Aztreonam and Temocillin (August 2014)

Information below is specific to the use of medicines in the adult setting.

The (non cystic fibrosis) use of carbapenems (e.g. meropenem) in NHSGGC has more than doubled since early 2010.  The potential consequence of this is increased emergence of multi-drug resistant gram negative bacteria (MDRGNB) and in particular, resistance to piperacillin/tazobactam (Tazocin^®) and carbapenems (antibiotics usually of last resort). Cases of carbapenem resistant Klebsiella and Escherichia coli have been reported throughout the UK.

The Antimicrobial Management Team is strategically introducing 2 antibiotics (aztreonam and temocillin) into guidance, as alternative options to carbapenems and piperacillin/tazobactam, to reduce emergence of MDRGNB.

Increased use of these antibiotics will have financial implications as both are more expensive than piperacillin/tazobactam and carbapenems.  However in the long term this will be less than the cost of treating carbapenem resistant bacteria.  

AZTREONAM KEY MESSAGES 

• It is a monobactam (monocyclic beta-lactam) antibiotic with activity against gram negative bacteria only.
• Licensed indications include bacteraemia, urosepsis, pneumonia, and intra-abdominal sepsis.  
• Within NHSGGC aztreonam is now indicated for various infections. Click here for further information.
• The usual adult dose of aztreonam is 2 grams.  The frequency will vary depending on the severity of the infection being treated and the patient’s renal function.
• It should be avoided in patients who have experienced anaphylaxis or angioedema to beta-lactam antibiotics, however, it may be considered with caution if any previous reaction has been limited to urticaria only.

TEMOCILLIN KEY MESSAGES 

• It is a penicillin antibiotic with activity against Gram negative bacteria only (except Pseudomonas and Acinetobacter).
• It is stable against a wide range of beta-lactamases. 
• It is licensed for septicaemia, urosepsis and pneumonia.   
• Within NHSGGC it is reserved for treatment of extended spectrum beta-lactamase infections in preference to meropenem.
• The usual adult dose is 1-2 grams every 12 hours; adjust the dose according to renal function.
• It is restricted to use on the advice of an infection specialist only (an Alert Antibiotic form must be completed and sent to pharmacy).

REMEMBER 

MDRGNB are increasing worldwide and prudent prescribing of carbapenems and piperacillin/tazobactam is essential in combating this threat.

Aztreonam and temocillin are alternative options to carbapenems and piperacillin/tazobactam to reduce the emergence of  MDRGNB.