Aztreonam is a parenterally administered, synthetic monobactam antibiotic that is specifically active against aerobic gram-negative bacilli is resistant to many beta-lactamases. Aztreonam therapy is often accompanied by mild, asymptomatic elevations in serum aminotransferase levels, but it has not been reported to cause clinically apparent liver injury.


Aztreonam (az tree' oh nam) is a monocyclic beta-lactam compound (monobactam) that was originally isolated from Chromobacterium violaceum. It acts by binding to penicillin binding proteins inhibiting cell wall synthesis and decreasing bacterial growth. Aztreonam is active mostly against gram negative organisms and more closely resembles aminoglycosides rather than penicillins. Aztreonam was approved for use in the United States in 1986 and is indicated in the treatment of various moderate-to-severe systemic or skin, intra-abdominal, genitourinary, and respiratory gram-negative infections. Aztreonam is available in generic forms and under the brand name Azactam as a powder or a solution for injection, and under the brand name Cayston as a powder for solution to use in inhalational therapy. The recommended dosage is 0.5 to 2 g by intravenous or intramuscular injection every 8 to 12 hours, typically for 5 to 14 days. The most common side effects of aztreonam are injection site phlebitis, rash and gastrointestinal symptoms.


Aztreonam has systemic toxicities that are similar to those of other beta lactam antibiotics, but it is unclear whether it can cause hepatic injury similar to that of the penicillins or cephalosporins. Asymptomatic serum aminotransferase elevations are common during high dose, intravenous aztreonam therapy (10% to 38%). The enzyme abnormalities are usually mild-to-moderate, asymptomatic, self-limited and not requiring drug discontinuation. Enzyme elevations occur slightly more commonly during aztreonam therapy than with other comparative antibiotics. Cases of frank liver injury and jaundice attributable to aztreonam must be extremely rare as no individual cases have been reported. For this reason, there is no data regarding the latency or pattern of the injury. Instances of marked aminotransferase elevations within 3 to 5 days of starting aztreonam have been reported, but these cases were without jaundice and resolved rapidly once the drug was stopped.

Likelihood score: E (unlikely cause of clinically apparent liver injury).

Mechanism of injury

Aztreonam has little hepatic metabolism and is excreted rapidly and largely unchanged in the urine, perhaps explaining the lack of hepatotoxicity associated with its use.

Outcome and Management

In the majority of cases, aztreonam induced liver injury appears to be transient, mild and asymptomatic, being marked by serum enzyme elevations only. Full recovery is expected after stopping the medication.

Drug Class: Antiinfective Agents



Aztreonam – Azactam®


Antiinfective Agents


Product labeling at DailyMed, National Library of Medicine, NIH



References updated: 02 August 2017

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