Cefotaxime - instructions for use, dose, side effects, contraindications

Pharmacodynamics:Cephalosporin antibiotic III generation for parenteral administration. It acts bactericidal, disrupting the synthesis of the mucopeptide of the cell wall of microorganisms. Has a wide range of action. It is active against Gram-positive and Gram-negative microorganisms resistant to other antibiotics: Staphylococcus spp. (including Staphylococcus aureus, including penicillinase-producing strains), Staphylococcus epidermidis (with the exception of Staphylococcus epidermidis and Staphylococcus aureus, methicillin-resistant), Streptococcus pneumoniae, Streptococcus pyogenes (group A beta-hemolytic streptococci), Streptococcus agalactiae (Group B streptococci ), Enterococcus spp., Enterobacter spp., Escherichia coli, Haemophilus influenzae (including strains forming penicillinase), Haemophilus parainfluenzae, Moraxelia catarrhalis, Klebsiella spp.(including Klebsiella pneumoniae, Klebsiella oxytoca), Morganella morganii, Neisseria gonorrhoeae (including strains forming penicillinase), Acinetobacter spp., Corynebacterium diphtheriae, Erysipelothrix rhusiopathiae, Eubacter spp., Propionibacterium spp :, Clostridium spp. (including Clostridium perfringens), Citrobacter spp., Proteus mirabilis, Proteus vulgaris, Providencia spp. (including Providencia rettgeri), Serratia spp., some strains of Pseudomonas aeruginosa, Neisseria meningitidis, Neisseria gonorrhoeae, Bacteroides spp. (including some strains of Bacteroides fragilis), Fusobacterium spp. (including Fusobacterium nucleatum), Peptococcus spp., Peptostreptococcus spp. Some strains of Pseudomonas aeruginosa, Acinetobacter, Helicobacter pylori, Bacteroides fragilis, Clostridium, difficile are not permanently affected. Resistant to most beta-lactamases of gram-positive and gram-negative microorganisms.

Pharmacokinetics:After a single intravenous injection at doses of 0.5, 1 and 2 g, the time to reach the maximum concentration (Cmax) is 5 minutes, Cmax is 39, 101.7 and 214 μg / ml, respectively. After intramuscular injection at doses of 0.5 and 1 g, the time to reach Cmax is -0.5 hours, and is 11 and 21 μg / ml, respectively. The connection with plasma proteins is 30-50%. Bioavailability is 90-95%. Creates therapeutic concentrations in most tissues (myocardium, bones, gallbladder, skin, soft tissues) and fluids (synovial, pericardial, pleural, sputum, bile, urine, cerebrospinal fluid) of the body. The volume of distribution is 0.25-0.39 l / kg. The half-life (T1 / 2) is 1 hour for intravenous administration and 1-1.5 hours for intramuscular injection. It is excreted by the kidneys, 20-36% - unchanged,the rest is in the form of metabolites (15-25% in the form of pharmacologically active deacetylcefotaxime and 20-25% in the form of 2 inactive metabolites). In chronic renal failure and in elderly people, T1 / 2 increases by 2 times. T1 / 2 in newborns - 0,75-1,5 h, in preterm infants (body weight less than 1500 g) increases to 4.6 h; in children with a body weight of more than 1500 g - 3.4 h. With repeated intravenous doses of 1 g every 6 hours for 14 days of cumulation is not observed. Cefotaxime passes through the placenta, in small concentrations penetrates into breast milk.

Indications:Bacterial infections of severe course caused by sensitive microorganisms: infections of the central nervous system (meningitis), lower respiratory tract and LOP organs, urinary tract, bones, joints, skin and soft tissues, pelvic organs, peritonitis, sepsis, endocarditis; gonorrhea; infected wounds and burns; abdominal infections, salmonellosis, Lyme disease, infections on the background of immunodeficiency, prevention of infections after surgery (including urological, obstetric-gynecological, on the organs of the gastrointestinal tract).

Contraindications:

- hypersensitivity (including penicillins, other cephalosporins, carbapenems);

- Pregnancy;

- Children's age of up to 2.5 years (for intramuscular injection).

Carefully:

in the period of newborn;

during lactation (in small concentrations is excreted with milk);

with chronic renal failure;

with nonspecific ulcerative colitis (including anamnesis).

Dosing and Administration:

The drug is administered intravenously (jet or drip) and intramuscularly. Adults and children over 12 years of age (with a body weight of 50 kg or more): for uncomplicated infections, as well as for infections of the urinary tract, either intramuscularly or intravenously, 1 g every 8-12 hours; with uncomplicated acute gonorrhea - intramuscularly, 1 g once; at infections of average gravity - intramuscularly or intravenously, 1-2 g every 12 h; in severe infections, for example, with meningitis - intravenously, 2 g every 4-8 hours, the maximum daily dose is 12 g. The duration of treatment is set individually.

