Aztreonam, the first monobactam antibiotic, represents a significant evolutionary advance in antimicrobial therapy. Aztreonam is stable in the presence of the hydrolytic beta-lactamase enzymes; as such, it is effective against most Gram-negative aerobes, including Pseudomonas aeruginosa, Escherichia coli, Klebsiella, and Enterobacter. Due to its specific spectrum of activity, aztreonam does not disturb the normal Gram-positive and anaerobic intestinal flora. The safety profile of aztreonam is superior: unlike the aminoglycosides, aztreonam does not cause nephrotoxicity or ototoxicity, and no routine monitoring of serum levels is required with its use. The pharmacokinetics of aztreonam after intravenous infusion or intramuscular dosing are presented as well as the dosage adjustments for hemodialysis and chronic ambulatory peritoneal dialysis (CAPD).
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