Dosage of Ceftazidime Flamingo in details
Dosage depends upon the severity, sensitivity, site and type of infection and upon the age and renal function of the patient.
Use Ceftazidime Flamingo injection by intravenous (i.v.) or deep intramuscular (i.m.) injection. Recommended i.m. injection sites are the upper outer quadrant of the gluteus maximus or lateral part of the thigh.
Ceftazidime Flamingo solutions may be given directly into the vein or introduced into the tubing of a giving set if the patient is receiving parenteral fluids.
Adults: 1 to 6 g/day in two or three divided doses by i.v. or i.m. injection.
Urinary Tract and Less Severe Infections: 500 mg or 1 g every 12 hours.
Most Infections: 1 g every 8 hours or 2 g every 12 hours.
Very Severe Infections Particularly in Immunocompromised Patients Including those with Neutropenia: 2 g every eight or 12 hours, or 3 g every 12 hours.
Fibrocystic Adults with Pseudomonal Lung Infections: 100 to 150 mg/kg/day in three divided doses.
In adults with normal renal function 9 g/day has been used without ill effect.
When used as a prophylactic agent in prostatic surgery, 1 g should be given at the induction of anaesthesia. A second dose should be considered at the time of catheter removal.
Infants and Children (Greater Than 2 Months): 30 to 100 mg/kg/day in two or three divided doses.
Doses up to 150 mg/kg/day (maximum 6 g/day) in three divided doses may be given to infected immunocompromised or fibrocystic children or children with meningitis.
Neonates (0 to 2 Months): 25 to 60 mg/kg/day in two divided doses.
In neonates, the serum half-life of Ceftazidime Flamingo can be three to four times that in adults.
Elderly: In view of the reduced clearance of Ceftazidime Flamingo in acutely ill elderly patients, the daily dosage should not normally exceed 3 g, especially in those over 80 years of age.
Renal Impairment: Ceftazidime Flamingo is excreted unchanged by the kidneys. Therefore, in patients with impaired renal function, the dosage should be reduced.
An initial loading dose of 1 g should be given. Maintenance doses should be based on creatinine clearance as shown in Table 2.
In patients with severe infections the unit dose should be increased by 50% or the dosing frequency increased. In such patients the Ceftazidime Flamingo serum levels should be monitored and trough levels should not exceed 40 mg/L.
In children the creatinine clearance should be adjusted for body surface area or lean body mass.
Haemodialysis: The serum half-life during haemodialysis ranges from 3 to 5 hours.
Following each haemodialysis period, the maintenance dose of Ceftazidime Flamingo recommended in Table 2 should be repeated.
Peritoneal Dialysis: Ceftazidime Flamingo may be used in peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD).
In addition to i.v. use, Ceftazidime Flamingo can be incorporated into the dialysis fluid (usually 125 to 250 mg for 2 litres of dialysis solution).
For patients in renal failure on continuous arteriovenous haemodialysis or high-flux haemofiltration in intensive therapy units; 1 g daily either as a single dose or in divided doses. For low-flux haemofiltration, follow the dosage recommended under impaired renal function.
For patients on venovenous haemofiltration and venovenous haemodialysis, follow the dosage recommendations in Tables 3 and 4.
What other drugs will affect Ceftazidime Flamingo?
Tell your doctor about all other medicines you use, especially:
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chloramphenicol (Chloromycetin);
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diuretics (water pills) such as furosemide (Lasix); or
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an antibiotic such as amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Mycifradin, Neo-Fradin, Neo-Tab), streptomycin, or tobramycin (Nebcin, Tobi).
This list is not complete and other drugs may interact with Ceftazidime Flamingo. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Ceftazidime Flamingo interactions
Probenecid: Concomitant administration of 2 g of oral probenecid does not affect the pharmacokinetics of Ceftazidime Flamingo, presumably because Ceftazidime Flamingo is excreted principally by glomerular filtration.
Aminoglycosides: In vitro studies indicate that the antibacterial activity of Ceftazidime Flamingo and aminoglycosides may be additive or synergistic against some organisms including some strains of Ps. aeruginosa and Enterobacteriaceae. However, synergism is unpredictable and antagonism has also occurred in vitro when Ceftazidime Flamingo was used in combination with an aminoglycoside especially with the organisms with high-level resistance.
Concurrent use of aminoglycosides and cephalosporins may increase the risk of nephrotoxicity during therapy. Although this effect has not been reported to date with Ceftazidime Flamingo, the manufacturer states that the possibility that nephrotoxicity may be potentiated if the drug is used concomitantly with an aminoglycoside should be considered.
Chloramphenicol: Chloramphenicol has been reported to antagonize the bactericidal activity of beta-lactam antibiotics including Ceftazidime Flamingo, in vitro, and the possibility of in vivo antagonism should be considered. Therefore, it is recommended that combined therapy with chloramphenicol and Ceftazidime Flamingo be avoided, particularly when bactericidal activity is considered important.
Beta-Lactam Antibiotics: Although a synergistic or partially synergistic effect has occurred in vitro against a few strains of Ps. aeruginosa when Ceftazidime Flamingo and carbenicillin, cefsulodin, mezlocillin, or piperacillin were used concomitantly, use of Ceftazidime Flamingo and another cephalosporin or an extended-spectrum penicillin has generally resulted in an effect that was only slightly additive or indifferent against Ps. aeruginosa. In addition, the combination of Ceftazidime Flamingo and cefoxitin has been antagonistic in vitro against Ps. aeruginosa. The clinical importance is unclear, but concomitant use of Ceftazidime Flamingo and ampicillin in vitro has resulted in antagonism against group B streptococci and Listeria monocytogenes. Combination of Ceftazidime Flamingo and clavulanic acid, a beta-lactamase inhibitor, is synergistic against some strains of B. fragilis resistant to Ceftazidime Flamingo alone. The combination was not effective against other Bacteroides, such as B. distasonis, that are not beta-lactamase producers.
Diuretics: Although concomitant use of cephalosporins and potent diuretics (e.g., furosemide) reportedly may adversely affect renal function, this effect apparently did not occur when furosemide was used concomitantly with Ceftazidime Flamingo in a few patients.
Alteration in Laboratory Values: Positive direct Coombs' test is known to develop in individuals during treatment with the cephalosporin group of antibiotics, including Ceftazidime Flamingo. In laboratory tests a false-positive reaction to glucose may occur with reducing substances but not with the use of specific glucose oxidase methods.
As with other beta-lactam antibiotics, granulocytopenia and more rarely, agranulocytosis may develop during treatment with Ceftazidime Flamingo, particularly if given over long periods. For courses of treatment lasting longer than 10 days, blood counts should therefore be monitored.
References
- DailyMed. "CEFTAZIDIME: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- MeSH. "Anti-Bacterial Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
- European Chemicals Agency - ECHA. "(6R,7R)-7-[[(2E)-2-(2-amino-1,3-thiazol-4-yl)-2-(1-hydroxy-2-methyl-1-oxopropan-2-yl)oxyiminoacetyl]amino]-8-oxo-3-(pyridin-1-ium-1-ylmethyl)-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylate pentahydrate: The information provided here is aggregated from the "Notified classification and labelling" from ECHA's C&L Inventory. ". https://echa.europa.eu/information-o... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
