Dose:     30 mg/kg/dose IV or IM    

Frequency:     Q 12 hours if < 1.2 kg and 0 to 4 weeks
                         Q 12 hours if 1.2 to 2 kg and 0 to 1 week
                         Q    8 hours if 1.2 to 2 kg and > 1 week
                         Q    8 hours if > 2 kg and < 1 week
                         Q    6 hours if > 2 kg and > 1 week 

Comments:   Aztreonam  is a monobactam antibiotic.  It has a similar antimicrobial spectrum to that of gentamicin and tobramycin (antimicrobial activity can be demonstrated against most Enterobacteriaceae. It does not induce beta-lactamase and is generally active against gram negative aerobic organisms that are resistant to antibiotics hydrolyzed by beta-lactamase. Its antimicrobial spectrum includes E. coli, Enterobacter species, Klebsiella pneumonia and K. oxytoca, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenza, and Citrobacter species. It does not appear to have any renal toxicity. Experience with this drug in infants is limited.  Further comments on aztreonam.

Toxicity:  Local reactions at the site of injection are the most commonly reported adverse effects (< 2%) followed by diarrhea, nausea, vomiting, or skin rash. Other systemic reactions were much rarer and included pseudomembranous colitis, hypotension, transient EKG changes, hepatitis (elevations of SGOT, SGPT, alkaline phosphatase, bilirubin), CNS disturbances, pancytopenia, anemia, neutropenia, leukocytosis. thrombocytopenia, thrombocytosis,   and petechiae (Mayo Clin Proc 1991; 66:1152-1157).

Preparation: Aztreonam (Azactam) is supplied in a 2 gram vial. Using sterile water for injection (preferred), D5W, D10W, LR, or NS, add 100 ml to 2.0 grams of aztreonam to make a solution with a concentration of 20 mg/ml. Twenty milliliters of this preparation can be transferred to 5 separate vials (400 mg/20 ml) which can be stored under refrigeration for up to 7 days. Each vial is stable for 24 hours if refrigerated after punctured unless it has been constituted using a dextrose solution. If mixed in dextrose solution, stability is decreased to 2 hours in room temperature, 8 hours if refrigerated. May be infused over 3 to 5 minutes.

Compatibility: Compatible with TPN, but compatibility with filter is unknown. Compatible with D5W, NS, and sterile water for injection. It is also compatible with allopurinol, amikacin, aminophylline, bumetanide, calcium gluconate, cefazolin, ceftazidime, ceftriaxone, clindamycin, dexamethasone, dobutamine, dopamine, enalaprilat, famotidine, filgrastim, fluconazole, furosemide, gentamicin, heparin, hydrocortisone, insulin, metoclopramide, mezlocillin, morphine, piperacillin, piperacillin-tazobactam, ranitidine, sodium bicarbonate, ticarcillin, trimethoprim-sulfamethoxazole, tobramycin, vancomycin (at concentrations of < 1 gm/L), and zidovudine. Aztreonam is known to be incompatible with acyclovir, amphotericin, lorazepam, metronidazole, nafcillin and metronidazole. It is equivocally compatible with ampicillin.