Ceftazidime

Ceftazidim is a subcategory of 3rd generation cephalosporins; This substance has the highest antibacterial effect relative to Pseudomonas aeruginosa and pathogens of nosocomial infections. At the same time, having a large spectrum of drug activity, it is used for severe infections in situations when it has not yet been able to detect the causative agent of pathology. It is recommended that this drug be administered for nosocomial lesions.

[1], [2], [3], [4], [5]

Indications Ceftazidime

It is used in the case of severe stages of infectious-inflammatory pathologies, which are caused by the activity of bacteria-sensitive bacteria:

• lesions affecting the organs in the pelvic area;
• sepsis, peritonitis or cholangitis;
• pneumonia ;
• empyema affecting the gallbladder;
• infections of the epidermis, bones, subcutaneous tissues and joints;
• pulmonary abscess;
• pleural empyema;
• pyelonephritis;
• renal abscess;
• Infected wounds or burns.

At the same time, the medication is prescribed for severe stages of infectious-inflammatory diseases in people with weakened immunity and for infections that occurred during hemodialysis or peritoneal dialysis.

[6]

Release form

The release of the drug substance is implemented in the form of a lyophilisate for intramuscular and intravenous injections. Inside the box - 10 or 50 bottles with powder.

[7], [8]

Pharmacodynamics

The drug demonstrates a bactericidal effect, destroying the binding of the constituent elements of the cell walls, because of which the membranes lose their resistance, and the microbial cell dies. Ceftazidime shows resistance to most β-lactamases.

With respect to the drug sensitive microbial strains: Sticks influenza, Klebsiella, E. Coli with Neisseria, Proteus, atsinetobaktery with tsitrobakter, Salmonella, Enterobacter, Providencia and Serratia, and besides Morganella, Shigella, Haemophilus parainfluenza with staphylococci (among them gold) and yersinii. In addition, the list includes bacteroids, clostridia, streptococci with peptococci, as well as micrococci, peptostreptokokki with propionibakteriyami and hemolytic streptococci subcategory A.

Resistance is demonstrated by: enterococci, chlamydia, epidermal staphylococci, capilobacteria with frateris bacteroids, fecal streptococci, listeria, golden staphylococci (resistant to methicillin) and clostridium differential.

[9], [10], [11], [12], [13], [14], [15], [16],

Pharmacokinetics

With intramuscular medication in portions of 0.5 and 1 g, the level of its Cmax is 17, respectively, and 39 mg / l. Reaches TCmax values after 1 hour. In the case of intravenous administration of the same dosages, the Cmax values are 42 and 69 mg / l, respectively.

Effective drug drug values inside the serum during parenteral injection are stored within 8-12 hours. The rate of synthesis with proteins is less than 10%.

The level of the drug, exceeding the minimum inhibitory performance relative to the majority of pathogenic bacteria that are sensitive to the drug, is noted inside the bile, sputum, bone and cardiac tissue, synovia, pleural, peritoneal and intraocular fluids.

Without complications overcomes the placenta and is noted inside the mother's milk. If there is no inflammation, it will be difficult for the drug substance to pass through the BBB.

Inside the cerebrospinal fluid, the indicators of drugs with meningitis are medically effective and are 4–20 mg / l or higher. The term half-life in an adult is 1.9 hours. In newborn babies, it is three times as long / four times as long. In the case of hemodialysis, this figure is 3-5 hours. In the intrahepatic metabolic processes is not involved.

Excreted through the kidneys per day, with the help of KF. At the same time 80-90% of the substance is displayed unchanged. Even less than 1% is excreted in the bile.

[17], [18], [19], [20]

Dosing and administration

Ceftazidime can be administered exclusively intramuscularly or intravenously.

For adults, apply 1 g of substance with 8-12-hour intervals. A regimen can be used in which 2 g of the drug is administered in a 12-hour interval. In severe stages of infection, especially with a weakened immunity (among those with neutropenia), use 2 g of the drug with 8-hour breaks.

In the case of lesions of the urethra, 0.25 g of the drug is injected 2 times a day.

In cystic fibrosis and infections of the respiratory system caused by the action of pseudomonads, it is necessary to administer 30-50 mg / kg of the drug at 8-hour intervals.

In the case of operations on the prostate, 1 g Ceftazidime is used for prophylaxis before the introduction of anesthesia, duplicating this injection after removing the catheter.

Older people can enter a maximum of 3 g of medicine per day.

Infants older than 2 months of age should use 30–50 mg / kg per day, which is divided into 3 injections. During the day, a maximum of 6 g of the substance is allowed.

Immunocompromised children, as well as cystic fibrosis or meningitis, are given 0.15 g / kg per day, divided into 3 injections. A day is allowed to use a maximum of 6 g of drugs.

For newborns younger than 2 months of age, a dose of 30 mg / kg per day is used, divided into 2 injections (used with extreme caution).

Persons with kidney disease should begin treatment with a portion of 1 g of drugs. Next, use a maintenance dosage, the size of which depends on the rate of excretion of the drug:

• QC values in the range of 50-31 th ml per minute - 1 g 2-fold per day;
• QC level within 30-16 ml per minute - 1 g 1 time per day;
• KK indicator in the range of 15-6 ml per minute - 0.5-1 g of the substance 1 time per day;
• QC level below 5 ml per minute - 0.5-1 g with a 48-hour break.

