Ceftazidime Dosing Recommendations
Standard Adult Dosing with Normal Renal Function
For adults with normal renal function, the usual recommended dose of ceftazidime is 1 gram IV or IM every 8 to 12 hours, with higher doses of 2 grams every 8 hours reserved for severe infections including meningitis, serious gynecologic and intra-abdominal infections, and very severe life-threatening infections in immunocompromised patients. 1
Infection-Specific Dosing for Adults:
- Uncomplicated urinary tract infections: 250 mg every 12 hours 1
- Complicated urinary tract infections: 500 mg every 8 to 12 hours 1
- Uncomplicated pneumonia and mild skin/soft tissue infections: 500 mg to 1 gram every 8 hours 1
- Bone and joint infections: 2 grams every 12 hours 1
- Serious gynecologic and intra-abdominal infections: 2 grams every 8 hours 1
- Meningitis: 2 grams every 8 hours 1
- Very severe life-threatening infections (especially immunocompromised): 2 grams every 8 hours 1
- Pseudomonas lung infections in cystic fibrosis (normal renal function): 30 to 50 mg/kg (maximum 6 grams/day) every 8 hours 1
Special Considerations for Severe Infections:
- For carbapenem-resistant Pseudomonas aeruginosa susceptible to ceftazidime: Use 2 grams IV every 8 hours for 5-14 days (longer courses of 10-14 days for pneumonia and bloodstream infections) 2
- For severe infections in patients with normal renal function and augmented renal clearance: Extended infusion duration of 3-4 hours may be necessary to achieve optimal pharmacodynamic targets 3
Pediatric Dosing with Normal Renal Function
For pediatric patients (1 month to 12 years), the recommended dose is 30 to 50 mg/kg IV every 8 hours, with a maximum of 6 grams per day. 1
Age-Specific Pediatric Dosing:
- Neonates (0-4 weeks): 30 mg/kg IV every 12 hours 1
- Infants and children (1 month-12 years): 30 to 50 mg/kg IV every 8 hours (maximum 6 grams/day) 1
- Higher doses (50 mg/kg) should be reserved for immunocompromised pediatric patients, those with cystic fibrosis, or meningitis 1
Renal Impairment Dosing Adjustments
Ceftazidime is excreted almost exclusively by glomerular filtration, requiring dose reduction in patients with impaired renal function (GFR <50 mL/min). 1
Initial Loading Dose:
- Give 1 gram loading dose in patients with suspected renal insufficiency before adjusting to maintenance dosing 1
Maintenance Dosing Based on Creatinine Clearance:
| Creatinine Clearance (mL/min) | Recommended Dose | Frequency |
|---|---|---|
| 50-31 | 1 gram | Every 12 hours |
| 30-16 | 1 gram | Every 24 hours |
| 15-6 | 500 mg | Every 24 hours |
| <5 | 500 mg | Every 48 hours |
Critical Dosing Principles for Renal Impairment:
- If the dose recommended for the specific infection is lower than the renal adjustment dose, use the lower dose 1
- For severe infections requiring 6 grams daily in normal renal function: Increase the unit dose by 50% or increase dosing frequency appropriately, guided by therapeutic monitoring 1
- Dosing intervals should be extended rather than reducing individual doses to maintain adequate peak concentrations 4, 5
Alternative Renal Function-Based Recommendations:
Research supports the following intervals based on creatinine clearance 4:
- ClCr >50 mL/min: Every 8 hours
- ClCr 30-50 mL/min: Every 12 hours
- ClCr 15-30 mL/min: Every 24 hours
- ClCr <15 mL/min: Every 36-48 hours
Hemodialysis Dosing
For patients undergoing hemodialysis, give a 1 gram loading dose followed by 1 gram after each hemodialysis session. 1
Key Hemodialysis Considerations:
- Ceftazidime is significantly removed by hemodialysis with a mean elimination half-life of 4.7 hours during dialysis 5
- Post-dialysis dosing of 1 gram is effective and safe for achieving pharmacodynamic targets over 48- and 72-hour interdialytic intervals for pathogens with MICs ≤8 mg/L 6
- The 2 gram post-dialysis dose is equally effective but may not be necessary for most patients 6
- Administer the dose after dialysis to avoid premature drug removal 1
Peritoneal Dialysis Dosing
For patients on intraperitoneal dialysis or continuous ambulatory peritoneal dialysis (CAPD), give a 1 gram loading dose followed by 500 mg every 24 hours. 1
Alternative Administration:
- Ceftazidime can be incorporated into dialysis fluid at a concentration of 250 mg per 2 liters of dialysis fluid 1
- For chronic peritoneal dialysis: Loading dose of 10 mg/kg followed by continuous administration of 5 mg/kg into each dialysis cavity 7
Monitoring and Safety Considerations
Neurotoxicity Monitoring:
- Monitor for neurotoxicity including seizures, encephalopathy, and confusion, particularly in patients with renal impairment where drug accumulation can occur 2
- Risk increases with accumulation in renal failure patients 4, 7, 5
Duration of Therapy:
- Continue ceftazidime for 2 days after signs and symptoms of infection have disappeared, but complicated infections may require longer therapy 1
- For pneumonia and bloodstream infections caused by resistant organisms: Use 10-14 day courses 2
Common Pitfalls to Avoid:
- Do not reduce individual doses below recommended levels in renal impairment; instead extend the dosing interval to maintain concentration-dependent killing 4, 5
- Do not administer before hemodialysis as this leads to premature drug removal and subtherapeutic levels 6
- Do not use standard dosing in patients with creatinine clearance <50 mL/min without adjustment 1, 4
No Hepatic Adjustment Required
No dosage adjustment is necessary for patients with hepatic dysfunction alone. 1