What it is and what it is used for

for

Ceftazidime is an antibiotic used in adults and children (including newborn babies). It works by killing bacteria that cause infections. It belongs to a group of medicines called cephalosporins. Ceftazidime is used to treat severe bacterial infections of:

• the lungs or chest
• the urinary tract
• the lungs and bronchi in patients suffering from cystic fibrosis
• the skin and soft tissues
• the brain (meningitis)
• the abdomen and abdominal wall (peritonitis)
• the ear
• the bones and joints. Ceftazidime can also be used:
• to prevent infections during prostate surgery in men
• to treat patients with low white blood cell counts (neutropenia) who have a fever due to a bacterial infection.

What you need to know before you take it

ceftazidime

You must not be given ceftazidime:

• if you are allergic to ceftazidime or any of the other ingredients of this medicine (listed in section 6)
• if you have had a severe allergic reaction to any other antibiotic (penicillins, monobactams and carbapenems) as you may also be allergic to ceftazidime ➣ Tell your doctor before you start ceftazidime if you think that this applies to you; you must not be given ceftazidime. Warnings and precautions Serious skin reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP) have been reported in association with ceftazidime treatment. Seek medical attention immediately if you notice any of the symptoms related to these serious skin reactions described in section 4. Talk to your doctor, pharmacist or nurse before you start on ceftazidime Take special care with ceftazidime You must look out for certain symptoms such as allergic reactions, nervous system disorders and gastrointestinal disorders such as diarrhoea while you are being given ceftazidime. This will reduce the risk of possible problems. See ('Conditions you need to look out for') in section 4. If you have had an allergic reaction to other antibiotics you may also be allergic to ceftazidime. If you need a blood or urine test Ceftazidime can affect the results of urine tests for sugar and a blood test known as Coombs test. If you are having tests: ➣ Tell the person taking the sample that you have been given ceftazidime. Other medicines and ceftazidime Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines you can obtain without a prescription. You shouldn't be given ceftazidime without talking to your doctor if you are also taking:
• An antibiotic called chloramphenicol
• Water tablets called furosemide
• A type of antibiotic called aminoglycosides e.g.gentamicin, tobramycin ➣ Tell your doctor if this applies to you Pregnancy, breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. Your doctor will consider the benefit of treating you with ceftazidime against the risk to your baby. Driving and using machines Ceftazidime can cause side effects that affect your ability to drive, such as dizziness. Don't drive or use machines unless you are sure you're not affected. Important information about some of the ingredients of ceftazidime Ceftazidime contains sodium This medicine contains 52mg sodium (main component of cooking/table salt) in each 1g vial. This is equivalent to 2.6% of the recommended maximum daily dietary intake of sodium for an adult. This medicine contains 104mg sodium (main component of cooking/table salt) in each 2g vial. This is equivalent to 5.2% of the recommended maximum daily dietary intake of sodium for an adult.

How to take it

Information for Health Care Professionals Ceftazidime 1g powder for solution for injection or infusion and Ceftazidime 2g powder for solution for injection or infusion Dosage and Administration Information Only Please refer to the Summary of Product Characteristics for further information

• Posology and method of administration Method of administration The dose depends on the severity, susceptibility, site and type of infection and on the age and renal function of the patient. Ceftazidime should be administered by intravenous injection or infusion, or by deep intramuscular injection. Recommended intramuscular injection sites are the upper outer quadrant of the gluteus maximus or lateral part of the thigh. Ceftazidime solutions may be given directly into the vein or introduced into the tubing of a giving set if the patient is receiving parenteral fluids. The standard recommended route of administration is by intravenous intermittent injection or intravenous continuous infusion. Intramuscular administration should only be considered when the intravenous route is not possible or less appropriate for the patient. Posology Adults and children ≥ 40kg Intermittent administration Infection Dose to be administered Broncho-pulmonary infections in cystic fibrosis 100 to 150 mg/kg/day every 8h, maximum 9g per day Febrile neutropenia Nosocomial pneumonia 2g every 8h Bacterial meningitis Bacteraemia* Bone and joint infections Complicated skin and soft tissue infections Complicated intra-abdominal infections Peritonitis associated with dialysis in patients on CAPD Complicated urinary tract infections Peri-operative prophylaxis for transuretheral resection of prostate (TURP) Chronic suppurative otitis media Malignant otitis externa Continuous Infusion Infection Febrile neutropenia Nosocomial pneumonia Broncho-pulmonary infections in cystic fibrosis Bacterial meningitis Bacteraemia* Bone and joint infections Complicated skin and soft tissue infections Complicated intra-abdominal infections Peritonitis associated with dialysis in patients on CAPD

In adults with normal renal function 9g/day has been used without adverse effects.