For people with a severe stage of infection, a 1-fold portion of the drug can be doubled, while keeping track of its blood parameters, which should be within 40 mg / l.

In the case of hemodialysis, support portions of the drug are used, taking into account the level of CC; injections should be done after the procedure. With the passage of peritoneal dialysis sessions, in addition to intravenous injections, the drug can be included in the dialysis fluid (0.125-0.25 g of the substance per 2 liters of fluid).

Persons with renal failure undergoing continuous hemodialysis using an AV shunt, and in addition, people who undergo high-speed hemofiltration sessions are given 1 g of medication per 24 hours. If hemofiltration occurs at low speed, portions are administered, which are prescribed for renal diseases.

To make an intramuscular liquid, the lyophilisate is diluted in a solvent (1-3 ml); in the manufacture of intravenous fluid requires 2.5-10 ml of solvent; for infusion - 50 ml. The small bubbles that appear in the finished solution are carbon dioxide; they do not affect the drug activity of Ceftazidime (gas elimination may be necessary), as well as the yellowing of the liquid. Only freshly prepared liquid can be used for administration.

[26], [27], [28], [29], [30]

Use Ceftazidime during pregnancy

Use of Ceftazidime during pregnancy is allowed only when absolutely necessary.

At the time of treatment with medication you need to stop breastfeeding.

[21], [22], [23]

Contraindications

It is contraindicated to be prescribed to persons with a history of intolerance to drugs or other cephalosporins.

Caution is required in such cases:

• pathologies associated with the digestive tract;
• renal failure;
• combined use with aminoglycosides or diuretic drugs loop type.

[24]

Side effects Ceftazidime

Among the adverse events:

• CNS function disorders: seizures, convulsions, encephalopathy, headaches, fluttering tremor, paresthesia and dizziness;
• problems with the work of the urogenital system: the toxic nature of nephropathy, renal dysfunction and candidal vaginitis;
• disorders of hematopoietic processes: hemorrhages, lymphocytosis, neutro-, thrombocyto-or leukopenia and hemolytic anemia;
• gastrointestinal lesions: cholestasis, abdominal pain, nausea, diarrhea, oropharyngeal candidiasis, vomiting and colitis;
• local symptoms: phlebitis (in the case of intravenous administration), pain, burning sensation and thickening in the injection area (in the case of intramuscular administration);
• signs of allergy: urticaria, SSD, angioedema, eosinophilia, anaphylaxis, fever, PET, and bronchospasm;
• change in test results: an increase in urea, indicators of PTV and liver enzyme activity, and in addition hypercreatininemia or bilirubinemia and false-positive data (urine sugar test and Coombs test).

[25],

Overdose

If poisoning drug may cause dizziness, paresthesia, headaches, inflammation, phlebitis and pain in the injection zone, and in addition, or hyperbilirubinemia -kreatininemii, leukopenia or thrombocytopenia, eosinophilia, thrombocytosis, seizures in people with kidney disease and prolongation of PTT.

Symptomatic treatment procedures are performed; if the kidneys fail, peritoneal dialysis or hemodialysis is performed.

[31],

Interactions with other drugs

Ceftazidime cannot be combined with aminoglycosides, because this results in a significant mutual inactivation of drugs (with parallel use, injections should be made in different areas of the body).

In addition, the drug has incompatibility with vancomycin (mixing them leads to the appearance of sediment). If their combined use through a single intravenous system is required, it should be flushed between drug administrations.

Sodium bicarbonate cannot be used as a solvent, because it forms carbon dioxide, which may require the elimination of gas.

Aminoglycosides, vancomycin with clindamycin and diuretic loops character reduce the clearance of the drug, which increases the likelihood of nephrotoxic effects.

Chloramphenicol and other bacteriostatic antibiotics weaken the drug activity of Ceftazidime.

[32]

Storage conditions

Ceftazidime must be maintained at temperatures not exceeding 25 ° C.

Shelf life

Ceftazidime can be applied within a 2-year term from the date the drug was manufactured.

[33], [34]

Application for children

The drug is prescribed in pediatrics with extreme caution (especially in the treatment of newborn babies).

[35], [36], [37], [38], [39], [40], [41], [42],

Analogs

Analogues of the drug are the substances Cefogram, Loraxon, Ceftriaxone with Medocef, Sulperazon and Medaxone with Cefotaxime, and in addition Oframax, Torocef, Sultsef, Cefoperazone and so on.

[43], [44], [45], [46], [47]

Reviews

Ceftazidime gets quite different reviews, so they can not be considered uniquely positive or negative. Someone medicine completely approached, eliminating the disease, but for someone it was completely useless, and even caused the appearance of negative symptoms. This can be attributed to the fact that different categories of antibiotics affect only bacteria that are sensitive to them, so before using them, it is necessary to accurately identify the type of microbe that causes the pathology.

[48], [49], [50], [51], [52], [53]