Ceftazidime-avibactam

(Avycaz®)

Avycaz®

Drug updated on 5/17/2024

Dosage FormInjection (intravenous; 2 g ceftazidime [equivalent to 2.635 grams of ceftazidime pentahydrate/sodium carbonate powder] and 0.5 g avibactam [equivalent to 0.551 grams of avibactam sodium])
Drug ClassAntibacterials
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated for the treatment of complicated intra-abdominal infections (cIAI), used in combination with metronidazole, in adult and pediatric patients (at least 31 weeks gestational age), caused by designated susceptible Gram-negative microorganisms.
  • Indicated for the treatment of complicated urinary tract infections (cUTI), including pyelonephritis, in adult and pediatric patients (at least 31 weeks gestational age), caused by designated susceptible Gram-negative microorganisms.
  • Indicated for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP), in adult and pediatric patients (at least 31 weeks gestational age), caused by designated susceptible Gram-negative microorganisms.

Summary
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  • Ceftazidime-avibactam (Avycaz) demonstrated superior clinical efficacy compared to polymyxins in treating carbapenem-resistant Enterobacteriaceae (CRE) infections, with significantly lower 30-day mortality rates, higher clinical cure rates, and higher microbial clearance rates.
  • The safety profile of ceftazidime-avibactam is comparable to that of polymyxin regarding renal toxicity, as the incidence rate for acute kidney injury was similar between patients receiving both drugs.
  • In treating complicated intra-abdominal infections (cIAI), cefepime plus metronidazole showed optimal empirical treatment effectiveness. While different beta-lactam/beta-lactamase inhibitor combinations including ceftazidime-avibactam present potential benefits, choices should consider specific patient risk profiles and microbial susceptibilities.
  • For complicated urinary tract infections (cUTIs), Avycaz, along with other novel antibiotics, offered higher clinical cure rates and microbiological eradication at test-of-cure compared to conventional antibiotics despite having similar adverse event rates.
  • Comparative studies between novel antibiotics like Avycaz and carbapenems for cIAIs did not exhibit significant differences in terms of clinical cure rates or adverse events, positioning it as a competitive alternative which can help reduce reliance on carbapenems thereby aiding antimicrobial stewardship efforts.
  • In renal patients, there's an indication that using ceftazidime-avibactam might lead to a slightly increased risk of mortality when dosage adjustments are made due to impaired kidney function, but this requires further investigation since baseline conditions could influence outcomes.
  • The use of Avycaz has been successful in real-world settings, especially when dealing with serious gram-negative bacterial infections such as CRE where options are limited; however, resistance emergence, while infrequent, is notable, particularly among KPC-producing Klebsiella pneumoniae strains, necessitating vigilant monitoring.
  • When compared with other beta-lactam/beta-lactamase inhibitors like ceftolozane-tazobactam, Avycaz did not show significant differences in treating cIAIs, but nuanced differences might emerge when dealing with specific pathogens or patient subgroups. These findings are based on a review of 13 systematic reviews and meta-analyses.

Product Monograph / Prescribing Information

Document TitleYearSource
Avycaz (ceftazidime and avibactam) Prescribing Information.2024Allergan USA Inc., Madison, NJ

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Ceftazidime–avibactam versus polymyxins in treating patients with carbapenem resistant enterobacteriaceae infections: a systematic review and meta analysis.2024Infection
Efficacy, safety, and tolerability of antimicrobial agents for complicated intra-abdominal infection: a systematic review and network meta-analysis.2023BMC Infectious Diseases
Comparing novel antibiotics and carbapenems for complicated intra-abdominal infections: a systematic review and meta-analysis of randomized controlled trials.2023International Journal of Antimicrobial Agents
Clinical efficacy and safety of novel antibiotics for complicated urinary tract infection: a systematic review and meta-analysis of randomized controlled trials.2023International Journal of Antimicrobial Agents
Efficacy and safety of ceftazidime– avibactam versus polymyxins in the treatment of carbapenem-resistant enterobacteriaceae infection: a systematic review and meta-analysis.2023BMJ Open
The efficacy and safety of eravacycline compared with current clinically common antibiotics in the treatment of adults with complicated intra-abdominal infections: a Bayesian network meta-analysis.2022Frontiers in Medicine
Are there differences between ceftolozane/tazobactam and ceftazidime/avibactam in treating patients with complicated abdominal infections? Evidence from clinical trials.2022Journal of Chemotherapy
Clinical efficacy of renal dosing adjustments of ceftazidime–avibactam in patients affected by carbapenem-resistant gram-negative infections: a systematic review and meta-analysis of observational studies.2022British Journal of Clinical Pharmacology
Ceftazidime-avibactam for the treatment of serious gram-negative infections with limited treatment options: a systematic literature review.2022Infectious Diseases and Treatment
The revival of aztreonam in combination with avibactam against metallo-β-lactamase-producing gram-negatives: a systematic review of in vitro studies and clinical cases.2021Antibiotics
Meta-analysis of clinical outcomes using ceftazidime/avibactam, ceftolozane/tazobactam, and meropenem/vaborbactam for the treatment of multidrug-resistant gram-negative infections.2021Open Forum Infectious Diseases
Choosing optimal antibiotics for the treatment of patients infected with enterobacteriaceae: a network meta-analysis and cost-effectiveness analysis.2021Frontiers in Pharmacology
Novel beta-lactam/beta-lactamase plus metronidazole vs carbapenem for complicated intra-abdominal infections: a meta-analysis of randomized controlled trials.2021Open Forum Infectious Diseases

Clinical Practice Guidelines