Recommended Dosing for Ceftazidime in Normal and Impaired Renal Function
The standard adult dosage for ceftazidime is 1 gram administered intravenously every 8 to 12 hours, with dosage adjustments required based on renal function, infection severity, and the susceptibility of the causative organism. 1
Standard Dosing for Normal Renal Function
Adult Dosing
- Usual recommended dosage: 1 gram IV/IM every 8-12 hours 1
- Uncomplicated urinary tract infections: 250 mg IV/IM every 12 hours 1
- Complicated urinary tract infections: 500 mg IV/IM every 8-12 hours 1
- Uncomplicated pneumonia; mild skin infections: 500 mg to 1 gram IV/IM every 8 hours 1
- Bone and joint infections: 2 grams IV every 12 hours 1
- Serious gynecologic and intra-abdominal infections: 2 grams IV every 8 hours 1
- Meningitis: 2 grams IV every 8 hours 1
- Very severe life-threatening infections, especially in immunocompromised patients: 2 grams IV every 8 hours 1
- Lung infections caused by Pseudomonas in cystic fibrosis patients: 30-50 mg/kg IV up to maximum 6 grams per day, every 8 hours 1
Pediatric Dosing
- Neonates (0-4 weeks): 30 mg/kg IV every 12 hours 1
- Infants and children (1 month-12 years): 30-50 mg/kg IV up to maximum 6 grams per day, every 8 hours 1
Dosing in Renal Impairment
Ceftazidime is excreted almost exclusively by glomerular filtration, making dosage adjustment essential in renal impairment 1, 2:
| Creatinine Clearance (mL/min) | Recommended Unit Dose | Frequency of Dosing |
|---|---|---|
| 50-31 | 1 gram | every 12 hours |
| 30-16 | 1 gram | every 24 hours |
| 15-6 | 500 mg | every 24 hours |
| less than 5 | 500 mg | every 48 hours |
Special Considerations
Hemodialysis Patients
Peritoneal Dialysis Patients
- Loading dose: 1 gram 1
- Maintenance: 500 mg every 24 hours 1
- Can be incorporated in dialysis fluid at concentration of 250 mg per 2L of dialysis fluid 1
Critically Ill Patients
For critically ill patients with severe infections, higher dosing may be considered:
- The unit dose may be increased by 50% or the dosing frequency increased appropriately 1
- In patients with suspected sepsis, the Journal of Microbiology, Immunology and Infection guidelines recommend ceftazidime 2g IV every 8 hours for carbapenem-resistant Pseudomonas aeruginosa infections 3
Monitoring and Precautions
- Duration of therapy: Generally continue for 2 days after signs and symptoms of infection have disappeared; complicated infections may require longer therapy 1
- Neurotoxicity risk: Ceftazidime has a lower relative pro-convulsive activity (17) compared to other beta-lactams like cefazolin (294) or cefepime (160) 3
- Therapeutic monitoring: Consider therapeutic drug monitoring in critically ill patients to ensure adequate drug exposure while avoiding toxicity 3
Important Clinical Considerations
Underdosing ceftazidime in renal impairment may lead to treatment failure. A recent study showed that dose reduction of ceftazidime/avibactam according to renal function in patients with KPC-producing Klebsiella pneumoniae bloodstream infection was independently associated with higher mortality 4
When calculating creatinine clearance for dosing adjustments, use the Cockcroft-Gault equation 1:
- Males: Creatinine clearance (mL/min) = Weight (kg) × (140 - age) ÷ (72 × serum creatinine [mg/dL])
- Females: 0.85 × male value
For patients with fluctuating renal function, frequent monitoring of creatinine clearance and appropriate dose adjustments are necessary to maintain therapeutic levels while minimizing toxicity risk 1, 5