The dose of the drug is set individually depending on the severity of the course of the disease, localization, the type of pathogen and its sensitivity to the drug, as well as the patient's age and function of the nights.
The drug is injected intravenously or deeply intramuscularly into the region of the upper-outer quadrant of the gluteus maximus or the lateral surface of the thigh.
A solution of ceftazidime can be injected directly into the vein or into the tube of the infusion system if the patient receives infusion therapy.
Adults and children with a body weight of 40 kg and more
1-6 g / day in 2 or 3 injections intravenously or intramuscularly.
- With bronchopulmonary bacterial infection in cystic fibrosis is prescribed by 100-150 mg / kg / day, in 3 administrations (the maximum daily dose is 9 g)1.
- With febrile neutropenia due to bacterial infection, nosocomial pneumonia, bacterial meningitis, bacteremia appoint 2 g every 8 hours.
- With infections of bones and joints, complicated infections of the skin and soft tissues, infections of the ENT organs, complicated intra-abdominal infections, peritonitis associated with holding hemo- and peritoneal dialysis and a continuous ambulatory peritoneal dialysis appoint 1-2 g every 8 hours.
- With infections of the gastrointestinal tract and bile ducts - 1 g every 8 hours or 2 g every 12 hours.
- In severe infections, especially in patients with reduced immunity (including patients with neutropenia), 2 g every 8 or 12 hours, or 3 g every 12 hours.
- With complicated infections urinary tract is recommended to inject 1-2 g every 8 or 12 hours.
- For the prevention of operations on the prostate gland (transurethral resection), Fortum is prescribed at a dose of 1 g during anesthesia and a second dose is administered when the catheter is removed.
Mode of prolonged infusion
With febrile neutropenia due to bacterial infection, bronchopulmonary bacterial infection in cystic fibrosis, nosocomial pneumonia, bacterial meningitis, bacteremia, infections of bones and joints, complicated skin and soft tissue infections, complicated intra-abdominal infections, peritonitis associated with hemo- and peritoneal dialysis and with continuous outpatient peritoneal dialysis Fortum is administered as a loading dose of 2 g followed by the introduction of the drug in the regime of prolonged infusion in doses of 4 to 6 g every 24 hours.
1 In adult patients with normal the kidney function with the administration of the drug in a dose of up to 9 grams per day, no side effects were observed.
Special patient groups
Children older than 2 months with a body weight of less than 40 kg
- With infections of the gastrointestinal tract and bile ducts 30-100 mg / kg / day in 2 or 3 injections
- With infections of the ENT organs: malignant external otitis, complicated infections of bones and joints, complicated infections of the skin and soft tissues, complicated intra-abdominal infections, peritonitis associated with hemo- and peritoneal dialysis and with continuous ambulatory peritoneal dialysis - 100-150 mg / kg / day in three injections, maximum - 6 g / day.
- With febrile neutropenia, bronchopulmonary bacterial infection in mukonecidosis, bacterial meningitis, severe infections such as septicemia, bacteremia, infections in patients with immunodeficiency 150 mg / kg / day in three injections, maximum - 6 g / day.
Mode of prolonged infusion
With febrile neutropenia due to bacterial infection, bronchopulmonary bacterial infection in cystic fibrosis, nosocomial pneumonia, bacterial meningitis, bacteremia, infections of bones and joints, complicated infections of the skin and soft tissues, complicated intra-abdominal infections, peritonitis associated with hemo- and peritoneal dialysis and with continuous outpatient peritoneal dialysis Fortum is administered as a loading dose of 60-100 mg / kg followed by the administration of the drug in the regime of prolonged infusion at a dose of 100-200 mg / kg / day, maximum 6 g / day.
Newborns aged 0 to 28 days and children between the ages of 28 days and up to 2 months
25-60 mg / kg / day in 2 injections.
Mode of prolonged infusion
Safety and efficacy of Fortum in the regime of prolonged infusion in newborns from 0 to 28 days and children from 28 days to 2 months have not been studied.
Elderly patients
Given the reduced ground clearance ceftazidime in elderly patients age, the recommended dose of ceftazidime should not exceed 3 g / day, especially in patients older than 80 years.
Patients with impaired renal function
Ceftazidime is excreted by the kidneys unchanged. Therefore, in patients with impaired renal function, the dose of ceftazidime should be reduced. The initial dose is 1 g. Supporting doses are selected depending on the values of creatinine clearance.
