Month: July 2026

Ceftazidime/Avibactam: Managing Pediatric Drug-Resistant Gram-Negative Infections

Posted on by

By: Jenna-Lynn Kelley, PharmD Candidate

Real-world pediatric outcomes data have finally closed a problematic evidence gap.1 Morrisette and colleagues recently published a descriptive study showcasing the efficacy of ceftazidime/avibactam in pediatric drug-resistant Gram-negative infections in the Open Forum Infectious Diseases journal.1 This addition to pediatric literature is the missing puzzle piece that will give pharmacists confidence when considering ceftazidime/avibactam for these challenging infections in children.

Ceftazidime/Avibactam from a Real-World Perspective

The promising results of ceftazidime/avibactam in real-world pediatric practice settings published in April 2026 solidify its well-established place in therapy.1,2 In this retrospective observational cohort study, seventy-three of 100 (73%) pediatric patients achieved clinical success without experiencing microbiologic or clinical recurrence within 30 days of discontinuation or development of resistance within 90 days of initiation.1 Furthermore, most patients did not have a recurrent infection within 30 days of ceftazidime/avibactam discontinuation (94%) and clinically improved without the need for treatment modification due to suspected treatment failure (97%).1 There were also several pre-defined adverse events potentially attributable to ceftazidime/avibactam (e.g. acute kidney injury, Clostridioides difficile infection, hepatotoxicity, gastrointestinal and central nervous system effects), however authors did not identify any of these adverse events in the study.1 All-cause mortality was reported in 16 (16%) patients.1 Though the included cohort was mostly White (62%), it was considerably well-generalized across age and gender.1 As expected, infections were mainly caused by highly prevalent drug-resistant Gram-negative bacteria such as Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales, and Klebsiella pneumoniae.1-3 Interestingly, many patients had baseline hematologic conditions and other immunodeficiencies (42%) and a long median length of hospital stay (42 days, IQR 17-139.5 days) despite a majority of community admissions (77%), implying that pediatric oncology patients potentially made up a decent subset of the cohort.1

The Trusted Role of Ceftazidime/Avibactam

Current evidence-based literature recognizes ceftazidime/avibactam as a reliable antimicrobial agent for drug-resistant Gram-negative infections, though the majority of evidence has largely focused on adult patients. 2024 IDSA guidance strongly recommends its use in both adult and pediatric antimicrobial-resistant infections caused by pathogens such as P. aeruginosa and CRE, though pediatric dosing recommendations are not provided.2 Several primary sources, as shown below in Table 1, have also reported optimistic results regarding the use of ceftazidime/avibactam in pediatric patients. Despite the demonstrated success of ceftazidime/avibactam in these descriptive studies, the small sample sizes and narrow focus on pediatric intensive care units limits their scope. The real-world outcomes newly published in April 2026 enhance the impact of these studies by offering a larger cohort and broader demographics.

Table 1. Primary sources on ceftazidime/avibactam in pediatric patients 4-7
First Author, Year Study Design Population Results
Havan M, 20264 Retrospective observational study PICU, 1 month-18 years (n=21), CZA for confirmed MDR or PDR GN infection 85.7% microbiological clearance
Araujo da Silva AR, 20245 Retrospective observational study PICU, 0-18 years (n=37), CZA > 24 hours 4 / 5 carbapenem-resistant GN microbiological clearance
Bradley JS, 20196 Phase II, single-blind randomized controlled trial Hospitalized, 3 months – 18 years (n=83), complicated intra-abdominal infection 90% favorable clinical and microbiological response in both arms
Bradley JS, 20197 Phase II, single-blind randomized controlled trial Hospitalized,  3 months – 18 years (n=95), complicated urinary tract infection 95% favorable outcomes in both arms

Abbreviations. CZA: ceftazidime/avibactam; GN: Gram-negative; MDR: multidrug-resistant; n = sample size; PDR: pandrug-resistant; PICU: pediatric intensive care unit

The Benefit of Ceftazidime/Avibactam Validation in Pediatric Patients

Antimicrobial resistance is climbing at an alarming rate, contributing to an estimated 1.3 million deaths worldwide in 2019.1-3,8,9 The CDC considers multidrug-resistant (MDR) P. aeruginosa a serious national threat and carbapenem-resistant Enterobacterales (CRE) an urgent national threat, making it critical to effectively treat resulting infections.3 The prevalence of inappropriate antibiotic prescribing makes this feat increasingly challenging.8,10 Given the concerning ascent of drug resistance in Gram-negative infections, the optimistic outcomes from this observational cohort study are a relieving addition to current pediatric literature.

