Rx Drugs Info

tazicef (ceftazidimeinjection, powder, for solution 
[Hospira Worldwide, Inc.]

for intravenous

or intramuscular use

PRESCRIBING INFORMATION

Rx only

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tazicef (ceftazidime) and other antibacterial drugs, Tazicef (ceftazidime) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.

DESCRIPTION

Ceftazidime is a semisynthetic, broad-spectrum, beta-lactam antibiotic for parenteral administration. It is the pentahydrate of pyridinium, 1-[[7-[[(2-amino-4-thiazolyl)[(1-carboxy-1-methylethoxy) imino] ace-tyl]amino]-2-carboxy-8-oxo-5-thia-1-azabicyclo(4.2.0.)oct-2-en-3-yl] methyl]-, hydroxide, inner salt, [6R-[6α,7β(Z)]]. It has the following structure:

Image from Drug Label Content

The molecular formula is C22H32N6012S2, representing a molecular weight of 636.6.

Tazicef (ceftazidime for injection, USP) is a sterile, dry, powdered mixture of ceftazidime pentahydrate and sodium carbonate. The sodium carbonate at a concentration of 118 mg/gram of ceftazidime activity has been admixed to facilitate dissolution. The total sodium content of the mixture is approximately 54 mg (2.3 mEq)/gram of ceftazidime activity.

Tazicef in sterile crystalline form is supplied in vials equivalent to 1 gram or 2 grams of anhydrous ceftazidime, in piggyback vials equivalent to 1 gram or 2 grams of anhydrous ceftazidime and in ADD-Vantage® vials equivalent to 1 gram or 2 grams of anhydrous ceftazidime. Solutions of Tazicef range in color from light yellow to amber, depending on the diluent and volume used. The pH of freshly reconstituted solutions usually ranges from 5.0 to 7.5.

CLINICAL PHARMACOLOGY

After IV administration of 500-mg and 1-gram doses of ceftazidime over 5 minutes to normal adult male volunteers, mean peak serum concentrations of 45 mcg/mL and 90 mcg/mL, respectively, were achieved. After IV infusion of 500-mg, 1-gram and 2-gram doses of ceftazidime over 20 to 30 minutes to normal adult male volunteers, mean peak serum concentrations of 42 mcg/mL, 69 mcg/mL and 170 mcg/mL, respectively, were achieved. The average serum concentrations following IV infusion of 500-mg, 1-gram and 2-gram doses to these volunteers over an 8-hour interval are given in Table 1.

Table 1

Ceftazidime IV Dosage

Serum Concentrations (mcg/mL)

0.5 hr.

1 hr.

2 hr.

4 hr.

8 hr.

500 mg

1 gram

2 grams

42

60

129

25

39

75

12

23

42

6

11

13

2

3

5

The absorption and elimination of ceftazidime were directly proportional to the size of the dose. The half-life following IV administration was approximately 1.9 hours. Less than 10% of ceftazidime was protein bound. The degree of protein binding was independent of concentration. There was no evidence of accumulation of ceftazidime in the serum in individuals with normal renal function following multiple IV doses of 1 gram and 2 grams every 8 hours for 10 days.

Following IM administration of 500-mg and 1-gram doses of ceftazidime to normal adult volunteers, the mean peak serum concentrations were 17 mcg/mL and 39 mcg/mL, respectively, at approximately 1 hour. Serum concentrations remained above 4 mcg/mL for 6 and 8 hours after the IM administration of 500-mg and 1-gram doses, respectively. The half-life of ceftazidime in these volunteers was approximately 2 hours.

The presence of hepatic dysfunction had no effect on the pharmacokinetics of ceftazidime in individuals administered 2 grams intravenously every 8 hours for 5 days. Therefore, a dosage adjustment from the normal recommended dosage is not required for patients with hepatic dysfunction, provided renal function is not impaired.

Approximately 80% to 90% of an IM or IV dose of ceftazidime is excreted unchanged by the kidneys over a 24-hour period. After the IV administration of single 500-mg or 1-gram doses, approximately 50% of the dose appeared in the urine in the first 2 hours. An additional 20% was excreted between 2 and 4 hours after dosing, and approximately another 12% of the dose appeared in the urine between 4 and 8 hours later. The elimination of ceftazidime by the kidneys resulted in high therapeutic concentrations in the urine.

The mean renal clearance of ceftazidime was approximately 100 mL/min. The calculated plasma clearance of approximately 115 mL/min. indicated nearly complete elimination of ceftazidime by the renal route. Administration of probenecid before dosing had no effect on the elimination kinetics of ceftazidime. This suggested that ceftazidime is eliminated by glomerular filtration and is not actively secreted by renal tubular mechanisms.

Since ceftazidime is eliminated almost solely by the kidneys, its serum half-life is significantly prolonged in patients with impaired renal function. Consequently, dosage adjustments in such patients as described in the DOSAGE AND ADMINISTRATION section are suggested.

Therapeutic concentrations of ceftazidime are achieved in the following body tissues and fluids.

Table 2. Ceftazidime Concentrations in Body Tissues and Fluids

Tissue or

Fluid

Dose/

Route

No.

Patients

Time of

Sample

Post-Dose

Average

Tissue or

Fluid

Level

(mcg/mL or mcg/g)

Urine

500 mg IM

6

0 to 2 hours

2,100.0

2 grams IV

6

0 to 2 hours

12,000.0

Bile

2 grams IV

3

90 min.

