ZERBAXA®

(ceftolozane and tazobactam) for injection (1.5 g), for intravenous use

Announcements

Announcements

  • ZERBAXA Is Indicated for the Treatment of Pediatric Patients (Birth to Less Than 18 Years Old) with cUTI or cIAI. See Prescribing Information for details.

Dosing

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Dosing and administration

Dosage for adult patients with hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP)

The recommended dose of ZERBAXA in adult patients 18 years and older with HABP/VABP and creatinine clearance (CrCl) greater than 50 mL/min is 3 grams (two 1.5 g vials) over 1-hour period every 8 hours for 8 to 14 days.

Two 1.5 g vials of ZERBAXA equal a 3-g infusion over a one-hour period repeated every 8 hours Two 1.5 g vials of ZERBAXA equal a 3-g infusion over a one-hour period repeated every 8 hours

Renal dosing adjustments for adult patients with HABP/VABP per estimated CrCl (mL/min)a,b

  • 30 to 50 1.5 g (1 g and 0.5 g) intravenously every 8 hours
  • 15 to 29 750 mg (500 mg and 250 mg) intravenously every 8 hours
  • For patients with end-stage renal disease on hemodialysis: a single loading dose of 2.25 g (1.5 g and 0.75 g) followed by a 450-mg (300 mg and 150 mg) maintenance dose administered every 8 hours for the remainder of the treatment period (on hemodialysis days, administer the dose at the earliest possible time following completion of dialysis).

aCreatinine clearance (CrCl) estimated using Cockcroft-Gault formula.

bAll doses of ZERBAXA are administered over 1 hour.

3-g dose selected based on Phase 1 PK/PD study

Time (hr) Ceftolozane (μg/mL) 1000 1 0 10 100 Plasma, first dose Plasma, last dose ELF, last dose MIC = 4 µg/mL 0 1 2 3 4 5 6 7 8
  • ZERBAXA at 3-g IV dose achieved target concentration in the epithelial lining fluid (ELF) over 100% of the dosing interval.

PK/PD study design

  • Following 1-hour intravenous infusions of ZERBAXA 3 g (ceftolozane 2 g and tazobactam 1 g) or adjusted based on renal function every 8 hours in ventilated adult patients with confirmed or suspected pneumonia (N=22), mean pulmonary epithelial lining fluid-to-free plasma AUC ratios of ceftolozane and tazobactam were approximately 50% and 62%, respectively, and are similar to those in healthy subjects (approximately 61% and 63%, respectively) receiving ZERBAXA 1.5 g (ceftolozane 1 g and tazobactam 0.5 g)
  • Minimum ceftolozane and tazobactam epithelial lung lining fluid concentrations in ventilated subjects at the end of the dosing interval were 8.2 mcg/mL and 1.0 mcg/mL, respectively

Dosage for adult patients (18 years and older) with cIAI and cUTI with CrCl > 50 mL/min

Dosage for Patients with cIAI with CrCl Greater than 50 mL/min
Complicated intra-abdominal infectionsc
Dose (g) 1.5
Frequency Every 8 hours
Infusion time 1 hour
Duration of treatment 4 to 14 days

cUsed in conjunction with metronidazole 500 mg intravenously every 8 hours

Dosage for Patients with cUTI with CrCl Greater than 50 mL/min
Complicated urinary tract infections, including pyelonephritis
Dose (g) 1.5
Frequency Every 8 hours
Infusion time 1 hour
Duration of treatment 7 days

Dosage adjustments in adult patients (18 years and older) with renal impairment

Dose adjustment is required for patients with CrCl 50 mL/min or less. All doses of ZERBAXA are administered over 1 hour. For patients with changing renal function, monitor CrCl at least daily and adjust the dosage of ZERBAXA accordingly.

Renal dosing adjustments for adult patients (18 years and older) with cIAI and cUTI with CrCl 50 mL/min or less

  • 30 to 50750 mg (500 mg and 250 mg) intravenously every 8 hours
  • 15 to 29375 mg (250 mg and 125 mg) intravenously every 8 hours
  • For patients with end-stage renal disease (ESRD) on hemodialysis (HD): a single loading dose of 750 mg (500 mg and 250 mg) followed by a 150 mg (100 mg and 50 mg) maintenance dose administered every 8 hours for the remainder of the treatment period (on hemodialysis days, administer the dose at the earliest possible time following completion of dialysis).

Dosage for pediatric patients (birth to less than 18 years of age) with eGFRd greater than 50 mL/min/1.73 m2

Dosage for pediatric patients (birth to less than 18 years of age) with eGFRd greater than 50 mL/min/1.73 m2
Complicated intra-abdominal infectionse
Dose (g)30 mg/kg up to a maximum dose of 1.5 gf
FrequencyEvery 8 hours
Infusion time1 hour
Duration of treatment5 to 14 days
Dosage for pediatric patients (birth to less than 18 years of age) with eGFRd greater than 50 mL/min/1.73 m2
Complicated urinary tract infections, including pyelonephritis
Dose (g)30 mg/kg up to a maximum dose of 1.5 gf
FrequencyEvery 8 hours
Infusion time1 hour
Duration of treatment7 to 14 days

dEstimated GFR using an age-appropriate equation for use in the pediatric population

eUsed in conjunction with metronidazole

fPediatric patients weighing greater than 50 kg should not exceed a maximum dose of 1.5 g

Dosage adjustments in pediatric patients (birth to less than 18 years of age) with renal impairment

Dosage adjustment of ZERBAXA in pediatric patients (birth to less than 18 years of age) with eGFR 50 mL/min/1.73 m2 or less has not been determined.