Adults and children with a body weight of 40 kg and more
Supportive doses of ceftazidime for patients with impaired renal function
| Clearance creatinine (ml / min)
| Concentration of creatinine and blood plasma, μmol / l (mg / dl) | Recommended single doses of ceftazidime (g) | Frequency administration of the drug
|
| >50 | < 150 (< 1,7) | standard doses |
| from 50 to 31 | 150 to 200 (from 1.7 to 2.3) | 1,0 | every 12 hours |
| from 30 to 16 | from 200 to 350 (2.3 to 4.0) | 1,0 | every 24 hours |
| 15 to 6 | from 350 to 500 (4.0 to 5.6) | 0,5 | every 24 hours |
| <5 | > 500 (> 5,6) | 0,5 | every 48 hours |
Patients with severe infections recommended one time dose should be increased by 50% or increased frequency of drug administration. These patients should be monitored concentration ceftazidime in plasma blood; the concentration of ceftazidime should not exceed 40 mg / l. For children, the clearance of creatinine is calculated according to fat-free body weight or body surface area.
Doses of ceftazidime for patients with impaired renal function - extended infusion
| Clearance creatinine (ml / min) | Creatinine concentrations in blood plasma, μmol / L (mg / dl) | Frequency of drug administration |
| from 50 to 31 | 150 to 200 (from 1.7 to 2.3) | The loading dose of 2 g followed by 1-3 g for 24 hours in the regime of extended infusion |
| from 30 to 16 | from 200 to 350 (2.3 to 4.0) | The loading dose of 2 g followed by 1 g for 24 hours in the regime of extended infusion |
| ≤ 15 | >350 (> 4,0) | Not yet rated |
Care should be taken when selecting a dose. A thorough clinical monitoring of the safety and effectiveness of the therapy is recommended.
Children with a body weight of less than 40 mg
Supportive doses of ceftazidime for patients with impaired renal function
| Clearance creatinine (ml / min) **
| Concentration of creatinine and blood plasma * μmol / l (mg / dL) | Featured single doses of ceftazidime mg / kg body weight
| Frequency introduction of preparation
|
| from 50 to 31 | 150 to 200 (from 1.7 to 2.3) | 25 | every 12 hours |
| from 30 to 16 | from 200 to 350 (2.3 to 4.0) | 25 | every 24 hours |
| 15 to 6 | from 350 to 500 (4.0 to 5.6) | 12,5 | every 24 hours |
| < 5 | >500 (> 5,6) | 12,5 | every 48 hours |
| * Concentrations of creatinine in blood plasma are indicative values that can not indicate the same degree of renal impairment for all patients. ** Calculated based on area body surface or measurements. |
Children with impaired renal function, the clearance of creatinine is calculated according to the surface area of the body or the fat-free body weight.
A thorough clinical monitoring of safety and effectiveness of the therapy.
Extended infusion regimen for patients with impaired renal function
The efficacy and safety of the Fortum drug, administered in the extended infusion regime in children with impaired function of noctums with a body weight of less than 40 kg, has not been studied. A thorough clinical monitoring of the safety and effectiveness of the therapy is recommended. If extended infusion is used in children with impaired renal function, creatinine clearance should be calculated according to body surface area or lean body mass.
Hemodialysis
During hemodialysis, the elimination half-life is 3-5 hours.
After each hemodialysis session, maintenance doses of ceftazidime are administered in accordance with the table above.
Peritoneal dialysis
Ceftazidime can be used during peritoneal dialysis and continuous ambulatory peritoneal dialysis. In addition to intravenous introduction, ceftazidime can be added to the dialysis solution (usually at a dose of 125-250 mg per 2 liters of dialysate solution).
For patients with renal failure who are on continuous hemodialysis using an arteriovenous shunt, or for patients on high-speed haemofiltration in the intensive care unit, the recommended dose is 1 g / day daily (one or more introductions).
For patients who are on hemofiltration at a low rate, the same doses of the drug are recommended, as in the case of impaired renal function. Patients on hemodialysis or haemofiltration using a veno-venous shunt are recommended doses shown in the tables below.
Doses of ceftazidime in patients on hemofiltration using a veno-venous shunt
| Creatinine clearance (ml / min) | Maintenance dose (mg) depending on the rate of ultrafiltration (ml / min) * |
| | 5 | 16,7 | 33,3 | 50 |
| 0 | 250 | 250 | 500 | 500 |
| 5 | 250 | 250 | 500 | 500 |
| 10 | 250 | 500 | 500 | 750 |
| 15 | 250 | 500 | 500 | 750 |
| 20 | 500 | 500 | 500 | 750 |
* A maintenance dose is given every 12 hours.
Doses of ceftazidime in patients on continuous hemodialysis using a veno-venous shunt
| Creatinine clearance (ml / min) | Maintenance dose (mg) depending on the rate of dialysis * |
| | 1.0 l / h | 2.0 l / h |
| Rate of ultrafiltration (l / h) | Rate of ultrafiltration (l / h) |
| 0,5 | 1,0 | 2,0 | 0,5 | 1.0 | 2,0 |
| 0 | 500 | 500 | 500 | 500 | 500 | 750 |
| 5 | 500 | 500 | 750 | 500 | 500 | 750 |
| 10 | 500 | 500 | 750 | 500 | 750 | 1000 |
| 15 | 500 | 750 | 750 | 750 | 750 | 1000 |
| 20 | 750 | 750 | 1000 | 750 | 750 | 1000 |
* A maintenance dose is given every 12 hours.