36.4

Synovial fluid

2 grams IV

13

2 hours

25.6

Peritoneal fluid

2 grams IV

8

2 hours

48.6

Sputum

1 gram IV

8

1 hour

9.0

Cerebrospinal fluid (inflamed meninges)

2 grams q8h IV

2 grams q8h IV

5

6

120 min.

180 min.

9.8

9.4

Aqueous humor

2 grams IV

13

1 to 3 hours

11.0

Blister fluid

1 gram IV

7

2 to 3 hours

19.7

Lymphatic fluid

1 gram IV

7

2 to 3 hours

23.4

Bone

2 grams IV

8

0.67 hour

31.1

Heart muscle

2 grams IV

35

30 to 280 min.

12.7

Skin

2 grams IV

22

30 to 180 min.

6.6

Skeletal muscle

2 grams IV

35

30 to 280 min.

9.4

Myometrium

2 grams IV

31

1 to 2 hours

18.7

Microbiology: Ceftazidime is bactericidal in action, exerting its effect by inhibition of enzymes responsible for cell-wall synthesis. A wide range of gram-negative organisms is susceptible to ceftazidime in vitro, including strains resistant to gentamicin and other aminoglycosides. In addition, ceftazidime has been shown to be active against gram-positive organisms. It is highly stable to most clinically important beta-lactamases, plasmid or chromosomal, which are produced by both gram-negative and gram-positive organisms and, consequently, is active against many strains resistant to ampicillin and other cephalosporins.

Ceftazidime has been shown to be active against the following organisms both in vitro and in clinical infections (see INDICATIONS AND USAGE).

Aerobes, Gram-Negative: Citrobacter spp. (including Citrobacter freundii and Citrobacter diversus); Enterobacter spp. (including Enterobacter cloacae and Enterobacter aerogenes ); Escherichia coli; Haemophilus influenzae, including ampicillin-resistant strains; Klebsiella spp. (including Klebsiella pneumoniae); Neisseria meningitidis; Proteus mirabilis; Proteus vulgaris; Pseudomonas spp.

(including Pseudomonas aeruginosa); and Serratia spp.

Aerobes, Gram-Positive: Staphylococcus aureus, including penicillinase- and non-penicillinase-producing strains; Streptococcus agalactiae (group B streptococci); Streptococcus pneumoniae; and Streptococcus pyogenes (group A beta-hemolytic streptococci).

Anaerobes: Bacteroides spp. (NOTE: Many strains of Bacteroides fragilis are resistant).

Ceftazidime has been shown to be active in vitro against most strains of the following organisms; however, the clinical significance of these data is unknown: Acinetobacter spp.; Clostridiumspp. (not including Clostridium difficile ); Haemophilus parainfluenzae; Morganella morganii (formerly Proteus morganii ); Neisseria gonorrhoeae; Peptococcus spp.; Peptostreptococcus spp.; Providencia spp. (including Providencia rettgeri, formerly Proteus rettgeri); Salmonella spp.; Shigella spp.; Staphylococcus epidermidis; and Yersinia enterocolitica .

Ceftazidime and the aminoglycosides have been shown to be synergistic in vitro against Pseudomonas aeruginosa and the enterobacteriaceae. Ceftazidime and carbenicillin have also been shown to be synergistic in vitro against Pseudomonas aeruginosa.

Ceftazidime is not active in vitro against: methicillin-resistant staphylococci, Streptococcus faecalis and many other enterococci, Listeria monocytogenes, Campylobacter spp., or Clostridium difficile.

Susceptibility Tests: Diffusion Techniques: Quantitative methods that require measurement of zone diameters give an estimate of antibiotic susceptibility. One such procedure1-3 has been recommended for use with disks to test susceptibility to ceftazidime.

Reports from the laboratory giving results of the standard single-disk susceptibility test with a 30 mcg ceftazidime disk should be interpreted according to the following criteria:

Susceptible organisms produce zones of 18 mm or greater, indicating that the test organism is likely to respond to therapy.

Organisms that produce zones of 15 mm to 17 mm are expected to be susceptible if high dosage is used or if the infection is confined to tissues and fluids (e.g., urine) in which high antibiotic levels are attained. Resistant organisms produce zones of 14 mm or less, indicating that other therapy should be selected. Organisms should be tested with the ceftazidime disk, since ceftazidime has been shown by in vitro tests to be active against certain strains found resistant when other beta-lactam disks are used.

Standardized procedures require the use of laboratory control organisms. The 30 mcg ceftazidime disk should give zone diameters between 25 mm and 32 mm for Escherichia coli ATCC 25922. For Pseudomonas aeruginosa ATCC 27853, the zone diameters should be between 22 mm and 29 mm. For Staphylococcus aureus ATCC 25923, the zone diameters should be between 16 mm and 20 mm.

Dilution Techniques: In other susceptibility testing procedures, e.g., ICS agar dilution or the equivalent, a bacterial isolate may be considered susceptible if the minimum inhibitory concentration (MIC) value for ceftazidime is not more than 16 mcg/mL. Organisms are considered resistant to ceftazidime if the MIC is ≥64 mcg/mL. Organisms having an MIC value of <64 mcg/mL but >16 mcg/mL are expected to be susceptible if high dosage is used or if the infection is confined to tissues and fluids (e.g., urine) in which high antibiotic levels are attained.

As with standard diffusion methods, dilution procedures require the use of laboratory control organisms. Standard ceftazidime powder should give MIC values in the range of 4 mcg/mL to 16 mcg/mL for Staphylococcus aureus ATCC 25923. For Escherichia coli ATCC 25922, the MIC range should be between 0.125 mcg/mL and 0.5 mcg/mL. For Pseudomonas aeruginosa ATCC 27853, the MIC range should be between 0.5 mcg/mL and 2 mcg/mL.