ZERBAXA is not recommended in pediatric patients who have an eGFR 50 mL/ min/1.73m2 or less.

Dosing and billing guide


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Indications and Usage

ZERBAXA is indicated for the treatment of adult patients (18 years and older) with hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP), caused by the following susceptible Gram-negative microorganisms: Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Serratia marcescens.

ZERBAXA is indicated for the treatment of adult and pediatric patients (birth to less than 18 years old) with complicated urinary tract infections (cUTI), including pyelonephritis, caused by the following susceptible Gram-negative microorganisms: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa.

ZERBAXA used in combination with metronidazole is indicated for the treatment of adult and pediatric patients (birth to less than 18 years old) with complicated intra-abdominal infections (cIAI) caused by the following susceptible Gram-negative and Gram-positive microorganisms: Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Bacteroides fragilis, Streptococcus anginosus, Streptococcus constellatus, and Streptococcus salivarius.

Usage

To reduce the development of drug-resistant bacteria and maintain the effectiveness of ZERBAXA and other antibacterial drugs, ZERBAXA should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Important Safety Information

  • Patients with renal impairment: Decreased efficacy of ZERBAXA has been observed in patients with baseline CrCl of 30 to ≤50 mL/min. In a clinical trial of adult patients, patients with cIAIs with CrCl >50 mL/min had a clinical cure rate of 85.2% when treated with ZERBAXA plus metronidazole vs 87.9% when treated with meropenem. In the same trial, patients with CrCl 30 to ≤50 mL/min had a clinical cure rate of 47.8% when treated with ZERBAXA plus metronidazole vs 69.2% when treated with meropenem. A similar trend was also seen in the cUTI trial. Dose adjustment is required for adult patients with CrCl 50 mL/min or less. All doses of ZERBAXA are administered over 1 hour. Monitor CrCl at least daily in patients with changing renal function and adjust the dose of ZERBAXA accordingly.
  • Hypersensitivity: ZERBAXA is contraindicated in patients with known serious hypersensitivity to the components of ZERBAXA (ceftolozane/ tazobactam), piperacillin/tazobactam, or other members of the beta-lactam class. Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving beta-lactam antibacterials. Before initiating therapy with ZERBAXA, make careful inquiry about previous hypersensitivity reactions to cephalosporins, penicillins, or other beta-lactams. If an anaphylactic reaction to ZERBAXA occurs, discontinue use and institute appropriate therapy.
  • Clostridioides difficile-associated diarrhea (CDAD), ranging from mild diarrhea to fatal colitis, has been reported with nearly all systemic antibacterial agents, including ZERBAXA. Careful medical history is necessary because CDAD has been reported to occur more than 2 months after the administration of antibacterial agents. If CDAD is confirmed, antibacterial use not directed against C. difficile should be discontinued, if possible.
  • Development of drug-resistant bacteria: Prescribing ZERBAXA in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and risks the development of drug-resistant bacteria.
  • Adverse reactions in adult patients with HABP/VABP: The most common adverse reactions occurring in ≥5% of adult patients receiving ZERBAXA in the HABP/VABP trial were hepatic transaminase increased (11.9%), renal impairment/renal failure (8.9%), and diarrhea (6.4%).
  • Adverse reactions in adult patients with cIAI or cUTI: The most common adverse reactions occurring in ≥5% of adult patients receiving ZERBAXA in the cUTI and cIAI trials were headache (5.8%) in the cUTI trial, and nausea (7.9%), diarrhea (6.2%), and pyrexia (5.6%) in the cIAI trial.
  • Adverse reactions in pediatric patients with cIAI or cUTI: The most common adverse reactions occurring in ≥7% of pediatric patients receiving ZERBAXA in the cIAI trial were diarrhea (17%), thrombocytosis (16%), pyrexia (13%), abdominal pain (11%), vomiting (10%), increased aspartate aminotransferase (7%), and anemia (7%). The most common adverse reactions occurring in ≥7% of pediatric patients receiving ZERBAXA in the cUTI trial were thrombocytosis (9%), leukopenia (8%), diarrhea (7%), and pyrexia (7%).
  • Pediatric Use: There is insufficient information to recommend dosage adjustment for pediatric patients younger than 18 years of age with cIAI and cUTI with eGFR 50 mL/min/1.73m2 or less. ZERBAXA is not recommended in pediatric patients who have an eGFR 50 mL/min/1.73m2 or less. Pediatric patients born at term or pre-term may not have an eGFR of 50 mL/min/1.73m2 or greater at birth or within the first few months of life.

Before prescribing ZERBAXA, please read the accompanying Prescribing Information.

US-ZER-0146708/22