Food and Drug Administration (FDA) approval has been given to a new drug that combines ceftazidime, a cephalosporin, with a new beta-lactamase inhibitor, avibactam. The fixed-combination drug is sold under the trade name of Avycaz. The avibactam component of Avycaz helps to prevent the ceftazidime from being broken down by certain beta-lactamases. Avycaz is the fifth new antibiotic developed since the U.S. Congress passed the Generating Antibiotic Incentives Now Act of 2011.
When used in combination with metronidazole, Avycaz is approved to treat complicated intraabdominal infections caused by the following organisms: Escherichia coli, Klebsiella pneumoniae, K. oxytoca, Proteus mirabilis, Providencia stuartii, Enterobacter cloacae, and Pseudomonas aeruginosa. As monotherapy Avycaz is approved to treat complicated urinary tract infections, including pyelonephritis, caused by these organisms: E. coli; K. pneumoniae; Citrobacter koseri; E. aerogenes; E. cloacae; C. freundii; P. aeruginosa; and a grouping of Proteus pathogens that includes P. mirabilis, P. vulgaris, P. penneri, and P. hauseri.
Avycaz is given as an intermittent iv infusion. Its most common adverse effects are nausea, vomiting, constipation, and anxiety. The drug also carries risks of hypersensitivity reaction; Clostridium difficile–associated diarrhea (as with most antibiotics); and seizures or other neurologic events, especially in patients with impaired renal function. The dosage must be decreased when the creatinine clearance is low, even though Avycaz's efficacy has been shown to be impaired in patients with a creatinine clearance between 30 and 50 mL/min.
To help minimize the risk of bacterial resistance to Avycaz, the nurse should confirm that the organism is susceptible to Avycaz prior to the patient's first dose. The nurse should assess patients for a history of hypersensitivity reactions to other cephalosporins, penicillins, or carbapenems because cross-sensitivity may produce an anaphylactic reaction. When patients experience changes in renal function, the nurse should monitor their creatinine clearance daily. If the nurse isn't the prescriber, the prescriber should be notified if a drop in creatinine clearance necessitates a dosage adjustment. Patient education should include the risks of serious allergic reactions; serious diarrhea; and neurologic changes such as confusion, hallucinations, stupor, coma, muscle twitching, and seizures.
Complete FDA prescribing information can be found at http://1.usa.gov/1cpaymZ.