What is the recommended dilution fluid for ceftazidime (Ceftazidime) and avibactam (Avibactam)?

Recommended Dilution Fluids for Ceftazidime-Avibactam

Ceftazidime-avibactam should be constituted and diluted using 0.9% sodium chloride injection, 5% dextrose injection, combinations of dextrose and sodium chloride (up to 2.5% dextrose with 0.45% sodium chloride), or lactated Ringer's injection; sterile water for injection may be used for constitution only but must not be used as the final dilution fluid. 1

Constitution Process

• First, constitute the powder by adding 10 mL of one of the following solutions to the vial: sterile water for injection, 0.9% sodium chloride injection, 5% dextrose injection, combinations of dextrose and sodium chloride (up to 2.5% dextrose with 0.45% sodium chloride), or lactated Ringer's injection 1

• Mix gently until completely dissolved to achieve a ceftazidime concentration of approximately 167 mg/mL and avibactam concentration of approximately 42 mg/mL (total volume approximately 12 mL) 1

• The constituted solution is NOT for direct injection and must be further diluted before intravenous infusion 1

• The constituted solution may be held for no longer than 30 minutes prior to transfer and dilution in an infusion bag 1

Dilution for Infusion

• Withdraw the appropriate volume from the constituted vial and dilute further with the same diluent used for constitution (except sterile water for injection) 1

• Critical caveat: If sterile water for injection was used for constitution, you must use any of the other appropriate diluents (0.9% sodium chloride, 5% dextrose, dextrose-sodium chloride combinations, or lactated Ringer's) for the final dilution step 1

• The final diluted concentration should be 8-40 mg/mL ceftazidime and 2-10 mg/mL avibactam in the infusion bag 1

• The dilution volume should be 50-250 mL, with the 250 mL volume reserved only for the 2.5 gram dose 1

Compatible Diluent Options Summary

The following diluents are compatible for both constitution and dilution 1:

• 0.9% sodium chloride injection (normal saline)
• 5% dextrose injection
• Dextrose-sodium chloride combinations (up to 2.5% dextrose with 0.45% sodium chloride)
• Lactated Ringer's injection

Storage After Dilution

• Use the diluted solution within 12 hours when stored at room temperature 1

• Alternatively, refrigerate at 2-8°C (36-46°F) for up to 24 hours, then use within 12 hours of subsequent storage at room temperature 1

• Visually inspect the diluted solution before administration; the color should range from clear to light yellow 1

Administration Details

• Administer as a 2-hour intravenous infusion every 8 hours for the standard 2.5 gram dose 2, 1

• For complicated intra-abdominal infections, ceftazidime-avibactam should be given concurrently with metronidazole 500 mg IV every 6-8 hours 3, 2