▶Child 12–17 years: 2 g every 6 – 8 hours
Chronic pulmonaryPseudomonas aeruginosainfection in
patients with cystic fibrosis
▶BY INHALATION OF NEBULISED SOLUTION
▶Child 6–17 years: 75 mg 3 times a day for 28 days, doses
to be administered at least 4 hours apart, subsequent
courses repeated after 28 -day interval without
aztreonam nebuliser solutionlUNLICENSED USEInjection not licensed for use in children
under 7 days.
lCAUTIONS
▶When used by inhalationHaemoptysis—risk of further
haemorrhage
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonDyspnoea.respiratory disorders
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶When used by inhalationCough.haemoptysis.joint
disorders.laryngeal pain.nasal complaints.rash
▶Rare or very rare
▶With parenteral useAnaemia.asthenia.breast tenderness.
chest pain.confusion.diplopia.dizziness.eosinophilia.
haemorrhage.headache.hepatic disorders.hypotension.
insomnia.leucocytosis.myalgia.nasal congestion.
neutropenia.oral disorders.pancytopenia.paraesthesia.
pseudomembranous enterocolitis.seizure.
thrombocytopenia.thrombocytosis.tinnitus.vertigo.
vulvovaginal candidiasis
▶Frequency not known
▶With parenteral useAbdominal pain.angioedema.
diarrhoea.nausea.skin reactions.taste altered.toxic
epidermal necrolysis.vomiting
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
aztreonam hypersensitivity.
Use with caution in patients with hypersensitivity to
other beta-lactam antibiotics (although aztreonam may be
less likely than other beta-lactams to cause
hypersensitivity in penicillin-sensitive patients).
lPREGNANCY
▶With intravenous useNo information available;
manufacturer of injection advises avoid.
▶When used by inhalationNo information available;
manufacturer of powder for nebuliser solution advises
avoid unless essential.
lBREAST FEEDINGAmount in milk probably too small to be
harmful.
lHEPATIC IMPAIRMENTUse injection with caution.
Monitoring▶With intravenous useMonitor liver function.
lRENAL IMPAIRMENT
Dose adjustments▶With intravenous useIf estimated
glomerularfiltration rate 10 – 30 mL/minute/ 1. 73 m^2 , usual
initial dose of injection, then half normal dose. If
estimated glomerularfiltration rate less than
10 mL/minute/ 1. 73 m^2 , usual initial dose of injection, then
one-quarter normal dose.
lMONITORING REQUIREMENTS
▶When used by inhalationMeasure lung function before and
after initial dose of aztreonam and monitor for
bronchospasm.
lDIRECTIONS FOR ADMINISTRATION
;▶With intravenous useForintravenous injection, give over
3 – 5 minutes. Displacement value of injection may be
significant, consult local guidelines. For intermittent
intravenous infusion, dilute reconstituted solution further
in Glucose 5 %orSodium chloride 0. 9 % to a concentration
of less than 20 mg/mL; to be given over 20 – 60 minutes.
▶When used by inhalationOther inhaled drugs should be
administered before aztreonam; a bronchodilator should
be administered before each dose.
lNATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (December
2014 ) that aztreonam powder for nebuliser solution
(Cayston®) is accepted for restricted use within NHS
Scotland when inhaled colistimethate sodium and inhaled
tobramycin are not tolerated or are not providing
satisfactory therapeutic benefit (measured as 2 % decline
in forced expiratory volume in 1 second).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder and solvent for nebuliser solution
▶Cayston(Gilead Sciences International Ltd)
Aztreonam (as Aztreonam lysine) 75 mgCayston 75 mg powder
and solvent for nebuliser solution vials with Altera Nebuliser Handset
| 84 vialP£ 2 , 181. 53
Powder for solution for injection
▶Azactam(Bristol-Myers Squibb Pharmaceuticals Ltd)
Aztreonam 1 gramAzactam 1 g powder for solution for injection vials
| 1 vialP£ 9. 40 (Hospital only)
Aztreonam 2 gramAzactam 2 g powder for solution for injection vials
| 1 vialP£ 18. 82 (Hospital only)ANTIBACTERIALS›NITROIMIDAZOLE
DERIVATIVESMetronidazole
lDRUG ACTIONMetronidazole is an antimicrobial drug with
high activity against anaerobic bacteria and protozoa.lINDICATIONS AND DOSE
Anaerobic infections
▶BY MOUTH
▶Child 1 month: 7. 5 mg/kg every 12 hours usually treated
for 7 days (for 10 – 14 days inClostridium difficile
infection)
▶Child 2 months–11 years: 7. 5 mg/kg every 8 hours (max.
per dose 400 mg) usually treated for 7 days (for
10 – 14 days inClostridium difficileinfection)
▶Child 12–17 years: 400 mg every 8 hours usually treated
for 7 days (for 10 – 14 days inClostridium difficile
infection)
▶BY RECTUM
▶Child 1–11 months: 125 mg 3 times a day for 3 days, then
125 mg twice daily, for usual total treatment duration
of 7 days
▶Child 1–4 years: 250 mg 3 times a day for 3 days, then
250 mg twice daily, for usual total treatment duration
of 7 days
▶Child 5–9 years: 500 mg 3 times a day for 3 days, then
500 mg twice daily, for usual total treatment duration
of^7 days
▶Child 10–17 years: 1 g 3 times a day for 3 days, then 1 g
twice daily, for usual total treatment duration of 7 days
▶BY INTRAVENOUS INFUSION
▶Neonate up to 26 weeks corrected gestational age:Loading
dose 15 mg/kg, followed by 7. 5 mg/kg after 24 hours,
then 7. 5 mg/kg daily usually treated for a total duration
of 7 days (for 10 – 14 days inClostridium difficile
infection).▶Neonate 26 weeks to 34 weeks corrected gestational age:
Loading dose 15 mg/kg, followed by 7. 5 mg/kg after
12 hours, then 7. 5 mg/kg every 12 hours usually treated
for a total duration of 7 days (for 10 – 14 days in
Clostridium difficileinfection).
continued→BNFC 2018 – 2019 Bacterial infection 333
Infection5