Treatment of bone and joint infections caused by susceptible Staphylococcus aureus (oxacillin-susceptible strains only) Klebsiella, or Pseudomonas aeruginosa.
Intra-abdominal and Gynecologic Infections
Treatment of gynecologic infections (including endometritis, pelvic cellulitis, other infections of the female genital tract) caused by susceptible Escherichia coli.
Treatment of intra-abdominal infections (including peritonitis) caused by susceptible S. aureus (oxacillin-susceptible strains only), E. coli, or Klebsiella.
Treatment of polymicrobial intra-abdominal infections caused by susceptible aerobic and anaerobic bacteria and Bacteroides. Consider that many strains of B. fragilis are resistant; generally should not be used alone in serious intra-abdominal infections when this organism may be involved.
Meningitis and Other CNS Infections
Treatment of meningitis caused by susceptible H. influenzae, Neisseria meningitidis, Ps. aeruginosa, or Streptococcus pneumoniae in adults or children.
Ceftazidime in conjunction with an aminoglycoside considered a regimen of choice for treatment of meningitis caused by susceptible P. aeruginosa or susceptible Enterobacteriaceae† (e.g., E. coli, P. mirabilis, Enterobacter, S. marcescens).
Cefotaxime or ceftriaxone generally preferred when a third generation cephalosporin is indicated for treatment of meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae.
Respiratory Tract Infections
Treatment of respiratory tract infections (including pneumonia) caused by susceptible S. aureus (oxacillin-susceptible [methicillin-susceptible] strains only), S. pneumoniae, Citrobacter, Enterobacter, E. coli, Klebsiella, Proteus mirabilis, Pseudomonas (including Ps. aeruginosa), or Serratia.
For treatment of community-acquired pneumonia (CAP) caused by Ps. aeruginosa, ATS and IDSA recommend a combination regimen that includes an antipseudomonal β-lactam (cefepime, ceftazidime, aztreonam, imipenem, meropenem, piperacillin, ticarcillin) given in conjunction with ciprofloxacin, levofloxacin, or an aminoglycoside.
Septicemia
Treatment of septicemia caused by susceptible S. aureus (oxacillin-susceptible strains only), S. pneumoniae, Haemophilus influenzae, E. coli, Klebsiella, Ps. aeruginosa, or Serratia.
Skin and Skin Structure Infections
Treatment of skin and skin structure infections caused by susceptible S. aureus (oxacillin-susceptible strains only), S. pyogenes (group A β-hemolytic streptococci), Enterobacter, E. coli, Klebsiella, Proteus (including P. mirabilis), Ps. aeruginosa, or Serratia.
Urinary Tract Infections (UTIs)
Treatment of uncomplicated and complicated UTIs caused by susceptible Enterobacter, E. coli, Klebsiella, Proteus (including P. mirabilis), Ps. aeruginosa, or Serratia.
Burkholderia Infections
Treatment of septicemia or pulmonary infections caused by Burkholderia cepacia† (formerly Ps. cepacia); alone or in conjunction with an aminoglycoside. Co-trimoxazole considered drug of choice; ceftazidime, chloramphenicol, or imipenem are alternatives.
Treatment of severe melioidosis† caused by B. pseudomallei (formerly Ps. pseudomallei). Localized or mild disease may be effectively treated with a prolonged regimen of oral anti-infectives (e.g., co-trimoxazole with or without doxycycline). Severe illness usually treated with an initial parenteral regimen of ceftazidime, imipenem, or meropenem (some clinicians recommend that co-trimoxazole also be included, especially if the patient is septicemic) followed by prolonged maintenance with oral anti-infectives (e.g., co-trimoxazole with or without doxycycline). B. pseudomallei is difficult to eradicate (relapse of melioidosis is common). a
Otitis Externa
Treatment of malignant otitis externa† caused by Ps. aeruginosa.
Acute bacterial otitis externa localized in the external auditory canal may be effectively treated using topical anti-infectives (e.g., otic preparations of ciprofloxacin or ofloxacin), but malignant otitis externa is an invasive, potentially life-threatening infection (especially in immunocompromised patients such as those with diabetes mellitus or HIV infection) and requires prompt diagnosis and long-term treatment with parenteral anti-infectives (e.g., ceftazidime and/or ciprofloxacin).
Pseudomonas aeruginosa Infections
Generally considered a drug of choice for treatment of infections caused by Ps. aeruginosa, including acute exacerbations of bronchopulmonary Ps. aeruginosa infections in children and adults with cystic fibrosis.
In severe infections, especially in immunocompromised patients, concomitant use of ceftazidime and an aminoglycoside (e.g., amikacin, gentamicin, tobramycin) is recommended. Consider that ceftazidime-resistant strains of Ps. aeruginosa can emerge during therapy and superinfection with resistant strains has occurred.
Anti-infective therapy in patients with cystic fibrosis may result in clinical improvement and Ps. aeruginosa may be temporarily cleared from the sputum, but a bacteriologic cure is rarely obtained and should not be expected.
Vibrio Infections
Treatment of infections caused by Vibrio vulnificus†.
Optimum anti-infective therapy has not been identified; a tetracycline or third generation cephalosporin (e.g., cefotaxime, ceftazidime) is recommended. Because the case fatality rate associated with V. vulnificus is high, initiate anti-infective therapy promptly if indicated.
Empiric Therapy in Febrile Neutropenic Patients
Empiric treatment of presumed bacterial infections in febrile neutropenic adults or children†. Has been used alone or in conjunction with an aminoglycoside (e.g., amikacin, gentamicin, tobramycin).
Consider that gram-positive bacteria have become a predominant pathogen in febrile neutropenic patients and that ceftazidime is less active against gram-positives than many other cephalosporins and β-lactam antibiotics. An anti-infective active against staphylococci (e.g., vancomycin) probably should be used concomitantly if ceftazidime is used for empiric therapy.
Consult published protocols for the treatment of infections in febrile neutropenic patients for specific recommendations regarding selection of the initial empiric regimen, when to change the initial regimen, possible subsequent regimens, and duration of therapy in these patients. Consultation with an infectious disease expert knowledgeable about infections in immunocompromised patients also is advised.
Other cephalosporins or cephamycins (cefazolin, cefotetan, cefoxitin) are preferred drugs for perioperative prophylaxis. Ceftazidime and other third generation cephalosporins usually not used for perioperative prophylaxis since they are expensive, some are less active against staphylococci than cefazolin, they have a spectrum of activity wider than necessary for organisms encountered in elective surgery, and their use for prophylaxis promotes emergence of resistant organisms.
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