Ceftazidime with avibactam
Brand names: Zavicefta
Ceftazidime with avibactam is a fixed-dose intravenous antibiotic combining an anti-pseudomonal cephalosporin with the inhibitor avibactam, indicated for complicated intra-abdominal and urinary tract infections, hospital-acquired pneumonia and infections by aerobic Gram-negative organisms with limited treatment options.
Adult dose
Paediatric dose
Dose adjustments
Adults with estimated CrCl 50 mL/min or less (Cockcroft-Gault), all doses infused over 2 hours: CrCl 31-50 mL/min — 1 g/0.25 g every 8 hours; CrCl 16-30 mL/min — 0.75 g/0.1875 g every 12 hours; CrCl 6-15 mL/min — every 24 hours; end-stage renal disease including on haemodialysis — every 48 hours. (In the flattened SPC table the dose 0.75 g/0.1875 g is stated once and spans the 16-30, 6-15 and end-stage renal disease rows — confirm against the SPC table before publishing.) These recommendations are based on pharmacokinetic modelling. Ceftazidime and avibactam are removed by haemodialysis. Close monitoring of estimated creatinine clearance is advised, since it can change quickly early in treatment; neurological sequelae (tremor, myoclonus, non-convulsive status epilepticus, convulsion, encephalopathy and coma) have been reported with ceftazidime when the dose was not reduced in renal impairment.
Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.
dosePerKg refers to the CEFTAZIDIME component — ceftazidime/avibactam is a fixed 4:1 combination and the SPC's dose recommendations are based on the ceftazidime component only; the matching avibactam dose is 12.5 mg/kg. UK SPC, paediatric patients with estimated CrCl greater than 50 mL/min/1.73 m2 (Schwartz bedside formula): 6 months to less than 18 years — 50 mg/kg / 12.5 mg/kg to a maximum of 2 g/0.5 g every 8 hours over 2 hours; 3 months to less than 6 months — 40 mg/kg / 10 mg/kg every 8 hours (limited experience). Less than 3 months (patients with serum creatinine at or below the upper limit of normal for age): full-term neonates and infants over 28 days to less than 3 months — 30 mg/kg / 7.5 mg/kg every 8 hours; birth to 28 days or less — 20 mg/kg / 5 mg/kg every 8 hours; preterm infants (less than 37 weeks gestation) over 44 to less than 53 weeks postmenstrual age — 30 mg/kg / 7.5 mg/kg every 8 hours; 31 to 44 weeks or less postmenstrual age — 20 mg/kg / 5 mg/kg every 8 hours; 26 to less than 31 weeks postmenstrual age — 20 mg/kg / 5 mg/kg every 12 hours (this band is based on pharmacokinetic modelling only). Durations as for adults (cIAI 5-14 days, cUTI 5-14 days, HAP/VAP 7-14 days). Patients studied from 3 to 12 months of age were full term (37 weeks gestation or more). Verify the paediatric regimen against a children's formulary before use.
Contraindications
- Hypersensitivity to the active substances or to any of the excipients
- Hypersensitivity to any cephalosporin antibacterial agent
- Severe hypersensitivity (e.g. anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent (e.g. penicillins, monobactams or carbapenems)
Side effects
- Coombs direct test positive (very common, and one of the three most common reactions occurring in at least 5% of patients)
- Nausea and diarrhoea (common; usually mild or moderate in intensity) — also vomiting and abdominal pain
- Candidiasis including vulvovaginal and oral candidiasis; eosinophilia, thrombocytosis (common)
- Headache, dizziness (common); rash maculo-papular, urticaria, pruritus (common)
- Serious/uncommon or rare — Clostridioides difficile colitis and pseudomembranous colitis, thrombocytopenia, neutropenia, leukopenia, anaphylactic reaction, acute kidney injury, tubulointerstitial nephritis, and (frequency not known) Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS, acute generalised exanthematous pustulosis and Kounis syndrome
Interactions
- Probenecid — inhibits OAT1/OAT3 uptake of avibactam by 56% to 70% in vitro and may decrease its elimination; co-administration is not recommended (US labelling; the UK SPC §4.5 was not captured in this bundle)
- Laboratory tests — ceftazidime may cause a false-positive urinary glucose reaction with some methods; use tests based on enzymatic glucose oxidase reactions. A positive direct Coombs test is a common finding on treatment
Clinical monograph
How it works
Ceftazidime binds penicillin-binding proteins to disrupt cell-wall synthesis while avibactam protects it from hydrolysis by serine beta-lactamases such as ESBLs, AmpC, KPC and OXA-48-type enzymes; it has no activity against metallo-beta-lactamases.
Prescribing in practice
- Use under specialist guidance for resistant Gram-negative infections, recognising it does not cover metallo-beta-lactamase-producing organisms, so susceptibility should guide therapy.
- Avoid in significant hypersensitivity to either component or other cephalosporins, with caution in broader beta-lactam allergy.
- Dose must be reduced in renal impairment as both components are renally eliminated.
Monitoring
Monitor renal function to guide dosing together with clinical and microbiological response and signs of Clostridioides difficile-associated diarrhoea.
Counselling the patient
- This is a hospital intravenous antibiotic reserved for serious resistant infections.
- Report new or worsening diarrhoea, rash, or breathing difficulty.
- Mention any previous penicillin or cephalosporin allergy.
Evidence & guidelines
Its licensed indications are supported by the phase 3 RECLAIM, RECAPTURE and REPROVE trials in intra-abdominal, urinary and nosocomial pneumonia infections.
Reference: NICE TA836; BSAC; UKHSA AMR; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- MAGGIC Heart Failure Risk Score · Heart Failure
- Long QT Syndrome (Schwartz Score) · Channelopathy / Sudden Cardiac Death
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- C-Peptide to Glucose Ratio · Diabetes Classification
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023