Systematic (IUPAC) name
2-({[(1Z)-1-(2-amino-1,3-thiazol-4-yl) -2- {[(2S,3S)-2-methyl-4-oxo-1-sulfoazetidin-3-yl]amino} -2- oxoethylidene]amino}oxy)-2-methylpropanoic acid
Clinical data
Trade names Azactam
AHFS/ monograph
Pregnancy cat. B1 (Au), B (U.S.)
Legal status ℞-only (U.S.)
Routes Intravenous, intramuscular, inhalation
Pharmacokinetic data
Bioavailability 100% (IM)
Protein binding 56%
Metabolism hepatic (minor %)
Half-life 1.7 hours
Excretion Renal
CAS number 78110-38-0 YesY
ATC code J01DF01
PubChem CID 54116
DrugBank APRD00815
ChemSpider 4674940 YesY
KEGG D00240 YesY
ChEBI CHEBI:161680 YesY
Chemical data
Formula C13H17N5O8S2 
Mol. mass 435.433 g/mol
SMILES eMolecules & PubChem
 N(what is this?)  (verify)

Aztreonam (trade names Azactam injection, Cayston inhalation) is a synthetic monocyclic beta-lactam antibiotic (a monobactam), with the nucleus based on a simpler monobactam isolated from Chromobacterium violaceum. It was approved by the U.S. Food and Drug Administration (FDA) in 1986. It is resistant to some beta-lactamases, but is inactivated by extended-spectrum beta-lactamases.


Mechanism of action

Aztreonam is similar in action to penicillin. It inhibits mucopeptide synthesis in the bacterial cell wall, thereby blocking peptidoglycan crosslinking. It has a very high affinity for penicillin-binding protein 3 (PBP-3) and mild affinity for PBP-1a. Aztreonam binds the penicillin-binding proteins of gram-positive and anaerobic bacteria very poorly and is largely ineffective against them.[1] Aztreonam is bactericidal but less so than some of the cephalosporins.

Indications and spectrum of activity

Aztreonam has strong activity against susceptible gram-negative bacteria, including Pseudomonas aeruginosa. It has no useful activity against gram-positive bacteria or anaerobes. It is known to be effective against a wide range of bacteria including Citrobacter, Enterobacter, E. coli, Haemophilus, Klebsiella, Proteus, and Serratia species.[2]

Synergism between aztreonam and arbekacin or tobramycin against Pseudomonas aeruginosa has been suggested.[3]

Aztreonam is often used in patients who are penicillin allergic or who can not tolerate aminoglycosides.


Aztreonam is poorly absorbed when given via the oral route, so it must be administered as an intravenous or intramuscular injection (trade name Azactam ), or inhaled (trade name Cayston) using an ultrasonic nebulizer. In the United States the FDA approved the inhalative form on February 22, 2010 for the suppression of Pseudomonas aeruginosa infections in patients with cystic fibrosis.[4] It received conditional approval for administration in Canada and the European Union September 2009,[4] and has been fully approved in Australia.[5]

Common adverse effects

Reported side-effects include injection site reactions, rash, and rarely toxic epidermal necrolysis. Gastrointestinal side effects generally include diarrhea and nausea and vomiting. There may be drug-induced eosinophilia. Because of the un-fused beta-lactam ring unique to aztreonam, there is limited cross-reactivity between aztreonam and other beta-lactam antibiotics, and it is generally considered safe to admininister aztreonam to patients with hypersensitivity (allergies) to penicillins.[1]

Aztreonam is considered Pregnancy category B.


  1. ^ a b AHFS DRUG INFORMATION 2006 (2006 ed.). American Society of Health-System Pharmacists. 2006. 
  2. ^ Mosby's Drug Consult 2006 (16 ed.). Mosby, Inc.. 2006. 
  3. ^ Kobayashi, Y., Uchida, H., Kawakami Y. (1992). "Synergy with aztreonam and arbekacin or tobramycin against Pseudomonas aeruginosa isolated from blood". J Antimicrob Chemother 30 (6): 871–872. doi:10.1093/jac/30.6.871. PMID 1289363. 
  4. ^ a b Larkin, Catherine (February 22, 2010). "Gilead’s Inhaled Antibiotic for Lungs Wins Approval". BusinessWeek. Retrieved 2010-03-05. 
  5. ^ "FDA approves Gilead cystic fibrosis drug Cayston". BusinessWeek. February 23, 2010. Retrieved 2010-03-05. 

External links

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  • aztreonam — A synthetic bactericidal monolactam antibiotic with a wide spectrum of activity against Gram negative aerobic pathogens. * * * az·tre·o·nam .az trē ō .nam, az trē n a synthetic monobactam antibiotic C13H17N5O8S2 used esp. against gram negative… …   Medical dictionary

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