Recommended Dosage and Treatment Duration for Ceftazidime in Severe Gram-Negative Infections
For adults with severe bacterial infections caused by Gram-negative bacteria, the recommended dosage of ceftazidime is 2 grams administered intravenously every 8 hours, with treatment duration of 7-14 days depending on infection severity and clinical response. 1
Standard Dosing Regimen
The FDA-approved dosing guidelines for ceftazidime in adults with severe infections are:
- Standard severe infections: 1-2 grams IV every 8 hours
- Very severe life-threatening infections: 2 grams IV every 8 hours
- Pseudomonas infections in cystic fibrosis: 30-50 mg/kg IV every 8 hours (maximum 6 grams daily) 1
Specific Infection Types and Dosing
- Severe pneumonia: 2 grams IV every 8 hours
- Complicated intra-abdominal infections: 2 grams IV every 8 hours
- Meningitis: 2 grams IV every 8 hours
- Severe skin/soft tissue infections: 1-2 grams IV every 8 hours
- Complicated urinary tract infections: 500 mg to 1 gram IV every 8-12 hours 1
Combination Therapy Considerations
For severe infections caused by multidrug-resistant Gram-negative bacteria, particularly Pseudomonas aeruginosa, combination therapy is often recommended:
- Pseudomonas aeruginosa infections: Combination therapy is recommended to reduce the risk of developing resistance during treatment 2
- Carbapenem-resistant Enterobacteriaceae (CRE): Ceftazidime-avibactam at 2.5 grams (2g ceftazidime + 0.5g avibactam) IV every 8 hours is preferred over standard ceftazidime 2, 3
- Metallo-β-lactamase-producing CRE: Ceftazidime-avibactam combined with aztreonam is suggested as a preferential choice 2
Duration of Treatment
- Standard duration: 7-10 days for most severe infections
- Complicated infections: 10-14 days
- General guideline: Continue therapy for 2 days after signs and symptoms of infection have disappeared 1
Renal Dosage Adjustments
Ceftazidime is primarily excreted by the kidneys, requiring dosage adjustment in renal impairment:
| Creatinine Clearance (mL/min) | Recommended Dose | Frequency |
|---|---|---|
| 50-31 | 1 gram | q12h |
| 30-16 | 1 gram | q24h |
| 15-6 | 500 mg | q24h |
| <5 | 500 mg | q48h |
For hemodialysis patients: 1 gram loading dose, followed by 1 gram after each hemodialysis session 1
Administration Considerations
- IV administration: Infuse over 2-3 hours for optimal efficacy 3
- Preparation: Reconstitute with 10 mL of Sterile Water for Injection to yield approximately 100 mg/mL concentration 1
Monitoring During Treatment
- Monitor renal function regularly
- Assess clinical response within 48-72 hours
- Consider follow-up cultures in severe infections to confirm bacterial eradication
- Watch for potential adverse effects including acute kidney injury (8.4% incidence) 4
Clinical Efficacy Considerations
Real-world experience with ceftazidime (and ceftazidime-avibactam) shows clinical success rates of 70-80% for severe Gram-negative infections 4. Early administration (within 48 hours of infection onset) is associated with better outcomes and reduced risk of clinical failure 4.
Ceftazidime remains an effective option for severe Gram-negative infections with clinical cure rates typically between 75-100% when appropriately dosed 5, 6.