What is the recommended adult dose of Ceftazidime (Ceftazidime) for patients with normal and impaired renal function?

Recommended Adult Dosing of Ceftazidime

The standard adult dose of ceftazidime for patients with normal renal function is 1 gram intravenously every 8 to 12 hours, with adjustments based on infection severity and renal function. 1

Standard Dosing for Normal Renal Function

• The usual adult dosage is 1 gram administered intravenously or intramuscularly every 8 to 12 hours 1
• For more severe infections, dosing should be adjusted as follows:
  • 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 and 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
  • Pseudomonas lung infections in cystic fibrosis patients: 30-50 mg/kg IV up to maximum of 6 grams per day, given every 8 hours 1

Dosing in Renal Impairment

Ceftazidime is primarily eliminated by the kidneys through glomerular filtration, making dose adjustment essential in patients with renal impairment 1, 2:

• Creatinine clearance 50-31 mL/min: 1 gram every 12 hours 1
• Creatinine clearance 30-16 mL/min: 1 gram every 24 hours 1
• Creatinine clearance 15-6 mL/min: 500 mg every 24 hours 1
• Creatinine clearance less than 5 mL/min: 500 mg every 48 hours 1

For patients with severe infections who would normally receive higher doses (e.g., 6 grams daily), the unit dose may be increased by 50% or the dosing frequency may be increased appropriately, with careful monitoring 1.

Special Considerations

Hemodialysis Patients

• Loading dose of 1 gram followed by 1 gram after each hemodialysis session 1
• During hemodialysis, the mean half-life of ceftazidime is approximately 4.7 hours 3

Peritoneal Dialysis

• Loading dose of 1 gram followed by 500 mg every 24 hours 1
• Can be incorporated into dialysis fluid at a concentration of 250 mg per 2 L of dialysis fluid 1

Important Monitoring Considerations

• When using ceftazidime in patients with renal impairment, careful monitoring of renal function is essential 2, 3
• Recent evidence suggests that renal-adjusted dosing of ceftazidime may be associated with higher mortality in certain severe infections, suggesting that in some cases, higher doses with careful monitoring may be warranted 4

Duration of Therapy

• Generally, ceftazidime should be continued for 2 days after the signs and symptoms of infection have disappeared 1
• For complicated infections, longer therapy may be required 1

Administration Routes

• May be given intravenously or by deep intramuscular injection into a large muscle mass 1
• Intra-arterial administration should be avoided 1

Remember that dosing should be based on the severity of infection, the susceptibility of the causative organism, and the patient's clinical condition, with particular attention to renal function.