract Infection

7 days or less, 2000 g or less: 30 mg/kg IV every 12 hours
7 days or less, 2001 g or more: 30 mg/kg IV every 8 hours

8 to 30 days, 1199 g or less: 30 mg/kg IV every 12 hours
8 to 30 days, 1200 to 2000 g: 30 mg/kg IV every 8 hours
8 to 30 days, 2001 g or more: 30 mg/kg IV every 6 hours

1 month to 18 years: 30 mg/kg IV every 6 to 8 hours, up to a maximum of 2 g/dose or 8 g/day

Usual Pediatric Dose for Skin and Structure Infection

7 days or less, 2000 g or less: 30 mg/kg IV every 12 hours
7 days or less, 2001 g or more: 30 mg/kg IV every 8 hours

8 to 30 days, 1199 g or less: 30 mg/kg IV every 12 hours
8 to 30 days, 1200 to 2000 g: 30 mg/kg IV every 8 hours
8 to 30 days, 2001 g or more: 30 mg/kg IV every 6 hours

1 month to 18 years: 30 mg/kg IV every 6 to 8 hours, up to a maximum of 2 g/dose or 8 g/day

Usual Pediatric Dose for Cystic Fibrosis

Inhalation:
7 years or older:
Initial dose: 75 mg via nebulizer over approximately 2 to 3 minutes 3 times a day for 28 days; doses should be at least 4 hours apart

Maintenance dose: Administer in alternating cycles of 28 days on and 28 days off.

For patients on multiple inhaled therapies, the following order of administration is recommended: bronchodilator, mucolytics, and lastly, aztreonam for inhalation.

Renal Dose Adjustments

Parenteral:
CrCl 10 to 30 mL/min: Loading dose of 1 to 2 g IV followed by one-half of the normal dose at the usual dosage interval

CrCl 9 mL/min or less: Loading dose of 500 mg to 2 g IV followed by one-fourth of the normal dose at the usual dosage interval

Inhalation:
No adjustment recommended.

Liver Dose Adjustments

No adjustment recommended.

Dose Adjustments

Because of the serious nature of infections due to Pseudomonas Aeruginosa, dosage of 2 g IV every 6 to 8 hours is recommended, at least upon initiation of therapy, in systemic infections caused by this organism.

Precautions

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of skin rash or other signs of hypersensitivity and treatment should be initiated as appropriate. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following aztreonam therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Patients with renal or hepatic impairment should be monitored during therapy. Renal, hepatic, and hematopoietic monitoring is recommended periodically during prolonged therapy.

Renal function should be monitored, especially in elderly patients.

Safety and effectiveness of aztreonam for inhalation have not been established in patients with forced expiratory volume in 1 second (FEV1) less than 25% or greater than 75% predicted or in patients colonized with Burkholderia cepacia.

Safety and effectiveness of aztreonam for inhalation have not been established in pediatric patients less than 7 years of age.

Dialysis

Parenteral: For serious or life-threatening infections, in addition to the maintenance doses, one-eighth of the initial dose should be given after each hemodialysis.

Inhalation: No adjustment recommended.

Other Comments

The maximum recommended parenteral dose is 8 g/day.

If necessary, doses of 1 g or less may be given intramuscularly in moderately severe infections; however, IM administration may be a problem for patients with end-stage renal disease if there is an underlying coagulopathy.

The IV route is recommended for patients requiring single doses greater than 1 g or those with bacterial septicemia, localized parenchymal abscess (e.g., intraabdominal abscess), peritonitis, or other severe systemic or life-threatening infections.

Generally, aztreonam should be continued for at least 48 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. Persistent infections may require treatment for several weeks.

Following reconstitution, aztreonam for inhalation should be used at once using the Altera (R) Nebulizer System. It should not be used with any other nebulizer. Aztreonam for inhalation should not be mixed with any other drug in the Altera (R) Nebulizer Handset.

The use of a bronchodilator prior to administration of aztreonam for inhalation is recommended. Short-acting bronchodilators can be taken between 15 minutes and 4 hours prior to each dose and long-acting bronchodilators can be taken between 30 minutes and 12 hours prior to administration of aztreonam for inhalation.