With the purpose of preventing the development of infections before the surgical operation is introduced during the initial anesthesia once 1 g.If necessary, the administration is repeated after 6-12 hours. With caesarean section - at the time of imposition of the clamps on the umbilical vein - intravenously, 1 g, then 6 and 12 hours after the first dose - 1 g additionally.

With a creatinine clearance of 20 ml / min / 1.73 m2 or less, the daily dose is reduced by a factor of 2.

Premature and newborn before 1 week - intravenously, 50 mg / kg every 12 hours; at the age of 1-4 weeks - intravenously, 50 mg / kg every 8 hours; children weighing up to 50 kg-intravenously or intramuscularly, 50-180 mg / kg in 4-6 injections. In severe infections, including meningitis, the daily dose to children is increased to 100-200 mg / kg. intramuscularly or intravenously, in 4-6 receptions, the maximum daily dose is 12 g.

Rules for the preparation of injection solutions:

- for intravenous injection, water for injection is used as a solvent (0.5-1 g diluted in 4 ml of solvent, 2 g in 10 ml); the drug is injected slowly for 3-5 minutes.

- for intravenous infusion 0.9% NaCl solution or 5% dextrose solution is used as a solvent (1-2 g diluted in 50-100 ml of solvent). Duration of infusion - 50-60 minutes;

- for intramuscular injection water for injection or 1% lidocaine solution (for a dose of 0.5 g - 2 ml, for a dose of 1 g - 4 ml).

Side effects:

Allergic reactions: urticaria, chills or fever, rash, itchy skin, rarely - bronchospasm, eosinophilia, malignant exudative erythema (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome). angioedema, anaphylactic shock.

From the central nervous system: headache, dizziness.

From the urinary system: disturbance of kidney function, oliguria, interstitial nephritis.

From the gastrointestinal tract: nausea, vomiting, diarrhea or constipation, flatulence, abdominal pain, dysbiosis, impaired liver function, rarely - stomatitis, glossitis, pseudomembranous enterocolitis.

From the hematopoiesis: hemolytic anemia, leukopenia, neutropenia, granulocytopenia, thrombocytopenia, agranulocytosis, hypocoagulation.

From the cardiovascular system: potentially life-threatening arrhythmias after a rapid bolus injection into the central vein.

Laboratory indicators: azotemia, increased urea concentration in the blood, increased activity of "liver" transaminases and alkaline phosphatase, hypercreatininemia, hyperbilirubinemia, Coombs positive reaction.

Local reactions: phlebitis, soreness along the vein, soreness and infiltration at the site of intramuscular injection.

Other: superinfection (in particular, vaginal and oral candidiasis).

Overdose:Symptoms: seizures, encephalopathy (in the case of high doses, especially in patients with renal insufficiency), tremor, neuromuscular excitability. Treatment: symptomatic, there is no specific antidote.

Interaction:

- increases the risk of bleeding when combined with antiaggregants, non-steroidal anti-inflammatory drugs;

- the probability of kidney damage increases with the simultaneous administration of aminoglycosides, polymyxin B and "loop" diuretics;

- drugs that block tubular secretion, increase plasma concentrations of cefotaxime and slow its elimination;

- Pharmaceutically incompatible with solutions of other antibiotics in one syringe or dropper.

Special instructions:

- in the first weeks of treatment, pseudomembranous colitis can occur, which is manifested by severe prolonged diarrhea. At the same time, stop taking the drug and prescribe adequate therapy, including vancomycin or metronidazole; patients who had a history of allergic reactions to penicillins, may have increased sensitivity to cephalosporin antibiotics;

- when treating with a drug for more than 10 days, monitoring of the peripheral blood pattern is necessary. During treatment with cefotaxime, it is possible to obtain a false-positive Coombs test and a false positive urine reaction to glucose;

- if it is necessary to prescribe the drug during lactation, breastfeeding should be stopped;

- during treatment can not be used ethanol - possible effects similar to the action of disulfiram (facial hyperemia, stomach and stomach spasm, nausea, vomiting, headache, lowering blood pressure, tachycardia, dyspnea).

Form release / dosage:

Powder for the preparation of solution for intravenous and intramuscular injection of 0.5 g or 1.0 g.

Packaging:

Powder for the preparation of a solution for intravenous and intramuscular injection of 0.5 g or 1.0 g of cefotaxime in bottles with a capacity of 10 ml. Each bottle is placed in a pack of cardboard.

Packing for hospitals: 40 bottles in a cardboard box.

Storage conditions:

List B. Store in a dry, protected from light place at a temperature of no higher than 25 ° C.Keep out of the reach of children.

Shelf life:

2 years. Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LSR-006468/09

Date of registration:13.08.2009

The owner of the registration certificate:BELMEDPREPARATY, RUP BELMEDPREPARATY, RUP Republic of Belarus

Manufacturer: & nbsp

BELMEDPREPARATY, RUP Republic of Belarus

Information update date: & nbsp02.11.2015

Illustrated instructions

Instructions

Cefotaxime (Cefotaxime)