Hostname: page-component-7bb8b95d7b-nptnm Total loading time: 0 Render date: 2024-09-21T06:05:00.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Aztreonam

Published online by Cambridge University Press:  21 June 2016

Allan R. Tunkel
Allan R. Tunkel*
Affiliation:
Departments of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
Get access Rights & Permissions [Opens in a new window]

Extract

Aztreonam, the first licensed monobactam in the United States, is a β-lactam antimicrobial agent with a unique structure and in vitro spectrum of activity. The drug is active only against gram-negative aerobic bacteria in vitro, thus resembling the spectrum of aminoglycosides, but displays the safety profile typical of β-lactam agents. Due to these properties, aztreonam may prove useful in the therapy of various nosocomial infections. This review outlines the salient features of aztreonam and suggests areas of appropriate usage.

Type
Special Section
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 9 , September 1990 , pp. 486 - 494
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sykes, RB, Cimarusti, CM, Bonner, DP, et al. Monocyclic β-lactam antibiotics producedby bacteria. Nature. 1981;291:489–491.10.1038/291489a0Google Scholar
2. Imada, A, Kitano, K, Eintaka, K, Muroi, M, Asai, M. Sulfazecin and isosulfazecin, β-lactam antibiotics of bacterial origin. Nature. 1981;289:590–591.10.1038/289590a0CrossRefGoogle ScholarPubMed
3. Fernandes, PB, Bonner, DP, Sykes, RB. Azthreonam: a new concept in β-lactam antibiotics. Compr Ther. 1983;9:21–26.Google Scholar
4. Sykes, RB, Bonner, DP. Azthreonam: the first monobactam. Am J Med. 1985;78 (suppl 2A):2–10.10.1016/0002-9343(85)90196-2Google Scholar
5. Sykes, RB, Bonner, DP. Discovery and development of the monobactams. Rev Infect Dis. 1985;7 (suppl 4):S579–S592.10.1093/clinids/7.Supplement_4.S579CrossRefGoogle ScholarPubMed
6. Georgopapadakou, NH, Smith, SA, Sykes, RB. Mode of action of aztreonam. Antimicrob Agents Chemother. 1982;21:950–956.10.1128/AAC.21.6.950Google Scholar
7. Georgopapadakou, NH, Smith, SA, Cimarusti, CM, Sykes, RB. Binding of monobactams to penicillin-bin ding proteins of Escherichia coli and Staphylococcus aureus: relation to anti-bacterial activity. Antimicrob Agents Chemother. 1983;23:98–104.10.1128/AAC.23.1.98Google Scholar
8. Livermore, DM, Williams, JD. In vitro activity of the monobactam, SQ 26,776, against gram-negative bacteria and its stability to their β-lactamases. J Antimicrob Chemother. 1981;8(suppl E):29–37.10.1093/jac/8.suppl_E.29CrossRefGoogle ScholarPubMed
9. Norrdy, R, Friberg, K, Holm, SE. In vitro antibacterial activity of SQ 26,776. J Antimicrob Chemother. 1981;8(suppl E):69–76.10.1093/jac/8.suppl_E.69Google Scholar
10. Fainstein, V, Weaver, S, Bodey, GP. Comparative in vitro study of SQ 26,776. Antimicrob Agents Chemother. 1982;21:294–298.10.1128/AAC.21.2.294Google Scholar
11. Barry, AL, Thornsberry, C, Jones, RN, Gowan, TL. Aztreonam: antibacterial activity, (β-lactamase stability, and interpretive standards and quality control guidelines for disk-diffusion susceptibility tests. Rev Infect Dis. 1985;7(suppl 4):S594–S604.10.1093/clinids/7.Supplement_4.S594Google Scholar
