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By Hans P. Schlecht, MD, MSc; Christopher Bruno, MD

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Monobactams are parenteral β-lactam bactericidal antibiotics.

Aztreonam is currently the only available monobactam. Aztreonam is as active as ceftazidime against

  • Enterobacteriaceae that do not produce ampC β-lactamase or extended-spectrum β-lactamase (ESBL)

  • Pseudomonas aeruginosa

Aztreonam is not active against anaerobes. Gram-positive bacteria are resistant to aztreonam (in contrast to cephalosporins). Aztreonam acts synergistically with aminoglycosides.

Because the metabolic products of aztreonam differ from those of other β-lactams, cross-hypersensitivity is unlikely. Thus, aztreonam is used mainly for

  • Severe aerobic gram-negative bacillary infections, including meningitis, in patients who have a serious β-lactam allergy but who nevertheless require β-lactam therapy

Other antibiotics are added to cover any suspected gram-positive cocci and anaerobes.

The dose is reduced in renal failure.

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