Ceftolozane/tazobactam (Zerbaxa)

The Pharmacy and Therapeutics Committee approved the addition of ceftolozane/tazobactam (Zerbaxa) to the inpatient formulary in October 2015 with use restricted to the infectious diseases (ID) services. The addition of ceftazidime/avibactam (Avycaz) was also considered and not recommended. Drug monographs can be found at the bottom of the page.

Restriction:

  1. All orders for ceftolozane/tazobactam must be reviewed and approved by an ID service. The ordering physician is responsible for contacting an ID service.
  2. If ceftolozane/tazobactam is approved, ID will relay this information to the ordering physician as well as to the pharmacy. If ceftolozane/tazobactam is thought to be inappropriate, ID will provide alternative recommendations and communicate these recommendations to the physician originating the order.
  3. ID may decide that a formal consultation is necessary for approval. In this instance, a formal ID consultation will be required for use of ceftolozane/tazobactam.

Criteria for Use:

  • Ceftolozane/tazobactam should only be used when there is documented or strong suspicion for infection due to multidrug-resistant Pseudomonas or Enterobacteriaceae with no alternative treatment options.
  • For mixed infections, ceftolozane/tazobactam must be used in combination with agents possessing gram-positive and/or anaerobic activity.

Dosing Recommendations:

Complicated urinary tract infections, including pyelonephritis: 1.5 g IV every 8 hours
Complicated intra-abdominal infections: 1.5 g IV q8h (in combination with metronidazole)
Nosocomial pneumonia: 3 g IV q8h 

Creatinine Clearance Dose Adjustment by Indication
  cUTI, cIAI Nosocomial Pneumonia
> 50 mL/min 1.5 g IV q8h 3 g IV q8h
30-50 mL/min 750 mg IV q8h 1.5 g IV q8h
15-29 mL/min 375 mg IV q8h 750 mg IV q8h
< 15 mL/min, not on dialysis No recommendations/not studied
ESRD on hemodialysis 750 mg IV x 1 dose followed by 150 mg IV q8h 2.25 g IV x 1 dose, followed by 450 mg IV q8h