12. Jacobus, NV, Ferreira, MC, Barza, M. In vitro activity of aztreonam, a monobactam antibiotic. Antimicrob Agents Chemother. 1982;22:832–838.10.1128/AAC.22.5.832CrossRefGoogle ScholarPubMed
13. Buesing, MA, Jorgensen, JH. In vitro activity of aztreonam in combination with newer (β-lactams and amikacin aeainst multiDlv resistant gram-negative bacilli. Antimicrob Agents Chemother. 1984;25:283–285.10.1128/AAC.25.2.283Google Scholar
14. Zar, FA, Kany, RJ Jr. In vitro studies of investigational (β-lactams as possible therapy for Pseudomonas aeruginosa endocarditis. Antimicrob Agents Chemother. 1985;27:1–3.10.1128/AAC.27.1.1CrossRefGoogle ScholarPubMed
15. Wu, DH, Baltch, AL, Smith, RP, Conley, PE. Effect of aztreonam in combination with azlocillin or piperacillin on Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1984;26:519–521.10.1128/AAC.26.4.519CrossRefGoogle ScholarPubMed
16. Stutman, HR, Welch, DF, Scribner, RK, Marks, MI. In vitro antimicrobial activity of aztreonam alone and in combination against bacterial isolates from pediatric patients. Antimicrob Agents Chemother. 1984;25:212–215.10.1128/AAC.25.2.212Google Scholar
17. Swabb, EA, Sugerman, AA, Piatt, TB, Pilkiewicaz, FG, Frantz, M. Single-dose pharmacokinetics of the monobactam aztreonam (SQ 26,776) in healthy subjects. Antimicrob Agents Chemother. 1982;21:944–949.10.1128/AAC.21.6.944Google Scholar
18. Swabb, EA, Sugerman, AA, McKinstry, DN. Multiple-dose pharmacokinetics of the monobactam aztreonam (SQ 26,776) in healthy subjects. Antimicrob Agents Chemother. 1983;23:125–132.10.1128/AAC.23.1.125CrossRefGoogle ScholarPubMed
19. Swabb, EA. Clinical pharmacology of aztreonam in healthy recipients and patients: a review. Rev Infect Dis. 1985;7(suppl 4):S605–S612.10.1093/clinids/7.Supplement_4.S605CrossRefGoogle ScholarPubMed
20. Swabb, EA, Singhui, SM, Leitz, MA, Frantz, M, Sugerman, AA. Metabo-lism and pharmacokinetics of aztreonam in healthy subjects. Antimicrob Agents Chemother. 1983;24:394–400.10.1128/AAC.24.3.394CrossRefGoogle Scholar
21. MacLeod, CM, Hartley, EA, Payne, JA, Hudes, E, Vemam, K, Devlin, RG. Effects of cirrhosis on kinetics of aztreonam. Antimicrob Agents Chemother. 1984;26:493–497.10.1128/AAC.26.4.493Google Scholar
22. Janicke, DM, Cafarell, RF, Parker, SW, Apicella, MA, Jusko, WJ. Pharmacokinetics of aztreonam in patients with gram-negative infections. Antimicrob Agents Chemother. 1985;27:16–20.10.1128/AAC.27.1.16Google Scholar
23. Mibindu, JGL, Scheld, WM, Bolton, ND, Spyker, DA, Swabb, EA, Bolton, WK. Pharmacokinetics of aztreonam in patients with various degrees of renal dysfunction. Antimicrob Agents Chemother. 1983;24:252–261.10.1128/AAC.24.2.252Google Scholar
24. Sattler, FR, Schramm, M, Swabb, EA. Safety of aztreonam and SQ 26,992 in elderly Datients with renal insufficiency. Rev Infect Dis. 1985;7(suppl 4):S622–S627.10.1093/clinids/7.Supplement_4.S622Google Scholar
25. Gerig, JS, Bolton, ND, Swabb, EA, Scheld, WM, Bolton, WK. Effect of hemodialysis and peritoneal dialysis on aztreonam pharmacokinetics. Kidney Intern. 1984;26:308–318.10.1038/ki.1984.174CrossRefGoogle ScholarPubMed