Patients with impaired hepatic function
According to available data, there is no need for correction of the dosing regimen in patients with mild to moderate liver function impairment. There are no results of studies involving patients with impaired hepatic function.A thorough clinical monitoring of the safety and efficacy of the therapy is recommended.
Instructions for preparing a solution
Fortum powder in the form of a powder for injection solution is in vials under reduced pressure. When the powder is dissolved, carbon dioxide is liberated and the pressure in the vial is increased, so small bubbles of carbon dioxide may be present in the resulting prepared drug solution, which can be ignored.
| Number of ceftazidime in vial | Method of administration | Number of solvent (ml) | Nearconcentration (mg / ml) |
| 250 mg | at/m | 1.0 ml | 210 |
| in / in | 2.5 ml | 90 |
| 500 mg | at/m | 1.5 ml | 260 |
| in / in | 5.0 ml | 90 |
| 1 g | w / m | 3.0 ml | 260 |
| IV bolus | 10.0 ml | 90 |
| IV infusion | 50.0 ml * | 20 |
| 2 grams | IV bolus | 10.0 ml | 170 |
| IV infusion | 50.0 ml * | 40 |
Adding solvent spend in 2 introduction.
A drug Fortum is compatible with most of the most common solutions for intravenous administration, but sodium bicarbonate is not recommended at As a solvent (see section "Interaction from other medicinal products ").
Depending on the concentration, type of solvent and storage conditions, the resulting solution preparation Fortum can have a color from light yellow to dark yellow. If the rules of dilution of the drug are observed, then its effectiveness does not depend on the shade of the solution.
Ceftazidime in a concentration of 1 mg / ml to 40 mg / ml is compatible with the following solvents:
- 0.9% solution of sodium chloride;
- Hartman's solution;
- 5% dextrose solution;
- 0.225% sodium chloride solution and 5% dextrose solution;
- 0.45% sodium chloride solution and 5% dextrose solution:
- 0.9% solution of sodium chloride and 5% solution of dextrose;
- 0.18% sodium chloride solution and 4% dextrose solution;
- 10% dextrose solution;
- dextran 40 for injection of 10% in a 0.9% solution of sodium chloride;
- dextran 40 for injection of 10% in a 5% solution of dextrose;
- dextran 70 for injection of 6% in a 0.9% solution of sodium chloride;
- dextran 70 for injection of 6% in a 5% dextrose solution.
Ceftazidime in a concentration of 0.05 mg / ml to 0.25 mg / ml is compatible with the solution for intraperitoneal dialysis (lactate).
For intramuscular injection adults ceftazidime can be diluted with 0.5% or 1% lidocaine solution.
If ceftazidime in a concentration of 4 mg / ml is mixed with the following solutions, both components retain activity:
- hydrocortisone (hydrocortisone sodium phosphate) 1 mg / ml in a 0.9% solution of sodium chloride or 5% solution of dextrose;
- cefuroxime (cefuroxime sodium salt) 3 mg / ml in 0.9% solution sodium chloride;
- cloxacillin (cloxacillin sodium salt) 4 mg / ml in a 0.9% solution of sodium chloride;
- heparin 10 IU / ml or 50 IU / ml in a 0.9% solution of sodium chloride;
- potassium chloride 10 mEq / L or 40 mEq / L in a 0.9% solution of sodium chloride. When mixing a solution of ceftazidime (500 mg in 1.5 ml of water for injection) and metronidazole (500 mg at 100 ml), both components remain active.
Preparation of a solution for intramuscular or intravenous bolus administration
1. Insert the syringe needle into the vial through the rubber stopper and add the recommended amount of solvent through it.
2. Remove the syringe needle and shake the vial to get a clear solution.
3. Flip the bottle. With a piston fully inserted into the syringe, pierce the rubber plug of the vial with a needle and move it forward needle in the bottle so that it is in solution. Collect the entire solution in a syringe. The solution in width can contain small bubbles of carbon dioxide.
Preparation of a solution for intravenous infusions (vials of 1 g and 2 g)
1. Insert the syringe needle into the vial through a rubber stopper and add 10 ml of solvent through it.
2. Take out the needle of the syringe and shake the vial to make a clear solution.
3. Insert the gas mist into the vial through the rubber stopper to reduce the internal pressure in the vial.
4. Transfer cooked solution into the infusion system, bringing the total volume to at least 50 ml. Enter by intravenous infusion for 15-30 minutes.
To ensure sterility, it is important not to inject the gas outlet needle into the bottle until the powder dissolves.