Ceftazidime-Avibactam Dosing Regimen
For adults with normal renal function (CrCl >50 mL/min), administer ceftazidime-avibactam 2.5 grams (ceftazidime 2 grams + avibactam 0.5 grams) IV every 8 hours as a 2-hour infusion. 1
Standard Dosing by Indication
Complicated Intra-Abdominal Infections (cIAI)
- Dose: 2.5 g IV every 8 hours over 2 hours
- Duration: 5-14 days 2, 1
- Critical requirement: Must be combined with metronidazole 500 mg IV every 6-8 hours for anaerobic coverage 2, 1
Complicated Urinary Tract Infections (cUTI) including Pyelonephritis
- Dose: 2.5 g IV every 8 hours over 2 hours
- Duration: 5-10 days (typically 7-14 days) 2, 1
- No additional anaerobic coverage needed
Hospital-Acquired/Ventilator-Associated Pneumonia (HAP/VAP)
- Dose: 2.5 g IV every 8 hours over 2 hours
- Duration: 10-14 days (typically 7-14 days) 2, 1
- No additional anaerobic coverage needed
Renal Dose Adjustments (Adults)
Monitor creatinine clearance daily in patients with changing renal function and adjust dosing accordingly. 1 This is particularly critical as renal function can improve rapidly during treatment, potentially leading to subtherapeutic drug levels.
| CrCl (mL/min) | Dose | Frequency |
|---|---|---|
| 31-50 | 1.25 g (ceftazidime 1 g + avibactam 0.25 g) | Every 8 hours |
| 16-30 | 0.94 g (ceftazidime 0.75 g + avibactam 0.19 g) | Every 12 hours |
| 6-15 | 0.94 g (ceftazidime 0.75 g + avibactam 0.19 g) | Every 24 hours |
| ≤5 (including hemodialysis) | 0.94 g (ceftazidime 0.75 g + avibactam 0.19 g) | Every 48 hours |
For hemodialysis patients: Administer after dialysis on dialysis days, as both drugs are removed by hemodialysis. 1
Pediatric Dosing
Ages 2 to <18 years (eGFR >50 mL/min/1.73 m²)
- Dose: 62.5 mg/kg (ceftazidime 50 mg/kg + avibactam 12.5 mg/kg)
- Maximum: 2.5 g per dose
- Frequency: Every 8 hours over 2 hours
- Duration: Same as adults by indication 1
Ages 6 months to <2 years (no renal impairment)
- Dose: 62.5 mg/kg (ceftazidime 50 mg/kg + avibactam 12.5 mg/kg)
- Frequency: Every 8 hours over 2 hours 1
Ages 3 months to <6 months
- Dose: 50 mg/kg (ceftazidime 40 mg/kg + avibactam 10 mg/kg)
- Frequency: Every 8 hours over 2 hours 1
Ages >28 days to <3 months
- Dose: 37.5 mg/kg (ceftazidime 30 mg/kg + avibactam 7.5 mg/kg)
- Frequency: Every 8 hours over 2 hours 1
Ages ≤28 days (gestational age ≥31 weeks)
- Dose: 25 mg/kg (ceftazidime 20 mg/kg + avibactam 5 mg/kg)
- Frequency: Every 8 hours over 2 hours 1
For pediatric cIAI: Add metronidazole 10 mg/kg IV every 8 hours 1
Critical Clinical Considerations
Infusion Duration
Always infuse over 2 hours. 1 Extended infusion (3 hours) may be considered for critically ill patients or those with high MIC pathogens to optimize pharmacodynamic target attainment, though this is not standard FDA labeling. 2
Specific Pathogen Considerations
- Carbapenem-resistant Enterobacterales (CRE): Standard dosing is appropriate for KPC and OXA-48 producers 2, 3
- Metallo-β-lactamase producers (NDM, VIM): Ceftazidime-avibactam is NOT effective as monotherapy; requires combination with aztreonam 4, 3
- Difficult-to-treat Pseudomonas aeruginosa: Standard dosing is appropriate 2
Common Pitfalls to Avoid
- Forgetting metronidazole for cIAI: Ceftazidime-avibactam lacks anaerobic coverage—always add metronidazole for intra-abdominal infections 2, 1
- Not adjusting for renal function: Both drugs are renally cleared; failure to adjust leads to toxicity 1
- Not monitoring changing renal function: Critically ill patients often have fluctuating renal function requiring daily reassessment 1, 5
- Using for MBL producers without aztreonam: This will result in treatment failure 4, 3
Special Populations
CVVH/CRRT patients: Clearance increases significantly during continuous renal replacement therapy. Standard dosing may be inadequate; consider therapeutic drug monitoring if available. 6, 7
VA-ECMO patients: Drug clearance may change after ECMO weaning; reassess dosing if therapy extends beyond ECMO support. 7