INDICATIONS AND USAGE

Tazicef (ceftazidime for injection, USP) is indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following diseases:

  1. Lower Respiratory Tract Infections, including pneumonia, caused by Pseudomonas aeruginosa and other Pseudomonas spp.; Haemophilus influenzae, including ampicillin-resistant strains; Klebsiella spp.; Enterobacter spp.; Proteus mirabilis; Escherichia coli ; Serratia spp.; Citrobacter spp.; Streptococcus pneumoniae; and Staphylococcus aureus (methicillin-susceptible strains).

  2. Skin and Skin-Structure Infections caused by Pseudomonas aeruginosa; Klebsiella spp.; Escherichia coli ; Proteus spp.; including Proteus mirabilis and indole-positive Proteus; Enterobacter spp.; Serratia spp.; Staphylococcus aureus (methicillin-susceptible strains); and Streptococcus pyogenes (group A beta-hemolytic streptococci).

  3. Urinary Tract Infections, both complicated and uncomplicated, caused by Pseudomonas aeruginosa; Enterobacter spp.; Proteus spp., including Proteus mirabilis and indole-positive Proteus ; Klebsiella spp.; and Escherichia coli.

  4. Bacterial Septicemia caused by Pseudomonas aeruginosa, Klebsiella spp., Haemophilus influenzae, Escherichia coli, Serratia spp., Streptococcus pneumoniae, and Staphylococcus aureus (methicillin-susceptible strains).

  5. Bone and Joint Infections caused by Pseudomonas aeruginosa; Klebsiella spp.; Enterobacter spp., and Staphylococcus aureus (methicillin-susceptible strains).

  6. Gynecologic Infections, including endometritis, pelvic cellulitis, and other infections of the female genital tract caused by Escherichia coli.

  7. Intra-abdominal Infections, including peritonitis caused by Escherichia coli, Klebsiella spp., and Staphylococcus aureus (methicillin-susceptible strains) and polymicrobial infections caused by aerobic and anaerobic organisms and Bacteroides spp. (many strains of Bacteroides fragilis are resistant).

  8. Central Nervous System Infections, including meningitis, caused by Haemophilus influenzae and Neisseria meningitidis . Ceftazidime has also been used successfully in a limited number of cases of meningitis due to Pseudomonas aeruginosa and Streptococcus pneumoniae.

Specimens for bacterial cultures should be obtained before therapy in order to isolate and identify causative organisms and to determine their susceptibility to ceftazidime. Therapy may be instituted before results of susceptibility studies are known; however, once these results become available, the antibiotic treatment should be adjusted accordingly.

Tazicef (ceftazidime for injection, USP) may be used alone in cases of confirmed or suspected sepsis. Ceftazidime has been used successfully in clinical trials as empiric therapy in cases where various concomitant therapies with other antibiotics have been used.

Tazicef may also be used concomitantly with other antibiotics, such as aminoglycosides, vancomycin and clindamycin, in severe and life-threatening infections and in the immunocompromised patient. When such concomitant treatment is appropriate, prescribing information in the labeling for the other antibiotics should be followed. The dose depends on the severity of the infection and the patient’s condition.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tazicef (ceftazidime) and other antibacterial drugs, Tazicef (ceftazidime) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

CONTRAINDICATIONS

Tazicef is contraindicated in patients who have shown hypersensitivity to ceftazidime or the cephalosporin group of antibiotics.

WARNINGS

BEFORE THERAPY WITH TAZICEF IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFTAZIDIME, CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS-HYPERSENSITIVITY AMONG BETA-LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF AN ALLERGIC REACTION TO TAZICEF OCCURS, DISCONTINUE TREATMENT WITH THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, IV FLUIDS, IV ANTIHISTAMINES, CORTICOSTEROIDS, PRESSOR AMINES AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED.

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ceftazidime, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.

Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is a primary cause of “antibiotic-associated colitis.”

After the diagnosis of pseudomembranous colitis has been established, appropriate therapeutic measures should be initiated. Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation and treatment with an oral antibacterial drug clinically effective against Clostridium difficile colitis.

Elevated levels of ceftazidime in patients with renal insufficiency can lead to seizures, encephalopathy, asterixis and neuromuscular excitability (see PRECAUTIONS).

PRECAUTIONS

General:

Ceftazidime has not been shown to be nephrotoxic; however, high and prolonged serum antibiotic concentrations can occur from usual dosages in patients with transient or persistent reduction of urinary output because of renal insufficiency. The total daily dosage should be reduced when ceftazidime is administered to patients with renal insufficiency (see DOSAGE AND ADMINISTRATION). Elevated levels of ceftazidime in these patients can lead to seizures, encephalopathy, asterixis and neuromuscular excitability. Continued dosage should be determined by degree of renal impairment, severity of infection and susceptibility of the causative organisms.

As with other antibiotics, prolonged use of Tazicef (ceftazidime for injection, USP) may result in overgrowth of nonsusceptible organisms. Repeated evaluation of the patient’s condition is essential. If superinfection occurs during therapy, appropriate measures should be taken.

Inducible type-1 beta-lactamase resistance has been noted with some organisms (e.g., Enterobacter spp., Pseudomonas spp., and Serratia spp.). As with other extended-spectrum beta-lactam antibiotics, resistance can develop during therapy, leading to clinical failure in some cases. When treating infections caused by these organisms, periodic susceptibility testing should be performed when clinically appropriate. If patients fail to respond to monotherapy, an aminoglycoside or similar agent should be considered.