26. Wise, R, Dyas, A, Hegarty, A, Andrews, JM. Pharmacokinetics and tissue penetration of aztreonam. Antimicrob Agents Chemother. 1982;22;969–971.10.1128/AAC.22.6.969Google Scholar
27. Scheld, WM, Brodeur, JP, Foresman, PA, Gratz, JC, Rodeheaver, GT. Comparative evaluation of astreonam in therapy for experimental bacterial meningitis and cerebritis. Rev Infect Dis. 1985;7(suppl 4):S635–S647.10.1093/clinids/7.Supplement_4.S635CrossRefGoogle Scholar
28. Stutman, HR, Marks, MI, Swahb, EA. Single-dose pharmacokinetics of aztreonam in pediatric patients. Antimicrob Agents Chemother. 1984;26:196–199.10.1128/AAC.26.2.196Google Scholar
29. Modai, J, Vittecoq, D, Decazes, J, Wolff, M, Meulemans, A. Penetration of astreonam into cerebrospinal fluid of patients with bacterial meningitis, Antimicrob Agents Chemother. 1988;29:281–283.10.1128/AAC.29.2.281Google Scholar
30. Childs, SJ. Aztreonam in the treatment of urinary tract infection. Am J Med. 1985;78(suppl):44–46.10.1016/0002-9343(85)90203-7CrossRefGoogle ScholarPubMed
31. Cox, CE. Aztreonam therapy for complicated urinary tract infections caused by multi-drug-resistant bacteria. Rev Infect Dis. 1985;7(suppl 4):S767–S771.10.1093/clinids/7.Supplement_4.S767Google Scholar
32. Swabb, EA, Jenkins, SA, Muir, JG. Summary of worldwide clinical trials of aztreonam in patients with urinary tract infections. Rev Infect Dis. 1985;7(suppl 4):S772–S777.10.1093/clinids/7.Supplement_4.S772Google Scholar
33. Lefrock, JL, Smith, BR, Chandrasekar, P, Rolston, KVI, Molavi, A, Kannangara, W. Efficacy and safety of astreonam in the treatment of serious gram-negative bacterial infections. Arch Intern Med. 1988;147:325–328.10.1001/archinte.1987.00370020143052Google Scholar
34. Roberts, JA. Role of aztreonam in urinary tract infections. Urology. 1988;31(suppl):39–44.Google Scholar
35. Madsen, PO, Nielsen, KT, Graversen, PH. Aztreonam: clinical evaluation of the first monobactam antibiotic in treatment of urinary tract infections. J Urology. 1988;140:925–932.10.1016/S0022-5347(17)41891-XCrossRefGoogle ScholarPubMed
36. Stutman, HR. Clinical experience with aztreonam. Pediatr Infect Dis J. 1989;8(suppl 9):S109–Sll2.10.1097/00006454-198909001-00004Google Scholar
37. Sattler, FR, Moyer, JE, Schramm, M, Lombard, JS, Appelbaum, PC. Aztreonam compared with gentamicin for treatment of serious urinary tract infections. Lancet. 1984;1:1315–1317.10.1016/S0140-6736(84)91817-8Google Scholar
38. Childs, SJ, Bodey, GP. Aztreonam. Pharmacotherapy. 1986;6:138–152.10.1002/j.1875-9114.1986.tb03468.xGoogle Scholar
39. Lebel, MH, McCracken, GH Jr. Aztreonam: review of the clinical experience and potential uses in pediatrics. Pediatr Infect Dis J. 1988;7:331–339.10.1097/00006454-198805000-00009CrossRefGoogle ScholarPubMed
40. Kline, MW. The role of aztreonam in treatment of complicated urinary tract infections in children. Pediatr Infect Dis J. 1989;8(supple 9):S113–S116.10.1097/00006454-198909001-00005Google Scholar
41. Kline, MW, Kaplan, SL, Mason, EO. Aztreonam therapy of gram-negative infections predominantly of the urinary tract in children. Curr Ther Res. 1986;39:625–631.Google Scholar
42. Stutman, HR, Chartrand, SA, Tblentino, T, Friedhoff, L, Marks, MI. Aztreonam therapy for serious gram-negative infections in children, Am J Dis Child. 1986;140:1147–1151.Google Scholar