Practical Points for Pharmacists

The newly published pediatric outcomes data supporting the use of ceftazidime/avibactam in drug-resistant Gram-negative infections in children is a win, but the impact on practice depends on the ability to uphold ideal antimicrobial stewardship principles such as applying evidence-based dosing and administration. Most patients in the study received 50mg ceftazidime/kg (44%) or 2g ceftazidime (40%) every 8 hours, consistent with FDA-approved dosing, but the duration was less than the 3-hour prolonged infusion recommended by Lockowitz and colleagues to maximize the pharmacodynamics of the medication (when used for infections outside of the central nervous system).1,9,11-13 Further details regarding ceftazidime/avibactam’s use for specific drug-resistant Gram-negative infections can be found in this prior blog post by Galicia.9

Key Takeaways

An abundance of data supports the use of ceftazidime/avibactam in pediatric drug-resistant Gram-negative infections. To continue to preserve this antibiotic, it should only be used when necessary and pharmacists should remember to utilize appropriate dosing and prolonged infusion time (outside of central nervous system infections). This will ensure that ceftazidime/avibactam remains a reliable antimicrobial agent for drug-resistant Gram-negative infections in the pediatric population.

Jenna-Lynn Kelleyis a Doctor of Pharmacy candidate at the University of Connecticut. This post was written as part of her Advanced Pharmacy Practice Experience under the guidance of her professor, Jennifer Girotto PharmD, BCPPS, BCIDP, who also reviewed and edited the piece.

References

  1. Morrisette T, Stimes GT, Alvira-Arill GR, et al. Multicenter evaluation of ceftazidime/avibactam in pediatric patients across the united states: Real-world insights into the management of drug-resistant gram-negative infections. Open Forum Infect Dis. 2026;13(4):ofag177. doi: 10.1093/ofid/ofag177.
  2. Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious diseases society of america 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis. 2024. doi: 10.1093/cid/ciae403.
  3. U.S. Centers for Disease Control and Prevention. Antimicrobial resistance rates in the united states, 2021-2022. Updated July 2024. https://www.cdc.gov/antimicrobial-resistance/media/pdfs/antimicrobial-resistance-threats-update-2022-508.pdf. Accessed July 2026.
  4. Havan M, Arga G, Bulbul YE, et al. Ceftazidime-avibactam for multidrug and pandrug-resistant gram-negative infections in critically ill children: A single-center pediatric intensive care experience. Eur J Pediatr. 2026;185(4):219. doi: 10.1007/s00431-026-06862-1.
  5. Araujo da Silva AR, Quijada R. Use of ceftazidime-avibactam in children admitted to pediatric intensive care units. Children (Basel). 2024;11(6):664. doi: 10.3390/children11060664.
  6. Bradley JS, Broadhurst H, Cheng K, et al. Safety and efficacy of ceftazidime-avibactam plus metronidazole in the treatment of children ≥3 months to Pediatr Infect Dis J. 2019;38(8):816–824. doi: 10.1097/INF.0000000000002392.
  7. Bradley JS, Roilides E, Broadhurst H, et al. Safety and efficacy of ceftazidime-avibactam in the treatment of children >/=3 months to Pediatr Infect Dis J. 2019;38(9):920–928. doi: 10.1097/INF.0000000000002395.
  8. Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H, ARPEC project group. The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016;71(4):1106–1117. doi: 10.1093/jac/dkv418.
  9. Galicia M. Treatment of multidrug-resistant organisms in children: Challenges and current strategies. Published December 16, 2025. Accessed July 13, 2026. https://pharmacy.uconn.edu/2025/12/16/treatment-of-multidrug-resistant-organisms-in-children-challenges-and-current-strategies/.
  10. Levy ER, Swami S, Dubois SG, Wendt R, Banerjee R. Rates and appropriateness of antimicrobial prescribing at an academic children’s hospital, 2007-2010. Infect Control Hosp Epidemiol. 2012;33(4):346–353. doi: 10.1086/664761.
  11. Avycaz (ceftazidime and avibactam) for injection. Prescribing Information. Abbvie, Inc. Updated April 2025. Accessed July 13, 2026. www.accessdata.fda.gov
  12. Lockowitz CR, Hsu AJ, Chiotos K, et al. Suggested dosing of select beta-lactam agents for the treatment of antimicrobial-resistant gram-negative infections in children. J Pediatric Infect Dis Soc. 2025;14(2):piaf004. doi: 10.1093/jpids/piaf004.
  13. Ellis JM, Kuti JL, Nicolau DP. Use of monte carlo simulation to assess the pharmacodynamics of beta-lactams against pseudomonas aeruginosa infections in children: A report from the OPTAMA program. Clin Ther. 2005;27(11):1820–1830. doi: 10.1016/j.clinthera.2005.11.007.