Cephalosporins may be associated with a fall in prothrombin activity. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy. Prothrombin time should be monitored in patients at risk and exogenous vitamin K administered as indicated.

Tazicef should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.

Distal necrosis can occur after inadvertent intra-arterial administration of ceftazidime.

Prescribing Tazicef (ceftazidime) in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Drug Interactions:

Nephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside, antibiotics or potent diuretics, such as furosemide. Renal function should be carefully monitored, especially if higher dosages of the aminoglycosides are to be administered or if therapy is prolonged, because of the potential nephrotoxicity and ototoxicity of aminoglycoside antibiotics. Nephrotoxicity and ototoxicity were not noted when ceftazidime was given alone in clinical trials.

Chloramphenicol has been shown to be antagonistic to beta-lactam antibiotics, including ceftazidime, based on in vitro studies and time kill curves with enteric gram-negative bacilli. Due to the possibility of antagonism in vivo, particularly when bactericidal activity is desired, this drug combination should be avoided.

Drug/Laboratory Test Interactions:

The administration of ceftazidime may result in a false-positive reaction for glucose in the urine when using Clinitest® tablets, Benedict’s solution or Fehling’s solution. It is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix® or Tes-Tape®) be used.

Carcinogenesis, Mutagenesis, Impairment of Fertility:

Long-term studies in animals have not been performed to evaluate carcinogenic potential. However, a mouse micronucleus test and an Ames test were both negative for mutagenic effects.

Pregnancy:

Teratogenic Effects: Pregnancy Category B. Reproduction studies have been performed in mice and rats at doses up to 40 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus due to Tazicef. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Nursing Mothers:

Ceftazidime is excreted in human milk in low concentrations. Caution should be exercised when Tazicef is administered to a nursing woman.

Pediatric Use:

(See DOSAGE AND ADMINISTRATION).

Information for Patients:

Patients should be counseled that antibacterial drugs including Tazicef (ceftazidime) should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When Tazicef (ceftazidime) is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Tazicef (ceftazidime) or other antibacterial drugs in the future.

ADVERSE REACTIONS

Ceftazidime is generally well-tolerated. The incidence of adverse reactions associated with the administration of ceftazidime was low in clinical trials. The most common were local reactions following IV injection and allergic and gastrointestinal reactions. Other adverse reactions were encountered infrequently. No disulfiram-like reactions were reported.

The following adverse effects from clinical trials were considered to be either related to ceftazidime therapy or were of uncertain etiology:

Local Effects, reported in fewer than 2% of patients, were phlebitis and inflammation at the site of injection (1 in 69 patients).

Hypersensitivity Reactions, reported in 2% of patients, were pruritus, rash and fever. Toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme have also been reported with cephalosporin antibiotics, including ceftazidime. Immediate reactions, generally manifested by rash and/or pruritus, occurred in 1 in 285 patients. Angioedema and anaphylaxis (bronchospasm and/or hypotension) have been reported very rarely.

Gastrointestinal Symptoms, reported in fewer than 2% of patients, were diarrhea (1 in 78), nausea (1 in 156), vomiting (1 in 500) and abdominal pain (1 in 416). The onset of pseudomembranous colitis symptoms may occur during or after treatment (see WARNINGS).

Central Nervous System Reactions (fewer than 1%) include headache, dizziness and paresthesia. Seizures have been reported with several cephalosporins, including ceftazidime. In addition, encephalopathy, asterixis and neuromuscular excitabiIity have been reported in renally impaired patients treated with unadjusted dosage regimens of ceftazidime (see PRECAUTIONS: General).

Less Frequent Adverse Events (fewer than 1%) were candidiasis (including oral thrush) and vaginitis.

Hematologic: Rare cases of hemolytic anemia have been reported.

Laboratory Test Changes noted during Tazicef (ceftazidime for injection, USP) clinical trials were transient and included: eosinophilia (1 in 13), positive Coombs’ test without hemolysis (1 in 23), thrombocytosis (1 in 45), and slight elevations in one or more of the hepatic enzymes, aspartate aminotransferase (AST, SGOT) (1 in 16), alanine aminotransferase (ALT, SGPT) (1 in 15), LDH (1 in 18), GGT (1 in 19) and alkaline phosphatase (1 in 23). As with some other cephalosporins, transient elevations of blood urea, blood urea nitrogen and/or serum creatinine were observed occasionally. Transient leukopenia, neutropenia, agranulocytosis, thrombocytopenia and lymphocytosis were seen very rarely.

Observed During Clinical Practice: In addition to the adverse events reported from clinical trials, the following events have been identified during post-approval use of ceftazidime. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal connection to ceftazidime.

General: Anaphylactic or anaphylactoid reactions, which, in rare instances, were severe (e.g., cardiopulmonary arrest), including laryngeal edema, stridor, and urticaria; pain at injection site.

Hepatobiliary Tract and Pancreas: Hyperbilirubinemia.

Renal and Genitourinary: Renal impairment.

Cephalosporin-Class Adverse Reactions: In addition to the adverse reactions listed above that have been observed in patients treated with ceftazidime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics:

Adverse Reactions: Urticaria, colitis, renal dysfunction, toxic nephropathy, hepatic dysfunction

including cholestasis, aplastic anemia, hemorrhage.

Altered Laboratory Tests: Prolonged prothrombin time, false-positive test for urinary glucose,

elevated bilirubin, pancytopenia.