43. Rusconi, F, Assael, BM, Boccazzi, A, et al. Aztreonam in the treatment of severe urinary tract infections in pediatric patients. Antimicrob Agents Chemother. 1986;30:310–314.10.1128/AAC.30.2.310Google Scholar
44. Neu, HC. Current state of infectious diseases-potential areas of directed therapy with aztreonam. Am J Med. 1985;78(suppl 2A):77–80.10.1016/0002-9343(85)90208-6Google Scholar
45. Davies, BI, Maesen, FP, Teengs, J. Aztreonam in patients with acute exacerbations of chronic bronchitis: failure to prevent an emergence of pneumococcal infections. J Antimicrob Chemother. 1985;15:375–384.10.1093/jac/15.3.375CrossRefGoogle ScholarPubMed
46. Greenberg, RN, Reilly, PM, Luppen, KL, Bollinger, M, McMillian, R. Aztreonam therapy for gram-negative pneumonia. Am J Med. 1985;78(suppl 2A):31–33.10.1016/0002-9343(85)90200-1Google Scholar
47. Schentag, JJ, Vari, AJ, Winslade, NE, et al. Treatment with aztreonam or tobramycin in critical care patients with nosocomial gram-negative pneumonia. Am J Med. 1985;78(suppl 2A):34–41.10.1016/0002-9343(85)90201-3CrossRefGoogle ScholarPubMed
48. Rodriguez, JR, Ramirez-Ronda, CH. Efficacy and safety of aztreonam versus tobramycin for aerobic gram-negative bacilli lower respiratory tract infections. Am J Med. 1985;78(suppl 2A):42–43.10.1016/0002-9343(85)90202-5Google Scholar
49. Cook, JL. Gram-negative bacillary pneumonia in the nosocomial setting. Role of aztreonam therapy. Am J Med. 1990;88(suppl 3C):34S–37S.10.1016/0002-9343(90)90086-SCrossRefGoogle ScholarPubMed
50. Matsen, JM, Bosso, JA. The use of aztreonam in the cystic fibrosis patient. Pediatr Infect Dis J. 1989;8(suppl 9):Sl 17–S119.10.1097/00006454-198909001-00006CrossRefGoogle ScholarPubMed
51. Bosso, JA, Black, PG, Matsen, JM. Efficacy of aztreonam in pulmonary exacerbations of cystic fibrosis. Pediatr Infect Dis J. 1987;6:393–397.10.1097/00006454-198704000-00010Google Scholar
52. Scully, BE, Ores, CN, Prince, AS, Neu, HC. Treatment of lower respiratory tract infections due to Pseudomonas aeruginosa in patients with cystic fibrosis. Rev Infect Dis. 1985;7(suppl 4):S669–S674.10.1093/clinids/7.Supplement_4.S669CrossRefGoogle ScholarPubMed
53. Bosso, JA, Black, PG. Controlled trial of astreonam vs. tobramycin and azlocillin for acute pulmonary exacerbations of cystic fibrosis. Pediar Infect Dis J. 1988;7:171–179.10.1097/00006454-198803000-00008CrossRefGoogle Scholar
54. Scully, BE, Henry, SA. Clinical experience with aztreonam in the treatment of gram-negative bacteremia. Rev Infect Dis. 1985;7(suppl 4):S789–S793.10.1093/clinids/7.Supplement_4.S789Google Scholar
55. Henry, SA, Bendush, CB. Aztreonam: worldwide overview of the treatment of patients with gram-negative infections. Am J Med. 1985;78(suppl 2A):57–64.10.1016/0002-9343(85)90206-2CrossRefGoogle ScholarPubMed
56. Pierard, D, Boelaert, J, Van Landuyt, HW, Naessens, A, Huyghens, L, Lauwers, S. Aztreonam treatment of gram-negative septicemia. Antimicrob Agents Chemother. 1986;29:359–361.10.1128/AAC.29.2.359CrossRefGoogle ScholarPubMed
