Ceftazidime-Avibactam Dosage
For adults with normal renal function, administer ceftazidime-avibactam 2.5 grams (ceftazidime 2 grams and avibactam 0.5 grams) intravenously every 8 hours over 2 hours. 1
Adult Dosing
Standard Dosing (Normal Renal Function)
- Dose: 2.5 grams IV every 8 hours (ceftazidime 2 g + avibactam 0.5 g)
- Infusion time: 2 hours
- Duration:
- Complicated intra-abdominal infections (cIAI): 5-14 days
- Complicated urinary tract infections (cUTI): 7-14 days
- Hospital-acquired/ventilator-associated pneumonia (HABP/VABP): 7-14 days 1
Important: For cIAI, combine with metronidazole 0.5 g IV every 8 hours 1
Renal Impairment Adjustments
Dosing adjustments are critical because both ceftazidime and avibactam are predominantly renally cleared (80-90% and 97% unchanged in urine, respectively) 1. Monitor creatinine clearance at least daily in patients with changing renal function and adjust doses accordingly 1.
| CrCl (mL/min) | Dose | Frequency |
|---|---|---|
| 31-50 | 1.25 g (CAZ 1 g + AVI 0.25 g) | Every 8 hours |
| 16-30 | 0.94 g (CAZ 0.75 g + AVI 0.19 g) | Every 12 hours |
| 6-15* | 0.94 g (CAZ 0.75 g + AVI 0.19 g) | Every 24 hours |
| ≤5* | 0.94 g (CAZ 0.75 g + AVI 0.19 g) | Every 48 hours |
*Administer after hemodialysis on dialysis days 1
Critical caveat: Recent evidence suggests that renal dose reduction may be independently associated with higher mortality in KPC-producing Klebsiella pneumoniae bloodstream infections 2. This underscores the importance of optimizing exposure through extended infusions or therapeutic drug monitoring when feasible, particularly in severe infections.
Pediatric Dosing
Ages 2 to <18 Years (eGFR >50 mL/min/1.73 m²)
- Dose: 62.5 mg/kg IV every 8 hours (maximum 2.5 grams)
- Ceftazidime 50 mg/kg + avibactam 12.5 mg/kg
- Maximum: ceftazidime 2 g + avibactam 0.5 g
- Infusion time: 2 hours 1
Ages 6 Months to <2 Years
- Dose: 62.5 mg/kg IV every 8 hours
- Ceftazidime 50 mg/kg + avibactam 12.5 mg/kg
- Infusion time: 2 hours 1
Ages 3 to <6 Months
- Dose: 50 mg/kg IV every 8 hours
- Ceftazidime 40 mg/kg + avibactam 10 mg/kg
- Infusion time: 2 hours 1
Ages >28 Days to <3 Months (or corrected age >28 days for preterm)
- Dose: 37.5 mg/kg IV every 8 hours
- Ceftazidime 30 mg/kg + avibactam 7.5 mg/kg
- Infusion time: 2 hours 1
Neonates ≤28 Days (Gestational Age ≥31 Weeks)
- Dose: 25 mg/kg IV every 8 hours
- Ceftazidime 20 mg/kg + avibactam 5 mg/kg
- Infusion time: 2 hours 1
Pediatric Renal Impairment (Ages ≥2 Years)
| eGFR (mL/min/1.73 m²) | Dose | Frequency |
|---|---|---|
| 31-50 | 31.25 mg/kg (max 1.25 g) | Every 8 hours |
| 16-30 | 23.75 mg/kg (max 0.94 g) | Every 12 hours |
| 6-15* | 23.75 mg/kg (max 0.94 g) | Every 24 hours |
| ≤5* | 23.75 mg/kg (max 0.94 g) | Every 48 hours |
*Administer after hemodialysis on dialysis days 1
Note: There is insufficient data to recommend dosing for children <2 years with renal impairment 1, 3.
Special Populations
Hepatic Impairment
No dose adjustment required—neither ceftazidime nor avibactam undergo significant hepatic metabolism 1
Elderly Patients
No dose adjustment based on age alone, but adjust for renal function as elderly patients commonly have reduced creatinine clearance 1
Critically Ill Patients
Consider extended infusion (3 hours instead of 2 hours) or therapeutic drug monitoring, particularly in patients with augmented renal clearance or severe infections 4, 5. Recent data suggests that standard dosing may be suboptimal in critically ill patients with rapidly changing renal function 6.
Key Clinical Considerations
- Renal monitoring is mandatory: Both drugs are almost exclusively renally eliminated, making daily monitoring of renal function essential in hospitalized patients 1
- Hemodialysis timing: Both drugs are extensively removed by hemodialysis (approximately 55% in 4 hours), so always dose after dialysis 1
- Combination therapy for cIAI: Always add metronidazole for anaerobic coverage in intra-abdominal infections 7
- Pregnancy: No specific contraindications, but avoid doxycycline alternatives; use standard dosing 1