OVERDOSAGE

Ceftazidime overdosage has occurred in patients with renal failure. Reactions have included seizure activity, encephalopathy, asterixis and neuromuscular excitability. Patients who receive an acute overdosage should be carefully observed and given supportive treatment. In the presence of renal insufficiency, hemodialysis or peritoneal dialysis may aid in the removal of ceftazidime from the body.

DOSAGE AND ADMINISTRATION

Dosage: The usual adult dosage is 1 gram administered intravenously or intramuscularly every 8 or 12 hours. The dosage and route should be determined by the susceptibility of the causative organisms, the severity of infection and the condition and renal function of the patient.

The guidelines for dosage of Tazicef (ceftazidime for injection, USP) are listed in Table 3. The following dosage schedule is recommended.

Table 3. Recommended Dosage Schedule

Dose

Frequency

Adults

Usual recommended dose

1 gram IV or IM

q8 or 12h

Uncomplicated urinary tract infections

250 mg IV or IM

q12h

Bone and joint infections

2 grams IV

q12h

Complicated urinary tract infections

500 mg IV or IM

q8 or 12h

Uncomplicated pneumonia; mild skin and skin structure infections

500 mg to 1 gram IV or IM

q8h

Serious gynecological and intra-abdominal infections

2 grams IV

q8h

Meningitis

2 grams IV

q8h

Very severe life-threatening infections, especially in immunocompromised patients

2 grams IV

q8h

Lung infections caused by Pseudomonas spp. in patients with cystic fibrosis with normal renal function*

30 to 50 mg/kg IV to a maximum of 6 grams/day

q8h

Neonates (0 − 4 weeks)

30 mg/kg IV

q12h

Infants and children

(1 month − 12 years)

30 to 50 mg/kg IV to a maximum of 6 grams/day

q8h

*Although clinical improvement has been shown, bacteriological cures cannot be expected in patients with chronic respiratory disease and cystic fibrosis.

The higher dose should be reserved for immunocompromised pediatric patients or pediatric patients with cystic fibrosis or meningitis.

Impaired Hepatic Function : No adjustment in dosage is required for patients with hepatic dysfunction.

Impaired Renal Function : Ceftazidime is excreted by the kidneys, almost exclusively by glomerular filtration. Therefore, in patients with impaired renal function (glomerular filtration rate [GFR]<50 mL/min.), it is recommended that the dosage of ceftazidime be reduced to compensate for its slower excretion. In patients with suspected renal insufficiency, an initial loading dose of 1 gram of ceftazidime may be given. An estimate of GFR should be made to determine the appropriate maintenance dose. The recommended dosage is presented in Table 4.

Table 4. Recommended Maintenance Doses of Tazicef (ceftazidime for injection, USP) in Renal Insufficiency

NOTE: IF THE DOSE RECOMMENDED IN TABLE 3 ABOVE IS LOWER THAN THAT RECOMMENDED FOR PATIENTS WITH RENAL INSUFFICIENCY AS OUTLINED IN TABLE 4, THE LOWER DOSE SHOULD BE USED.

Creatinine

Clearance

(mL/min.)

Recommended

Unit Dose of

Tazicef

Frequency

of Dosing

50 − 31

1 gram

q12h

30 − 16

1 gram

q24h

15 − 6

500 mg

q24h

<5

500 mg

q48h

When only serum creatinine is available, the following formula (Cockcroft’s equation)4 may be used to estimate creatinine clearance. The serum creatinine should represent a steady state of renal function:

Males:

Creatinine clearance (mL/min.) = [Weight (kg) x (140 - age)] / [72 x serum creatinine (mg/dL)]

Females:

0.85 x male value

In patients with severe infections who would normally receive 6 grams of Tazicef daily were it not for renal insufficiency, the unit dose given in the table above may be increased by 50% or the dosing frequency increased appropriately. Further dosing should be determined by therapeutic monitoring, severity of the infection and susceptibility of the causative organism.

In pediatric patients as for adults, the creatinine clearance should be adjusted for body surface area or lean body mass and the dosing frequency reduced in cases of renal insufficiency.

In patients undergoing hemodialysis, a loading dose of 1 gram is recommended, followed by 1 gram after each hemodialysis period.

Tazicef (ceftazidime for injection, USP) can also be used in patients undergoing intra-peritoneal dialysis and continuous ambulatory peritoneal dialysis. In such patients, a loading dose of 1 gram of Tazicef may be given, followed by 500 mg every 24 hours. In addition to IV use, Tazicef can be incorporated in the dialysis fluid at a concentration of 250 mg for 2 liters of dialysis fluid.

Note:Generally Tazicef should be continued for 2 days after the signs and symptoms of infection have disappeared, but in complicated infections longer therapy may be required.

Administration: Tazicef may be given intravenously or by deep IM injection into a large muscle mass such as the upper outer quadrant of the gluteus maximus or lateral part of the thigh. Intra-arterial administration should be avoided (see PRECAUTIONS).

Note: Tazicef in ADD-Vantage® vials is not intended for direct IV or IM injection.

Intramuscular Administration: For IM administration, Tazicef should be reconstituted with Sterile Water for Injection. Refer to Table 5.

Intravenous Administration: The IV route is preferable for patients with bacterial septicemia, bacterial meningitis, peritonitis, or other severe or life-threatening infections, or for patients who may be poor risks because of lowered resistance resulting from such debilitating conditions as malnutrition,

trauma, surgery, diabetes, heart failure or malignancy, particularly if shock is present or pending.

