Application in adults
In adults, Sulmover® is recommended to be used in a daily dose of 2-4 g. In severe or refractory infections, the daily dose of the drug can be increased to 8 g. Since the recommended maximum daily dose of sulbactam is 4 g, patients receiving Sulmover® in severe infections may require additional administration of cefoperazone.
The dose should be divided into equal parts and administered every 12 hours.
Application for violations of the liver and kidneys
In patients with creatinine clearance of 15-30 ml / min, the maximum dose of sulbactam is 1 g every 12 hours (maximum daily dose of sulbactam 2 g), and in patients with creatinine clearance less than 15 ml / min the maximum dose of sulbactam is 500 mg every 12 hours the maximum daily dose of sulbactam 1 g). In severe infections, additional administration of cefoperazone may be required.
With hemodialysis, the pharmacokinetics of sulbactam significantly change and the half-life of cefoperazone from the serum decreases slightly. Therefore, the administration of Sulmover® should be performed after dialysis.
In patients with impaired liver function and concomitant renal dysfunction, monitoring the serum concentration of cefoperazone and correcting its dose should be necessary.If regular monitoring of serum concentration of cefoperazone in such cases is not carried out, then its daily dose should not exceed 2 g.
Application the children
In children, Sulmover® is recommended to be used in a daily dose of 40-80 mg / kg per day. The maximum daily dose of sulbactam in children should not exceed 80 mg / kg per day. In severe or refractory infections, the dose of the drug can be increased to 160 mg / kg per day.
The dose should be divided into equal parts and administered every 6-12 hours. In newborns during the first week of life, the drug should be injected every 12 hours.
Method of preparing a solution for parenteral use
Sulmover® is compatible with water for injection, 5% dextrose solution, 0.9% sodium chloride solution, 5% dextrose solution in 0.225% sodium chloride solution and 5% dextrose solution in 0.9% sodium chloride solution in concentrations from 10 mg / ml of cefoperazone and 5 mg / ml of sulbactam to 250 mg / ml, respectively.
| Total dose (g) | Equivalent doses of sulbactam + cefoperazone (d) | Minimum volume of solvent, ml | Maximum final concentration (mg / ml) |
| 0,5 | 0,25 + 0,25 | 2 | 125 + 125 |
| 1,0 | 0,5 + 0,5 | 4 | 125 + 125 |
| 1,5 | 0,75 + 0,75 | 6 | 125 + 125 |
| 3,0 | 1,5 + 1,5 | 12 | 125 + 125 |
| 4,0 | 2,0 + 2,0 | 16 | 125 + 125 |
Intravenous administration.
For intravenous bolus administration (intravenous injection), the contents of the vial are dissolved in 20 ml of the solvent and injected for a minimum of 3 minutes.For intravenous infusion administration, the preparation is dissolved, as indicated above, diluted to 50-100 ml, using for dilution any of these solvents except for water for injection, and injected for 30-60 minutes.
To prepare a solution for intravenous infusion, Ringer's lactate solution can be used, but it can not be used to initially dissolve the powder, given the incompatibility of this mixture. Compatibility can be achieved by a two-stage solution preparation: first use sterile water for injection (see table above) and then dilute the resulting solution with Ringer's lactate solution to a concentration of 5 mg / ml of sulbactam (2 ml of the initial solution is diluted in 50 ml Ringer's solution lactate or 4 ml in 100 ml Ringer's solution of lactate).
Intramuscular injection
To prepare the solution for intramuscular injection, use sterile water for injection. You can also use a 2% solution of lidocaine, but it can not be used to initially dissolve the powder, given their incompatibility. The solution containing cefoperazone in a concentration of 250 mg / ml or more, is prepared in two steps: first, use sterile water for injection (see Table.above), then diluted with 2% lidocaine solution to obtain a 0.5% lidocaine solution.