Ceftazidime Dosing for Urinary Tract Infections
For urinary tract infections (UTIs), ceftazidime should be dosed at 250 mg intravenously every 12 hours for uncomplicated UTIs and 500 mg intravenously every 8-12 hours for complicated UTIs, with dose adjustments required for renal impairment. 1
Dosing Recommendations Based on UTI Type
Uncomplicated UTIs
Complicated UTIs
Severe/Life-threatening UTIs
- For severe infections, dosage may be increased to 1-2 grams IV every 8 hours 1
- In very severe cases, especially with immunocompromised patients, up to 2 grams IV every 8 hours may be used 1
Renal Dosing Adjustments
Ceftazidime is primarily eliminated by glomerular filtration, requiring dose adjustments in renal impairment 1, 3:
| Creatinine Clearance (mL/min) | Recommended Dose | Frequency |
|---|---|---|
| >50 | Standard dose | Standard frequency |
| 31-50 | 1 gram | Every 12 hours |
| 16-30 | 1 gram | Every 24 hours |
| 6-15 | 500 mg | Every 24 hours |
| <5 | 500 mg | Every 48 hours |
Special Populations
Hemodialysis Patients
- Loading dose: 1 gram
- Maintenance: 1 gram after each hemodialysis session 1
Peritoneal Dialysis Patients
- Loading dose: 1 gram
- Maintenance: 500 mg every 24 hours 1
- Can be incorporated into dialysis fluid at 250 mg per 2L of dialysis fluid 1
Considerations for Resistant Organisms
For UTIs caused by Carbapenem-Resistant Enterobacterales (CRE), alternative therapies include:
- Ceftazidime-avibactam 2.5g IV q8h (weak recommendation, very low quality evidence) 4
- Meropenem-vaborbactam 4g IV q8h (weak recommendation, low quality evidence) 4
- Imipenem-cilastatin-relebactam 1.25g IV q6h (weak recommendation, low quality evidence) 4
- Single-dose aminoglycoside for simple cystitis due to CRE 4
Clinical Pearls
- Obtain cultures before initiating therapy to guide treatment 2
- Generally continue therapy for 2 days after signs and symptoms of infection have disappeared 1
- For complicated infections, longer therapy may be required 1
- Ceftazidime has excellent activity against most gram-negative pathogens including Pseudomonas aeruginosa 5
- Ceftazidime-avibactam may be considered for complicated UTIs caused by resistant organisms, with a dosage of 2000 mg/500 mg every 8 hours 6
Monitoring
- Monitor renal function during therapy, especially in patients with pre-existing renal impairment
- Assess clinical response within 48-72 hours to determine if therapy adjustments are needed
- Monitor for adverse effects, which are generally mild but may include transient leukopenia or elevated liver enzymes 5
Remember that local resistance patterns should be considered when selecting empiric therapy, and treatment should be adjusted based on culture and sensitivity results when available.