For direct intermittent IV administration, reconstitute Tazicef as directed in Table 5 with Sterile Water for Injection. Slowly inject directly into the vein over a period of 3 to 5 minutes or give through the tubing of an administration set while the patient is also receiving one of the compatible IV fluids (see COMPATIBILITY AND STABILITY).

For IV infusion, reconstitute the 1- or 2-gram piggyback vial with 100 mL of Sodium Chloride Injection or one of the compatible IV fluids listed under the COMPATIBILITY AND STABILITY section. Alternatively, reconstitute the 1-gram or 2-gram vial and add an appropriate quantity of the resulting solution to an IV container with one of the compatible IV fluids.

Intermittent intravenous infusion with a Y-type administration set can be accomplished with compatible solutions. However, during infusion of a solution containing ceftazidime it is desirable to discontinue the other solution.

All vials of Tazicef as supplied are under reduced pressure. When Tazicef is dissolved, carbon dioxide is released and a positive pressure develops. See RECONSTITUTION.

Solutions of Tazicef , like those of most beta-lactam antibiotics, should not be added to solutions of aminoglycoside antibiotics because of potential interaction.

However, if concurrent therapy with Tazicef and an aminoglycoside is indicated, each of these antibiotics can be administered separately to the same patient.

TAZICEF INJECTION IN ADD-VANTAGE® VIALS

Note: Tazicef (ceftazidime for injection, USP) in the ADD-Vantage® vial is intended to be administered as a single-dose intravenous infusion with the ADD-Vantage® flexible diluent container.

Tazicef in single-dose ADD-Vantage® vials should be prepared as directed (see RECONSTITUTION, for ADD-Vantage® Vials) with either 0.9% Sodium Chloride Injection in the 50 mL or 100 mL flexible diluent containers, 0.45% Sodium Chloride Injection in the 50 mL container or 5% Dextrose Injection in the 50 mL or 100 mL containers.

RECONSTITUTION

Single-Dose Vials:

For IM injection, IV direct (bolus) injection or IV infusion, reconstitute with Sterile Water for Injection according to the following table. The vacuum may assist entry of the diluent. SHAKE WELL.

Table 5

Vial

Size

Amount of

Diluent to

Be Added

Approx. Avail.

Volume

Approximate

Ceftazidime

Concentration

Intramuscular or Intravenous Direct (bolus) Injection

1 gram

3.0 mL

3.6 mL

280 mg/mL

Intravenous Infusion

1 gram

10 mL

10.6 mL

95 mg/mL

2 gram

10 mL

11.2 mL

180 mg/mL

Withdraw the total volume of solution into the syringe (the pressure in the vial may aid withdrawal).

The withdrawn solution may contain some bubbles of carbon dioxide.

Note: As with the administration of all parenteral products, accumulated gases should be expressed from the syringe immediately before injection of Tazicef.

These solutions of Tazicef are stable for 24 hours at room temperature or 7 days if refrigerated (5°C). Slight yellowing does not affect potency.

For IV infusion, dilute reconstituted solution in 50 to 100 mL of one of the parenteral fluids listed under COMPATIBILITY AND STABILITY.

“Piggyback” Vials:

For IV infusion, reconstitute with 10 mL of Sodium Chloride Injection according to the following table.

The vacuum may assist entry of the diluent. SHAKE WELL.

Table 6

Vial

Diluent to

Approx. Avail.

Approx. Avg.

Size

Be Added

Volume

Concentration

1 gram

100 mL*

100 mL

10 mg/mL

2 gram

100 mL*

100 mL

20 mg/mL

*Addition should be in two stages.

Insert a gas relief needle through the vial closure to relieve the internal pressure. With the gas relief needle in position, add the remaining 90 mL of Sodium Chloride Injection. Remove the gas relief needle and syringe needle; shake the vial and set up for infusion in the normal way.

Note: To preserve product sterility, it is important that a gas relief needle is not inserted through the vial closure before the product has dissolved.

These solutions of Tazicef (ceftazidime for injection, USP) are stable for 24 hours at room temperature or 7 days if refrigerated (5°C). Slight yellowing does not affect potency.

ADD-Vantage ® Vials: ADD-Vantage® vials of Tazicef (ceftazidime for injection, USP) are to be reconstituted only with 0.9% Sodium Chloride Injection or 5% Dextrose Injection in the 50 mL or 100 mL flexible diluent containers, or with 0.45% Sodium Chloride Injection in the 50 mL container.

DIRECTIONS FOR USE OF TAZICEF® (CEFTAZIDIME FOR INJECTION, USP) IN ADD-VANTAGE® VIALS

To Open Diluent Container:

Peel overwrap at corner and remove solution container. Some opacity of the plastic due to moisture absorption during the sterilization process may be observed. This is normal and does not affect the solution quality or safety. The opacity will diminish gradually.

To Assemble Vial and Flexible Diluent Container:

(Use Aseptic Technique)

  1. Remove the protective covers from the top of the vial and the vial port on the diluent container as follows:

    a. To remove the breakaway vial cap, swing the pull ring over the top of the vial and pull down far enough to start the opening (SEE FIGURE 1), then pull straight up to remove the cap. (SEE FIGURE 2.)

    Note: Do not access vial with syringe.

    Image from Drug Label Content

    Image from Drug Label Content

    Fig. 1

    Fig. 2

    b.To remove the vial port cover, grasp the tab on the pull ring, pull up to break the three tie strings, then pull back to remove the cover. (SEE FIGURE 3.)

