Ceftazidime is an antibacterial medication from the group of III generation cephalosporins, has a broad spectrum and bactericidal effect, violates the synthesis of the cell wall of microorganisms resistant to most beta-lactamases.
The drug is active against gram-negative organisms: Anavar pills Haemophillus influenzae, Neisseria gonorrhoeae and other Neisseria spp. and the majority of Enterobacteriaceae family (Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella pneumoniae and other Klebsiella spp., Morganella morganii and other Morganella spp., Proteus mirabilis (in t. h. indolpolozhitelny), Proteus vulgaris and other Proteus spp ., Providensia rettgeri other Providensia spp., and Serratia spp.), Acinetobacter spp., Haemophillus parainfluenzae (including the strains resistant to ampicillin), Pasteurella multocida, Salmonella spp., Shigella spp. and Yersinia enterocolitica.
Ceftazidime has the highest activity among the III generation cephalosporins against Pseudomonas aeruginosa in and in-hospital infection.
The drug is active against gram-positive bacteria: Micrococcus spp, Streptococcus aureus, Streptococcus mitis, Streptococcus pneumoniae, Streptococcus pyogenes group A, Streptococcus viridans, and other Streptococcus spp.. (Except Streptococcus faecalis); strains susceptible to methicillin: Staphylococcus aureus, Staphylococcus epidermidis.
Ceftazidime active against Anaerobic Bacteria:
Bacteroides spp. (Most strains Bacterioides fragilis – resistant), Clostridium perfingens, Peptococcus spp, Peptostreptococcus spp.. and Propionobacterium spp ..
The drug is not active against methicillin-resistant strains of Campilobacter spp, Chlamydia spp, Clostridium difficile, Enterococcus spp, Listeria monocytogenes and other Listeria spp, Staphylococcus aureus and Staphylococcus epidermidis….; Streptococcus faecalis.
After administration of the drug is rapidly distributed in the body and reach therapeutic concentrations in most tissues and fluids, including synovial, pericardial and peritoneal fluid and bile, urine and sputum.The distribution also occurs in bone, myocardium, gall bladder, skin and soft tissues in concentrations sufficient to treat infectious diseases, especially inflammatory processes, reinforcing the diffusion of the drug. Poorly penetrates the intact blood-brain barrier, but the drug achieved in cerebrospinal fluid levels sufficient for therapeutic treatment of meningitis.
Reversibly binds to plasma proteins (less than 15%), and only has a bactericidal action in free form. The degree of protein binding is concentration independent. The maximum concentration after intramuscular administration of 0.5 g or 1 g in 17 h, respectively equal ug / ml and 39 ug / ml, respectively, when administered intravenously 42 mg / ml and 69 ug / ml.
The time to reach maximum concentration when administered intramuscularly – 1 hour by intravenous injection – the end of infusion. Drug concentration equal to 4 g / ml is maintained for 6 – 8 hours Therapeutic plasma concentration is maintained for 8 – 12 h half-life with normal renal function – 1.8 h..; In case of violation – 2.2 hours.
The drug is not metabolized in the liver, the liver does not affect the pharmacodynamics and pharmacokinetics of the drug. The dose in these patients remained normal.
Excreted unchanged by the kidneys up to 80 – 90% (70% of the administered dose is excreted in the first 4 hours) throughout the day by glomerular filtration and tubular secretion equally. If the kidney function dose reduction is recommended.
The volume of distribution is 0.21 – 0.28 L / kg. The drug is accumulated in the soft tissues, kidneys, lungs, bones and joints, serous cavities.
Ceftazidime is assigned to adults and children for the treatment of the following infections caused by susceptible to malaria infections:
severe infections: meningitis; sepsis (septicemia); heavy purulent-septic conditions. bone and joint infections: septic arthritis, osteomyelitis, bacterial bursitis;
respiratory tract infections: acute and chronic bronchitis, infected bronchiectasis, pneumonia caused by Gram-negative bacteria, lung abscess, empyema;
Urinary tract infections: acute and chronic pyelonephritis, pyelitis, prostatitis, cystitis, urethritis (only bacteria), renal abscess;
Skin and soft tissue infections: mastitis, wound infections, skin ulcers, cellulitis, erysipelas, infected burns;
Gastrointestinal tract infections, abdominal and biliary tract: peritonitis, enterocolitis, retroperitoneal abscess, diverticulitis, inflammation of the pelvic organs, cholecystitis, cholangitis, empyema of the gall bladder;
infection of female genital mutilation;
ear infections, nose and throat: otitis media, sinusitis, mastoiditis, etc .;
gonorrhea (especially if you are sensitive to antibiotics of the penicillin group);
Hypersensitivity to cephalosporins and penicillins.
Pregnancy and lactation.
DOSAGE AND ADMINISTRATION
Ceftazidime is used only parenterally . Dose is determined individually, taking into account the severity of the disease, infection containment and susceptibility, age, body weight, anavar pills renal function.