57. Henry, SA. Overall clinical experience with aztreonam in the treatment of intra-abdominal infections. Rev Infect Dis. 1985;7(suppl 4):S729–S733.10.1093/clinids/7.Supplement_4.S729Google Scholar
58. Birolini, D, Moraes, MF, Loares, de, Sousa, O. Comparison of aztreonam plus clindamycin with tobramycin plus clindamycin in the treatment of intra-abdominal infections. Rev Infect Dis. 1985;7(suppl 4):S724–S728.10.1093/clinids/7.Supplement_4.S724Google Scholar
59. Berne, TV, Applebaum, MD, Chenella, FC, Yellin, AE, Gill, MA, Heseltine, PNR. Surgically treated gangrenous or perforated appendicitis. A comparison of aztreonam and clindamycin versus gentamicin and clindamycin. Ann Surg. 1987;205:133–137.10.1097/00000658-198702000-00006Google Scholar
60. Gottleib, A, Mills, J. Effectiveness of aztreonam for the treatment of gonorrhea. Antimicrob Agents Chemother. 1985;27:270–271.10.1128/AAC.27.2.270Google Scholar
61. Pastorek, JG, Cole, C, Aldridge, KE, Crapanzano, JC. Aztreonam plus clindamycin therapy for pelvic infections in women. Am J Med. 1985;78(suppl 2A):47–50.10.1016/0002-9343(85)90204-9CrossRefGoogle ScholarPubMed
62. Gibbs, RS, Blanco, JD. Lipscomb, KA St. Clair, PJ. Aztreonam versus gentamicin, each with clindamycin, in the treatment of endometritis. Obstet Gynecol. 1985;65:825–829.Google ScholarPubMed
63. Jones, PG, Rolston, KVI, Fainstein, V, Elting, L, Walters, RS, Bodey, GP. Aztreonam therapy in neutropenic patients with cancer. Am J Med. 1986;81:243–248.10.1016/0002-9343(86)90258-5CrossRefGoogle ScholarPubMed
64. Rolston, KVI, Bodey, GP, Elting, L. Aztreonam in the prevention and treatment of infection in neutropenic cancer patients. Am J Med. 1990;88(suppl 3C):24S–29S.10.1016/0002-9343(90)90084-QGoogle Scholar
65. Louie, TJ, Chubb, H, Bow, EJ, et al. Preservation of colonization resistance parameters during empiric therapy with aztreonam in the febrile neutropenic patient. Rev Infect Dis. 1985;7(suppl 4):S747–S761.10.1093/clinids/7.Supplement_4.S747Google Scholar
66. Simons, WJ, Lee, TJ. Aztreonam in treatment of bone and joint infections caused by gram-negative bacilli. Rev Infect Dis. 1985;7(suppl 4):S783–S788.10.1093/clinids/7.Supplement_4.S783Google Scholar
67. Pribyl, C, Salzer, R, Beskin, J, et al. Aztreonam. in the treatment of serious orthopedic infections. Am J Med. l985;78(suppl 2A):51–56.10.1016/0002-9343(85)90205-0Google Scholar
68. Neu, HC. Aztreonam: the first monobactam. Med Clinics North Am. 1988;72:555–566.10.1016/S0025-7125(16)30758-1Google Scholar
69. Chartrand, SA. Safety and toxicity profile of aztreonam. Pediatr Infect Dis J. 1989;8(suppl 9):S120–S123.10.1097/00006454-198909001-00007Google Scholar
70. Adkinson, NF, Saxon, A, Spence, MR, Swabb, EA. Cross-allergenicity and immunogenicity of aztreonam. Rev Infect Dis. 1985;7(suppl 4):613–621.10.1093/clinids/7.Supplement_4.S613CrossRefGoogle ScholarPubMed
71. Saxon, A, Hassner, A, Swabb, EA, Wheeler, B, Adkinson, NF. Lack of cross-reactivity between aztreonam, a monobactam antibiotic, and penicillin in penicillin-allergic subjects. J Infect Dis. 1984;149:16–22.10.1093/infdis/149.1.16Google Scholar
72. Adkinson, NF, Swabb, EA, Sugerman, AA. Immunology of the monobactam aztreonam. Antimicrob Agents Chemother. 1984;25:93–97.10.1128/AAC.25.1.93Google Scholar