  2. Screw the vial into the vial port until it will go no further. THE VIAL MUST BE SCREWED IN TIGHTLY TO ASSURE A SEAL. This occurs approximately 1/2 turn (180°) after the first audible click. (SEE FIGURE 4.) The clicking sound does not assure a seal; the vial must be turned as far as it will go.

    Note: Once vial is sealed, do not attempt to remove. (SEE FIGURE 4.)

  3. Recheck the vial to assure that it is tight by trying to turn it further in the direction of assembly.

  4. Label appropriately.

    Image from Drug Label Content

    Image from Drug Label Content

    Fig. 3

    Fig. 4

To Reconstitute the Drug:

  1. Squeeze the bottom of the diluent container gently to inflate the portion of the container surrounding the end of the drug vial.

  2. With the other hand, push the drug vial down into the container telescoping the walls of the container. Grasp the inner cap of the vial through the walls of the container. (SEE FIGURE 5.)

  3. Pull the inner cap from the drug vial. (SEE FIGURE 6.) Verify that the rubber stopper has been pulled out, allowing the drug and diluent to mix.

  4. Mix container contents thoroughly and use within the specified time.

    Image from Drug Label Content

    Image from Drug Label Content

    Fig. 5

    Fig. 6

Preparation for Administration:

(Use Aseptic Technique)

  1. Confirm the activation and admixture of vial contents.

  2. Check for leaks by squeezing container firmly. If leaks are found discard unit as sterility may be impaired.

  3. Close flow control clamp of administration set.

  4. Remove cover from outlet port at bottom of container.

  5. Insert piercing pin of administration set into port with a twisting motion until the pin is firmly seated. Note: See full directions on administration set carton.

  6. Lift the free end of the hanger loop on the bottom of the vial, breaking the two tie strings. Bend the loop outward to lock it in the upright position, then suspend container from hanger.

  7. Squeeze and release drip chamber to establish proper fluid level in chamber.

  8. Open flow control clamp and clear air from set. Close clamp.

  9. Attach set to venipuncture device. If device is not in-dwelling, prime and make venipuncture.

  10. Regulate rate of administration with flow control clamp.

WARNING: Do not use flexible container in series connections.

COMPATIBILITY AND STABILITY

Intramuscular: Tazicef (ceftazidime for injection, USP) when reconstituted as directed withSterile Water for Injection, maintains satisfactory potency for 24 hours at room temperature or for 7 days under refrigeration (5°C). Solutions in Sterile Water for Injection that are frozen immediately after reconstitution in the original container are stable for 3 months when stored at -20°C. Once thawed, solutions should not be refrozen. Thawed solutions may be stored for up to 8 hours at room temperature or for 4 days in a refrigerator (5°C).

Intravenous: Tazicef (ceftazidime for injection, USP) when reconstituted as directed with Sterile Water for Injection, maintains satisfactory potency for 24 hours at room temperature or for 7 days under refrigeration. Solutions in Sterile Water for Injection in the original container or in 0.9% Sodium Chloride Injection in Viaflex® small volume containers that are frozen immediately after reconstitution are stable for 3 months when stored at -20°C. For larger volumes where it may be necessary to warm the frozen product (to a maximum of 40°C), care should be taken to avoid heating after thawing is complete. Do not force thaw by immersion in water baths or by microwave irradiation. Once thawed, solutions should not be refrozen. Thawed solutions may be stored for up to 8 hours at room temperature or for 4 days in a refrigerator (5°C).

Tazicef is compatible with the more commonly used IV infusion fluids. Solutions at concentrations between 1 mg/mL and 40 mg/mL in the following infusion fluids may be stored for up to 24 hours at room temperature or 7 days if refrigerated: 0.9% Sodium Chloride Injection; Ringer’s Injection USP; Lactated Ringer’s Injection USP; 5% Dextrose Injection; 5% Dextrose and 0.225% Sodium Chloride Injection; 5% Dextrose and 0.45% Sodium Chloride Injection; 5% Dextrose and 0.9% Sodium Chloride Injection; 10% Dextrose Injection.

Tazicef is less stable in Sodium Bicarbonate Injection than in other IV fluids. It is not recommended as a diluent. Solutions of Tazicef in 5% Dextrose and 0.9% Sodium Chloride Injection are stable for at least 6 hours at room temperature in plastic tubing, drip chambers and volume control devices of common IV infusion sets.

Ceftazidime at a concentration of 20 mg/mL has been found physically compatible for 24 hours at room temperature or 7 days under refrigeration in Sterile Water for Injection when admixed with: cefazolin sodium 330 mg/mL; heparin 1000 units/mL; and cimetidine HCI 150 mg/mL.

Ceftazidime at a concentration of 20 mg/mL has been found physically compatible for 24 hours at room temperature or 7 days under refrigeration in 5% Dextrose Injection when admixed with potassium chloride 40 mEq/L.

Vancomycin solution exhibits a physical incompatibility when mixed with a number of drugs, including ceftazidime. The likelihood of precipitation with ceftazidime is dependent on the concentrations of vancomycin and ceftazidime present. It is therefore recommended, when both drugs are to be administered by intermittent IV infusion, that they be given separately, flushing the IV lines (with one of the compatible IV fluids) between the administration of these two agents.

ADD-Vantage ® Vials: Ordinarily, ADD-Vantage® vials should be reconstituted only when it is certain that the patient is ready to receive the drug. However, Tazicef in ADD-Vantage® vials is stable for 24 hours at room temperature when reconstituted as directed (see RECONSTITUTION, ADD-Vantage®Vials, and DIRECTIONS FOR USE OF TAZICEF® INJECTION IN ADD-VANTAGE® VIALS).

