Adult outpatient parenteral antimicrobial therapy (OPAT) good practice prescribing guide

Ceftazidime

Ceftazidime is a cephalosporin antibacterial that is licensed for many different indications including hospital acquired pneumonia, broncho-pulmonary infections in cystic fibrosis, complicated urinary tract, skin and soft tissue and intra-abdominal infections and peritonitis.

This guide shares practical experience on the use of ceftazidime in an OPAT setting. To create the guidance, we took an evidence based approach. We also used expert consensus and practical experience from across NHS Scotland.

This drug summary does not provide specific treatment guidelines. Individual patient treatment should take into account the core principles of antimicrobial stewardship. This includes selection of the appropriate antimicrobial for the shortest duration with oral therapy being preferred, whenever possible.

For information on Route and method of administration, Contraindications, Cautions and adverse effects and Drug interactions please refer to the following approved resources:

These resources also have more information on licensed indication, use in pregnancy and use in breast feeding. When using unlicensed medicines, and/or off-label doses or indications, follow local health board governance processes. 

The use of broad spectrum antibiotics is associated with an increased risk of Clostridioides difficile infection (CDI).  Please monitor patient for new loose stools.  If suspicion of CDI send stool sample to microbiology for analysis.

It is strongly recommended that OPAT services in Scotland adhere to the Key performance indicators for the management of patients in an outpatient parenteral antimicrobial therapy (OPAT) setting.

Ceftazidime

1. Indication and dose

Licensed indication(s) in the OPAT setting Dose
Malignant otitis externa 2g 8 hourly*

 

Off-label indications in the OPAT setting Dose
Infective exacerbation of bronchiectasis 2g 8 hourly*
Deep seated Gram negative infection (sensitive to ceftazidime) 2g 8 hourly*

*Note: 3g slow IV injection 12 hourly is not recommended in patients with normal renal function as it does not provide an optimal pharmacodynamic profile.

Ceftazidime cannot be infused as a continuous infusion over 24 hours as it is unstable. However, the total daily dose of 6g in 24 hours may be administered as two continuous infusions of 3g 12 hourly. See BSAC OPAT Publications (e-opat.com)

2. Dose adjustments

2a. Renal impairment

Renal function (Creatinine Clearance CrCl) ml/min Dosage adjustment Dosage interval
31-50  2g 12 hourly
16-30 2g 24 hourly
6-15  1g 24 hourly
less than 6 1g 48 hourly
Haemodialysis If receiving regular three times weekly haemodialysis (eg Mon, Wed, Fri) give 1g three times a week at the end of dialysis session
Irregular haemodialysis or other renal replacement therapy Seek advice from pharmacy


2b. Other dosage adjustments

Patient characteristic Dose advice
Hepatic impairment No dose adjustment necessary
Obesity No dose adjustment necessary


3. Monitoring requirements

Frequency Recommended monitoring
Baseline Urea and Electrolytes (U&Es), liver function tests (LFTs), C-reactive protein (CRP) and full blood count (FBC)

Weekly monitoring
(Note this may be more frequent if clinically necessary)

 U&Es, LFTs, CRP and FBC
Therapeutic drug monitoring No therapeutic drug monitoring required
Follow up Ensure follow up arranged with referring speciality and/ or completed with an infection specialist


For the use of other antibiotics in an OPAT setting please refer to the SAPG website

 

 Scottish Antimicrobial Prescribing Group (SAPG) | January 2024 for review January 2027

 

Content updated: April 2024