• When associated with, or suspected to be associated with, any of the infections listed in section 4.1. 1

Children < 40kg Infants and toddlers >2 months and children < 40kg Intermittent Administration

Infection Complicated urinary tract infections Chronic suppurative otitis media Malignant otitis externa Neutropenic children Broncho-pulmonary infections in cystic fibrosis Bacterial meningitis Bacteraemia* Bone and joint infections Complicated skin and soft tissue infections Complicated intra-abdominal infections Peritonitis associated with dialysis in patients on CAPD

Usual dose 100-150mg/kg/day in three divided doses, maximum 6g/day 150mg/kg/day in three divided doses, maximum 6g/day

100-150mg/kg/day in three divided doses, maximum 6g/day

Continuous Infusion Febrile neutropenia Nosocomial pneumonia Broncho-pulmonary infections in cystic fibrosis Bacterial meningitis Bacteraemia* Bone and joint infections Complicated skin and soft tissue infections Complicated intra-abdominal infections Peritonitis associated with dialysis in patients with CAPD

1-2g every 8h 1-2g every 8h or 12h 1g at induction of anaesthesia, and a second dose at catheter removal 1g to 2g every 8h

✂

Ceftazidime is usually given by a doctor or nurse. It can be given as a drip (intravenous infusion) or as an injection directly into a vein or into a muscle. Ceftazidime is made up by the doctor, pharmacist or nurse using water for injections or a suitable infusion fluid. The recommended dose The correct dose of ceftazidime for you will be decided by your doctor and depends on: the severity and type of infection, whether you are on any other antibiotics; your weight and age, how well your kidneys are working. Newborn babies (0-2 months) For every 1kg the baby weighs, they'll be given 25 to 60mg ceftazidime per day divided in two doses. Babies (over 2 months) and children who weigh less than 40kg For every 1kg the baby or child weighs, they'll be given 100 to 150mg of ceftazidime per day divided in three doses. Maximum 6g per day. Adults and adolescents who weigh 40kg or more 1 to 2g of ceftazidime three times daily. Maximum of 9g per day. Patients over 65 The daily dose should not normally exceed 3g per day, especially if you are over 80 years of age. Patients with kidney problems You may be given a different dose to the usual dose. The doctor or nurse will decide how much ceftazidime you will need, depending on the severity of the kidney disease. Your doctor will check you closely and you may have more regular kidney function tests. If you are given more ceftazidime than you should If you accidentally use more than your prescribed dose, contact your doctor or nearest hospital straight away. If you forget to use ceftazidime If you miss an injection, you should have it as soon as possible. However, if it is almost time for your next injection, skip the missed injection. Do not take a double dose (two injections at the same time) to make up for a forgotten dose.

Neonates and infants ≤ 2 months

Infection

Loading dose of 60-100mg/kg followed by a continuous infusion 100-200mg/kg/day, maximum 6g/day

Usual dose

Intermittent Administration

Dose to be administered Loading dose of 2g followed by a continuous infusion of 4 to 6g every 24h1

25-60mg/kg/day in two divided Most infections doses1 In neonates and infants ≤ 2 months, the serum half life of ceftazidime can be three to four times that in adults.

• Where associated with or suspected to be associated with any of the infections listed in section 4.1. 1

Loading dose of 2g followed by a continuous infusion of 4 to 6g every 24h1

106648/7

Customer

Wockhardt UK Limited

Description

Ceftazidime

Item Code

106648/7

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FPO If you stop taking ceftazidime Don't stop taking ceftazidime unless your doctor tells you to. If you have any questions on the use of this medicine, ask your doctor or nurse.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Conditions you need to look out for Seek medical attention immediately if you notice any of the following symptoms. The following serious side effects have occurred in a small number of people but their exact frequency is unknown:

• Severe allergic reaction. Signs include raised and itchy rash, swelling, sometimes of the face or mouth causing difficulty in breathing.
• Skin rash, which may blister, and looks like small targets (central dark spot surrounded by a paler area, with a dark ring around the edge).
• Reddish patches on the trunk, the patches are target-like macules or circular, often with central blisters, skin peeling, ulcers of mouth, throat, nose, genitals and eyes. These serious skin rashes can be preceded by fever and flu-like symptoms (Stevens-Johnson syndrome, toxic epidermal necrolysis).
• Widespread rash, high body temperature and enlarged lymph nodes (DRESS syndrome or drug hypersensitivity syndrome).
• A red, scaly widespread rash with bumps under the skin and blisters accompanied by fever. The symptoms usually appear at the initiation of treatment (acute generalised exanthematous pustulosis)
• Nervous system disorders: tremors, fits and, in some cases coma. These have occurred in people when the dose they are given is too high, particularly in people with kidney disease. ➣ Contact a doctor or nurse immediately if you get any of these symptoms. Common side effects These may affect up to 1 in 10 people:
• diarrhoea
• pain, burning, swelling or inflammation at the injection site. ➣ Tell your doctor if any of these are troubling you.
• swelling and redness along a vein
• red raised skin rash which may be itchiness Common side effects that may show up in blood tests:
• an increase in a type of white blood cell (eosinophilia)
• an increase in liver enzymes.
• an increase in the number of cells that help the blood to clot Uncommon side effects These may affect up to 1 in 100 people:
• inflammation of the gut which can cause pain or diarrhoea which may contain blood
• stomach ache
• thrush (fungal infections in the mouth or vagina)
• feeling sick or being sick
• headache
• fever and chills.
• dizziness ➣ Tell your doctor if you get any of these. Uncommon side effects that may show up in blood tests:
• a decrease in the number of white blood cells
• an increase in the level of urea, urea nitrogen or serum creatinine in the blood.
• a decrease in the number of blood platelets (cells that help the blood to clot) Very rare side effects These may affect up to 1 in 10,000 people:
• inflammation or failure of the kidneys. Other side effects Other side effects have occurred in a small number of people but their exact frequency is unknown:
• inflammation or failure of the kidneys
• unpleasant taste in the mouth
• pins and needles
• yellowing of the whites of the eyes or skin. Other side effects that may show up in blood tests:
• red blood cells destroyed too quickly
• severe decrease in the number of white blood cells.
• an increase in a certain type of white blood cells Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

How to store it

ceftazidime

Keep this medicine out of the sight and reach of children

• Do not use this medicine after the expiry date which is stated on the carton and vial. The expiry date refers to the last day of that month
• The vials should not be stored above 25o C
• Keep the vial in the outer carton in order to protect from light
• Chemical and physical in-use stability has been demonstrated for eight hours at 25o C and 24 hours at 4o C. From a microbiological point of view, once opened, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2-8o C, unless reconstitution has taken place in controlled and validated aseptic conditions. For single use only. Once reconstituted, any unused portion of solution should be discarded
• Do not use this medicine if you notice that the solution contains particles or is cloudy. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

Contents of the pack and other information

What ceftazidime contains The active substance is ceftazidime as ceftazidime pentahydrate. Each vial contains the equivalent of 1g or 2g of ceftazidime. It also contains the ingredient, sodium carbonate. The sodium content per vial is approximately 52mg (2.26mmol) for the 1g vial and 104mg (4.52mmol) for the 2g vial. What ceftazidime looks like and contents of the pack Ceftazidime is a white to cream coloured powder, which must be made into a solution before injection or infusion. It is available in packs of 1, 5 or 10 vials. Not all pack sizes are marketed. X-PIL Information To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge: 0800 198 5000 (UK Only) Please be ready to give the following information: Product Name Reference Number Ceftazidime 1g powder for solution for injection or infusion 29831/0031 Ceftazidime 2g powder for solution for injection or infusion 29831/0032 This is a service provided by the Royal National Institute of Blind People. Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder: Wockhardt UK Ltd, Ash Road North, Wrexham, LL13 9UF, UK Manufacturer: CP Pharmaceuticals Ltd, Ash Road North, Wrexham, LL13 9UF, UK This leaflet was last revised in 09/2024

PREPARATION OF SOLUTION INTRAMUSCULAR INJECTION Strength

Diluent

Amount of diluent to be added (ml)

1g

0.5% lidocaine 1% lidocaine

3ml 3ml

Approximate Approximate available concentration (mg/ml) volume (ml) 278 270

3.6ml 3.7ml

Approximate displacement volume (ml) 0.6ml 0.7ml

INTRAVENOUS BOLUS Strength

Diluent

1g 2g

Water for Injection Water for Injection

Amount of diluent to be Approximate Approximate available added (ml) concentration (mg/ml) volume (ml) 10ml 10ml

92 172

10.9ml 11.6ml

Customer

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Description

Ceftazidime

Item Code

106648/7

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Size

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Approximate displacement volume (ml) 0.9ml 1.6ml

INTRAVENOUS INFUSION Diluent (see full list of Amount of diluent to Strength compatible diluents be added (ml)# below table) Compatible diluent 1g 50ml list below 0.9% sodium chloride 50ml 2g 5% glucose 50ml

DATE

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Approximate concentration (mg/ml)

Approximate available volume (ml)

Approximate displacement volume (ml)

20

—

—

39 39

51.5ml 51.9ml

1.5ml 1.9ml

Note: addition should be in two stages. See preparation for intravenous infusion instructions below. Compatible diluents for intravenous infusion Ceftazidime at concentrations between 1mg/ml and 40mg/ml is compatible with the following diluent solutions for intravenous infusion preparation:

• Sodium Chloride 0.9%
• Glucose 5% and Sodium Chloride 0.9%
• Ringer Solution
• Glucose 5% and Sodium Chloride 0.45%
• Ringer Lactate Solution
• Glucose 5% and Sodium Chloride 0.2%
• Glucose 5%
• Dextran 40%/10% and Sodium Chloride 0.9%
• Glucose 10%
• Dextran 70%/6% and Sodium Chloride 0.9% Solutions range from light yellow to amber depending on concentration, diluent and storage conditions used. All sizes of vials as supplied are under reduced pressure. As the product dissolves, carbon dioxide is released and a positive pressure develops. For ease of use, it is recommended that the following techniques of reconstitution are adopted. Preparation of solution for bolus injection: 1. Insert the syringe needle through the vial closure and inject 10ml of Water for Injection. The vacuum may assist entry of the diluent. Remove the syringe needle. 2. Shake to dissolve: carbon dioxide is released and a clear solution will be obtained in about 1 to 2 minutes. 3. Invert the vial. With the syringe plunger fully depressed, insert the needle through the vial closure and withdraw the total volume of solution into the syringe (the pressure in the vial may aid withdrawal). Ensure that the needle remains within the solution and does not enter the head space. The withdrawn solution may contain small bubbles of carbon dioxide; they may be disregarded. These solutions may be given directly into the vein or introduced into the tubing of a giving set if the patient is receiving parenteral fluids. Preparation of solution for intravenous infusion: Prepare using a total of 50ml of compatible diluent, added in TWO stages as follows: 1. Insert the syringe needle through the vial closure and inject 10ml of Water for Injection or one of the listed compatible diluent solutions for intravenous infusion preparation to reconstitute. The vacuum may assist entry of the diluent. Remove the syringe needle. 2. Shake to dissolve: carbon dioxide is released and a clear solution obtained in about 1 to 2 minutes. 3. Do not insert a gas relief needle until the product has dissolved. Insert a gas relief needle through the vial closure to relieve the internal pressure. 4. Transfer the reconstituted solution to the final delivery vehicle (e.g. mini-bag or burette-type set) and add 40ml of compatible diluent* to make up a total volume of approximately 50ml and administer by slow intravenous infusion over 20 to 30 minutes. *For the second stage of preparation, use Sodium Chloride 0.9%, Glucose 5% or one of the listed compatible diluent solutions for intravenous infusion preparation, as Water for Injection produces hypotonic solutions when used at higher concentrations. Ceftazidime at concentrations between 1mg/ml and 40mg/ml is compatible with the diluent solutions for intravenous infusion preparation listed above NOTE: To preserve product sterility, it is important that a gas relief needle is not inserted through the vial closure before the product has dissolved. This leaflet was last revised in 09/2024 106648/7

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Paediatric population The safety and efficacy of ceftazidime administered as continuous infusion to neonates and infants ≤ 2 months has not been established. Elderly In view of age related reduced clearance of ceftazidime in elderly patients, the daily dose should not normally exceed 3g in those over 80 years of age. Hepatic impairment Available data do not indicate the need for dose adjustment in mild or moderate liver function impairment. There are no study data in patients with severe hepatic impairment (see also section 5.2). Close clinical monitoring for safety and efficacy is advised. Renal impairment Ceftazidime is excreted unchanged by the kidneys. Therefore, in patients with impaired renal function, the dosage should be reduced (see also section 4.4). An initial loading dose of 1g should be given. Maintenance doses should be based on creatinine clearance. For recommended maintenance doses of ceftazidime in renal impairment (including haemodialysis and peritoneal dialysis), follow the dosage recommendations in the SPC.

• Overdose Overdose can lead to neurological sequelae including encephalopathy, convulsion and coma. Symptoms of overdose can occur if the dose is not reduced appropriately in patients with renal impairment. Serum levels of ceftazidime can be reduced by haemodialysis or peritoneal dialysis.
• Incompatibilities In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. Ceftazidime is less stable in Sodium Bicarbonate Injection than other intravenous fluids. It is not recommended as a diluent. Ceftazidime and aminoglycosides should not be mixed in the same giving set or syringe. Precipitation has been reported when vancomycin has been added to ceftazidime in solution. Therefore, it would be prudent to flush giving sets and intravenous lines between administration of these two agents. Ceftazidime is incompatible with aminophylline. There is a possible incompatibility with pentamide.
• Instructions for use/handling For single use. Discard any unused contents. Instructions for reconstitution: See table for addition volumes and solution concentrations, which may be useful when fractional doses are required.

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