Note: Parenteral drug products should be inspected visually for particulate matter prior to administration whenever solution and container permit.

As with other cephalosporins, Tazicef powder, as well as solutions, tends to darken depending on storage conditions; within the stated recommendations, however, product potency is not adversely affected.

HOW SUPPLIED

Tazicef in the dry state should be stored at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature] and protected from light. Tazicef (ceftazidime for injection, USP) is a dry, white to off-white powder supplied in vials as follows:

Vials: equivalent to 1 gram and 2 grams of ceftazidime.

1 gram (tray of 25): NDC 0409-5082-16

2 gram (tray of 10): NDC 0409-5084-11

“Piggyback” Vials for IV admixture: equivalent to 1 gram of ceftazidime.

1 gram (tray of 10): NDC 0409-5083-11

ADD-Vantage® Vials: equivalent to 1 gram and 2 grams of ceftazidime.

1 gram: NDC 0409-5092-16

2 gram: NDC 0409-5093-11

Also available as:

Pharmacy Bulk Vials: equivalent to 6 grams of ceftazidime.

6 gram (tray of 10): NDC 0409-5086-11

Clinical Studies

N/A

REFERENCES

  1. Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966;45:493-496.

  2. National Committee for Clinical Laboratory Standards. Approved Standard: Performance Standards for Antimicrobial Disk Susceptibility Tests. (M2-A3), December, 1984.

  3. Certification procedure for antibiotic sensitivity discs (21 CFR 460.1). Federal Register. May 30, 1974;39:19182-19184.

  4. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31-41.

Rev: September, 2005

Manufactured by Sandoz GmbH for Hospira Worldwide, Inc.,

Lake Forest, IL 60045, USA.

Made in Kundl, Austria.

©Hospira 2005 EN-1039 Printed in Austria


Tazicef (ceftazidime)
PRODUCT INFO
Product Code 0409-5082 Dosage Form INJECTION, POWDER, FOR SOLUTION
Route Of Administration INTRAVENOUS, INTRAMUSCULAR DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
ceftazidime (ceftazidime) Active 1 GRAM  In 1 VIAL
Sodium carbonate Inactive 118 MILLIGRAM  In 1 VIAL
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0409-5082-16 4 TRAY In 1 CASE contains a TRAY
1 25 VIAL In 1 TRAY This package is contained within the CASE (0409-5082-16) and contains a VIAL
1 1 VIAL In 1 VIAL This package is contained within a TRAY and a CASE (0409-5082-16)

Tazicef (ceftazidime)
PRODUCT INFO
Product Code 0409-5084 Dosage Form INJECTION, POWDER, FOR SOLUTION
Route Of Administration INTRAVENOUS DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
ceftazidime (ceftazidime) Active 2 GRAM  In 1 VIAL
Sodium carbonate Inactive 236 MILLIGRAM  In 1 VIAL
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0409-5084-11 4 TRAY In 1 CASE contains a TRAY
1 10 VIAL In 1 TRAY This package is contained within the CASE (0409-5084-11) and contains a VIAL
1 1 VIAL In 1 VIAL This package is contained within a TRAY and a CASE (0409-5084-11)

Tazicef (ceftazidime)
PRODUCT INFO
Product Code 0409-5083 Dosage Form INJECTION, POWDER, FOR SOLUTION
Route Of Administration INTRAVENOUS DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
ceftazidime (ceftazidime) Active 1 GRAM  In 1 VIAL
Sodium carbonate Inactive 118 MILLIGRAM  In 1 VIAL
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0409-5083-11 4 TRAY In 1 CASE contains a TRAY
1 10 VIAL In 1 TRAY This package is contained within the CASE (0409-5083-11) and contains a VIAL, PIGGYBACK
1 1 VIAL In 1 VIAL, PIGGYBACK This package is contained within a TRAY and a CASE (0409-5083-11)

Tazicef (ceftazidime)
PRODUCT INFO
Product Code 0409-5092 Dosage Form INJECTION, POWDER, FOR SOLUTION
Route Of Administration INTRAVENOUS DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
ceftazidime (ceftazidime) Active 1 GRAM  In 1 VIAL
Sodium carbonate Inactive 118 MILLIGRAM  In 1 VIAL
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0409-5092-16 4 TRAY In 1 CASE contains a TRAY
1 25 VIAL In 1 TRAY This package is contained within the CASE (0409-5092-16) and contains a VIAL, PATENT DELIVERY SYSTEM
1 1 VIAL In 1 VIAL, PATENT DELIVERY SYSTEM This package is contained within a TRAY and a CASE (0409-5092-16)

Tazicef (ceftazidime)
PRODUCT INFO
Product Code 0409-5093 Dosage Form INJECTION, POWDER, FOR SOLUTION
Route Of Administration INTRAVENOUS DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
ceftazidime (ceftazidime) Active 2 GRAM  In 1 VIAL
Sodium carbonate Inactive 236 MILLIGRAM  In 1 VIAL
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0409-5093-11 4 TRAY In 1 CASE contains a TRAY
1 10 VIAL In 1 TRAY This package is contained within the CASE (0409-5093-11) and contains a VIAL, PATENT DELIVERY SYSTEM
1 1 VIAL In 1 VIAL, PATENT DELIVERY SYSTEM This package is contained within a TRAY and a CASE (0409-5093-11)

Revised: 01/2007Hospira Worldwide, Inc.

Data are from FDA and U.S. National Library of Medicine.