Increasing dose regimen in children with reactions to ceftazidime

Of 87 consecutive patients with cystic fibrosis treated with 859 courses of intravenous ceftazidime, 15 patients experienced reactions to drugs.

To see if by varying the means of administration further courses of treatment with ceftazidime could be tolerated in subjects who had experienced drug reactions.

Starting with a dose of 1 mg per hour, and doubling the dose every hour, ceftazidime was administered at increasing dosage by continuous infusion, reaching a rate of 150-300 mg/kg/day. Thereafter the full daily dose was given in three divided bolus doses. For patients who tolerated the maximum infusion rate but reacted adversely to bolus doses, the procedure was restarted, and once the normal daily dose rate had been achieved, treatment was completed by continuous intravenous infusion rather than bolus doses.

Of the 15 patients, three patients with urticaria and four patients with nonurticarial itchy rash tolerated further courses of ceftazidime without adverse reactions, and two patients have not had further treatment with intravenous antibiotics. The increasing dose regimen was tolerated in five of the remaining six patients, and further courses of treatment were tolerated in the four patients in whom this was required. One patient had recurrent urticaria despite three attempts at using the regimen, and treatment was given with alternative antibiotics.

A continuous drug infusion regimen of starting at a very low dosage and then increasing the dosage offers the potential for further treatment in some children with cystic fibrosis with adverse reactions to ceftazidime.