Ceftazidime–Avibactam in Pediatric Practice: A Narrative Review of Pharmacology, Clinical Evidence, and Future Directions

Abstract

Context: Multidrug-resistant (MDR) Gram-negative infections pose a major therapeutic challenge in pediatric populations, particularly among critically ill and immunocompromised children. Ceftazidime–avibactam (CZA), a combination of a third-generation cephalosporin and a non–β-lactam β-lactamase inhibitor, has emerged as a promising option for treating infections caused by carbapenem-resistant Enterobacterales and MDR Pseudomonas aeruginosa. However, pediatric data remain limited. This narrative review summarizes the current evidence on the pharmacology, clinical efficacy, safety, and therapeutic role of CZA in children, with particular emphasis on neonates, hematology–oncology patients, and other high-risk pediatric groups. Evidence Acquisition: A structured narrative literature search was conducted in PubMed/MEDLINE, Scopus, and Embase from database inception through March 31, 2025, including pediatric clinical trials, pharmacokinetic studies, observational cohort studies, case series, and relevant case reports involving ceftazidime–avibactam. Data were synthesized descriptively under predefined thematic headings. Results: CZA demonstrates potent activity against KPC-, OXA-48-, and extended-spectrum β-lactamase (ESBL)-producing organisms; however, it lacks efficacy against metallo-β-lactamase (MBL)-producing strains. Pediatric studies confirm that standard weight-based dosing (50 mg/kg ceftazidime + 12.5 mg/kg avibactam every 8 h) achieves therapeutic plasma concentrations and favorable clinical outcomes. Microbiological eradication rates of ≥ 80% have been reported in selected small and heterogeneous observational cohorts; however, these estimates should be interpreted cautiously because of limited sample sizes, variable infection types, and noncomparative study designs. Reported adverse events have generally been mild gastrointestinal events or transient hepatic events in short-term pediatric studies; however, long-term safety data remain limited. Conclusions: CZA may represent an important targeted therapeutic option for selected pediatric patients with MDR Gram-negative infections, particularly when activity is confirmed by susceptibility testing and its use is guided by antimicrobial stewardship principles and specialist input. Although available real-world and pharmacokinetic data are encouraging, further randomized controlled trials, neonatal dosing studies, and long-term safety evaluations are needed to better define its optimal role in pediatric infectious disease practice.