Ceftazidime Contraindications
The only absolute contraindication to ceftazidime is known hypersensitivity to ceftazidime or other cephalosporin antibiotics. 1
Absolute Contraindication
- Hypersensitivity to ceftazidime or any cephalosporin antibacterial drug is the sole FDA-labeled contraindication. 1
Critical Cross-Reactivity Considerations with Penicillin Allergy
While not an absolute contraindication, penicillin allergy requires careful assessment due to potential cross-reactivity:
Low Risk Profile of Ceftazidime
Ceftazidime has a unique R1 side chain structure that results in very low cross-reactivity with penicillins, making it one of the safer cephalosporins for patients with penicillin allergies. 2
Among patients with confirmed penicillin allergy, the cross-reactivity rate to low-similarity cephalosporins (including ceftazidime) is only 2.11% (95% CI: 0.98-4.46%). 2
Ceftazidime shares R1 side chains with ceftizoxime, cefepime, cephaloridine, and cefonicid, but not with common penicillins like amoxicillin or ampicillin. 2
When Penicillin Allergy is Present
For patients with nonanaphylactic penicillin allergy history: Ceftazidime can be administered via direct drug challenge without skin testing, given the dissimilar R1 side chains. 2
For patients with anaphylactic penicillin allergy history: Perform cephalosporin skin testing with ceftazidime at nonirritating concentrations (100 mg/mL for prick/puncture, 1 mg/mL and 10 mg/mL for intradermal testing) before parenteral administration. 2
- A negative skin test should be followed by a drug challenge to confirm tolerance. 2
- A positive skin test indicates drug-specific IgE antibodies; use an alternative antibiotic or perform desensitization. 2
Important Caveats
Do not apply these cross-reactivity guidelines to patients with severe delayed immunologic reactions or organ-specific reactions to beta-lactams, including:
- Stevens-Johnson syndrome or toxic epidermal necrolysis 2
- Hemolytic anemia 2
- Drug-induced liver injury 2
- Acute interstitial nephritis 2
These patients require alternative non-beta-lactam antibiotics entirely. 2