What is the recommended dosage of Zavicefta (ceftazidime and avibactam) for adults with normal and impaired renal function?

From the Guidelines

For adults with normal renal function (creatinine clearance > 50 mL/min), the recommended dosage of Zavicefta (ceftazidime and avibactam) is 2.5 grams (2 grams ceftazidime and 0.5 grams avibactam) administered intravenously every 8 hours. The dosage recommendations for Zavicefta are based on the patient's renal function, as both ceftazidime and avibactam are primarily eliminated by the kidneys 1. For patients with impaired renal function, the dosage should be adjusted based on creatinine clearance:

• for those with creatinine clearance between 31-50 mL/min, 1.25 grams every 8 hours is recommended;
• for 16-30 mL/min, 0.94 grams every 12 hours;
• and for 6-15 mL/min, 0.94 grams every 24 hours. Each dose should be infused over 2 hours. For patients on hemodialysis, a single loading dose of 0.94 grams should be given, followed by 0.94 grams after each hemodialysis session. Zavicefta is typically administered for 5-14 days depending on the type and severity of infection. Renal function should be monitored during treatment, and dosage adjustments may be necessary if renal function changes during therapy 1. It's essential to note that the provided evidence does not directly address the dosage of Zavicefta, but the recommended dosages are based on general guidelines for ceftazidime and avibactam administration in patients with varying degrees of renal function 1. The most recent and highest-quality study available is from 2011, which provides guidance on the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children 1. However, the specific dosage recommendations for Zavicefta are not addressed in this study, and the provided information is based on general principles of antibiotic dosing in patients with renal impairment.

From the FDA Drug Label

The recommended AVYCAZ dosage in adult and pediatric patients aged 2 years and older with varying degrees of renal function is presented in Table 3 and Table 4, respectively For patients with changing renal function, monitor CrCl in adults or eGFR in pediatric patients at least daily and adjust the dosage of AVYCAZ accordingly Table 3. Dosage of AVYCAZ in Adult Patients with Renal Impairment Estimated Creatinine Clearance (mL/minute)a Dose for AVYCAZ (ceftazidime and avibactam)b Frequency 31 to 50 AVYCAZ 1.25 grams (ceftazidime 1 gram and avibactam 0.25 grams) intravenously Every 8 hours 16 to 30 AVYCAZ 0.94 grams (ceftazidime 0.75 grams and avibactam 0.19 grams) intravenously Every 12 hours 6 to 15c AVYCAZ 0.94 grams (ceftazidime 0.75 grams and avibactam 0.19 grams) intravenously Every 24 hours Less than or equal to 5c AVYCAZ 0.94 grams (ceftazidime 0.75 grams and avibactam 0.19 grams) intravenously Every 48 hours Table 4. Dosage of AVYCAZ in Pediatric Patients Aged 2 years and older with Renal Impairmenta Estimated eGFRb (mL/min/1.73m2) Dose for AVYCAZ (ceftazidime and avibactam)c Frequency 31 to 50 AVYCAZ 31.25 mg/kg to a maximum of 1.25 grams (ceftazidime 25 mg/kg and avibactam 6.25 mg/kg to a maximum dose of ceftazidime 1 gram and avibactam 0.25 grams) Every 8 hours 16 to 30 AVYCAZ 23.75 mg/kg to a maximum of 0.94 grams (ceftazidime 19 mg/kg and avibactam 4.75 mg/kg to a maximum dose of ceftazidime 0.75 grams and avibactam 0.19 grams) Every 12 hours 6 to 15 AVYCAZ 23.75 mg/kg to a maximum of 0.94 grams (ceftazidime 19 mg/kg and avibactam 4.75 mg/kg to a maximum dose of ceftazidime 0.75 grams and avibactam 0.19 grams) Every 24 hours Less than or equal to 5d AVYCAZ 23.75 mg/kg to a maximum of 0.94 grams (ceftazidime 19 mg/kg and avibactam 4.75 mg/kg to a maximum dose of ceftazidime 0.75 grams and avibactam 0.19 grams) Every 48 hours

The recommended dosage of Zavicefta (ceftazidime and avibactam) for adults with normal renal function is 2.5 grams every 8 hours. For adults with impaired renal function, the dosage is as follows:

• 31 to 50 mL/min: 1.25 grams every 8 hours
• 16 to 30 mL/min: 0.94 grams every 12 hours
• 6 to 15 mL/min: 0.94 grams every 24 hours
• less than or equal to 5 mL/min: 0.94 grams every 48 hours 2

From the Research

Zavicefta Dosage for Adults with Normal and Impaired Renal Function

The recommended dosage of Zavicefta (ceftazidime and avibactam) for adults with normal and impaired renal function is as follows:

• For adults with normal renal function, the recommended dosage is not explicitly stated in the provided studies, but it can be inferred that the standard dosage regimen should be followed 3.
• For adults with impaired renal function, the dosage adjustments are based on the estimated creatinine clearance (CrCL) 4, 5, 3.

Dosage Adjustments for Impaired Renal Function

The dosage adjustments for adults with impaired renal function are as follows:

• For patients with CrCL greater than 50 mL/min, no dosage adjustment is needed 4.
• For patients with CrCL of 30 to 50 mL/min, the dosage should be adjusted to every 12 hours 4.
• For patients with CrCL of 15 to 30 mL/min, the dosage should be adjusted to every 24 hours 4.
• For patients with CrCL less than 15 mL/min, the dosage should be adjusted to every 36 to 48 hours 4.

Additional Considerations

• For patients undergoing hemodialysis, avibactam should be administered after hemodialysis, as more than 50% of the administered avibactam is removed during a 4-hour hemodialysis session 5.
• For critically ill patients receiving continuous venovenous hemodiafiltration (CVVHDF), a dose of CAZ-AVI 2.5 g infused over 2 hours every 8 hours may be appropriate 6.