The usual dose for adults and adolescents:
- in complicated urinary tract infections, intramuscular or intravenous injection of 500 mg – 1 g every 8-12 hours;
- in uncomplicated skin infections, pneumonia, intramuscularly or intravenously 500 mg – 1 g every 8 hours;
- cystic fibrosis, lung infections caused . Pseudomonas spp 100 to 150 mg / kg / day, frequency of administration – 3 times a day (dose application of up to 9 g / day in these patients did not cause complications);
- infections of joints and bones 2 g intravenously every 12 hours;
- with extremely severe or life-threatening infections, intravenous 2 g every 8 hours.Allergic reactions: rash, chills or fever, rash, pruritus, rarely – bronchospasm, eosinophilia, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell’s syndrome), angioedema, anaphylactic shock.From the digestive system: nausea, vomiting, diarrhea or constipation, bloating, abdominal pain, goiter, abnormal liver function (increased activity of “liver” transaminases, alkaline phosphatase, hypercreatininemia), rarely – stomatitis, glossitis, pseudomembranous enterocolitis.
From the side of hematopoiesis: leukopenia, neutropenia, granulocytopenia, thrombocytopenia, hemolytic anemia, anticoagulation.
From the urinary system: renal dysfunction (azotemia, increased blood urea), oliguria, anuria.
From the nervous system: headache, dizziness.
Local reactions: phlebitis, pain along the vein, pain and infiltration in the ground / m introduction.
Other: nasal bleeding, candidiasis, superinfection.
Symptoms of overdose:
Introduction inappropriately high doses of Ceftazidime drug may cause dizziness, paresthesia, headache, seizures, abnormalities in the results of laboratory tests.
Treatment of overdose:
Since there is no specific antidote, treatment with cephalosporin antibiotics overdose is symptomatic and supportive. In the case of severe overdose, when conservative therapy fails, the concentration of drug in the blood can be reduced by hemodialysis.
Interaction with other drugs
Pharmaceutically compatible with aminoglycosides, heparin, vancomycin. Can not be used with sodium bicarbonate solution as a solvent.
Loop diuretics, aminoglycosides, vancomycin, clindamycin ceftazidime reduce clearance, resulting in increased risk of nephrotoxicity.
Pharmaceutically compatible with the following solutions: a concentration of from 1 to 40 mg / ml – 0.9% sodium chloride, sodium lactate, Hartman’s solution, dextrose 5%, sodium chloride 0.225% and dextrose 5%, sodium chloride 0.45% and dextrose 5%, sodium chloride 0.9% and dextrose 5%, sodium chloride 0.18% and dextrose 4%, dextrose 10%, dextran 40: 10% sodium chloride solution, 0.9% dextran 40: 10% dextrose 5%, dextran 70: 6% sodium chloride solution, 0.9% dextran 70: 6% 5% dextrose solution.
At a concentration of 0.05 to 0.25 mg / ml ceftazidime compatible with intraperitoneal dialysis solution (lactate).
For i / m administration ceftazidime may be diluted with lidocaine hydrochloride 0.5% or 1%. Both components remain active if ceftazidime is added to the following solutions (concentration of ceftazidime 4 mg / mL) hydrocortisone (hydrocortisone sodium phosphate) 1 mg / ml in sodium chloride 0.9% or dextrose 5%, cefuroxime (cefuroxime sodium) 3mg / ml chloride 0.9% solution of sodium, cloxacillin (sodium cloxacillin) 4 mg / ml in sodium chloride 0.9%, heparin 10 IU / ml or 50 IU / ml in sodium chloride 0.9% potassium chloride, 10 mEq / liter or 40 mEq / l sodium chloride 0.9% solution. When mixing the ceftazidime solution (500 mg in 1.5 ml of water for injection) and metronidazole (500 mg / 100 ml), both components retain their activity.
In the presence of the following diseases or conditions, anavar pills you must carefully weigh the benefit-risk ratio for the patient:
- pregnancy and lactation;
- infants and children up to 1 month;
- bleeding in the anamnesis;
- A history of gastrointestinal disease, particularly ulcerative colitis;
In patients with a documented history of allergy to penicillin marked cross-hypersensitivity to cephalosporins in 3-7% of patients. Although many patients with an allergy to penicillin, which manifests itself in the form of a rash, cephalosporins used without adverse effects, it is advisable to use caution when assigning Ceftazidime drug.
All cephalosporins can interfere with the synthesis of vitamin K due to the suppression of the intestinal flora, which can cause a decrease in the level of vitamin K-dependent clotting factors, and in rare cases lead to gipotrombinemii and bleeding. Appointment of vitamin K quickly eliminates gipotrombinemiyu. In heavy, elderly and debilitated patients, in patients with impaired malnutrition and liver function in patients the risk of bleeding was highest.
Some patients during or after application of cephalosporins can develop pseudomembranous colitis caused by toxin Clostridium difficile . In mild cases enough to discontinuation of the drug, in more severe – it recommended the restoration of water-salt and protein balance, if these measures do not help, prescribe metronidazole, bacitracin, vancomycin.