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Cetyl
Cetyl is an antimicrobial drug used systemically. Included in the group of β-lactam antibiotics.
Indications of the cetylus
It is used to eliminate infections caused by microbes that are sensitive to the action of the drug:
- organs of the ENT system: sinusitis with pharyngitis, as well as tonsillitis and inflammation of the middle ear;
- infectious processes in the respiratory tract: acute bronchitis or exacerbation of chronic bronchitis, as well as pneumonia;
- infections of the organs of urination: cystitis with pyelonephritis, as well as urethritis;
- infectious processes in the field of soft tissues with skin: pyoderma and furunculosis, and in addition impetigo;
- cervicitis and gonorrhea, and in addition an acute stage of the gonococcal urethritis of an uncomplicated type;
- early signs of tick-borne borreliosis, and with it the prevention of the development of late signs of this disease in adolescents from 12 years old, as well as adults.
Pharmacodynamics
The cefuroxime axetil is a bactericidal antibiotic of the cephalosporin series, cefuroxime in the form for oral administration. It is resistant to the influence of most β-lactamases, and also actively acts against a large range of microbes (both gram-negative and gram-positive).
Bactericidal properties of the substance are due to the suppression of the binding processes inside the cell membrane of microbes.
Acquired resistance to the antibiotic is different in certain regions and is capable of changing over time, and in some strains there is even the possibility of significant differences. It is recommended to refer to local information (if any) about the sensitivity to the antibiotic - this is especially important in the treatment of severe forms of infection.
Cefuroxime has quite potent activity against the following microbes:
- Gram-negative aerobic bacteria: Influenza rod (including ampicillin-resistant strains), moraxel catarrils, Naomophilus parainfluenzae, gonococci (also strains that produce penicillinase along with penicillin-producing strains), E. Coli, Klebsiella, Proteus mirabilis and Proteus rettgeri, and Providencia spp .;
- Gram-positive aerobic bacteria: golden and coagulase-negative staphylococcus (strains sensitive to methicillin), streptococcus pyogenes (and other streptococci of β-hemolytic type), pneumococcus and streptococci from category B (streptococcus agalactia);
- anaerobic microbes: Gram-positive Gram-negative cocci (this includes peptococci and peptostreptococcus), Gram-positive (among them clostridia) and Gram-negative microbes (this includes species of bacteroides and fusobacteria), and propionibacteria;
- other bacteria: borrelia Burgdorfer;
- resistant to cefuroxime bacteria: clostridium difffile, pseudomonas, campylobacteria, Acinetobacter calcoaceticus, listeria monocytogenes, methicillin-resistant strains of epidermal and golden staphylococci and legionella;
- individual strains of bacteria resistant to the substance of cefuroxime: fecal enterococcus, morgana bacterium, vulgar proteus, enterobacter, tsitrobacter, serrations and bacteroids of fragilis.
Pharmacokinetics
When ingested, cefuroxime axetil is absorbed through the intestine, and then hydrolyzed inside the mucosa, and then enters the circulatory system in the form of cefuroxime.
The required medicinal suction level reaches immediately after eating. The peak of the substance inside the serum is observed approximately 2-3 hours after the use of the tablet. The half-life is about 1-1.5 hours. The index of synthesis with protein is 33-55% (depends on the method of determination). Excretion of cefuroxime is carried out through the kidneys (unchanged) by secretion of the tubules and filtration of the glomeruli.
Combination with probenecid increases the mean serum concentration AUC by 50%.
Serum cefuroxime values decrease with the dialysis procedure.
Use of the cetylus during pregnancy
There is no evidence from experiments that would demonstrate the teratogenic and embryopathic properties of Cetyl, but caution should be used in the early stages of pregnancy.
The medicine passes into the breast milk, so caution is required and when using it during lactation.
Side effects of the cetylus
The use of the drug can trigger the development of certain side effects:
- infestations with infectious processes: increased growth of fungi of the genus Candida;
- hemopoietic system: development of hemolytic form of anemia, eosinophilia, and in addition, leukopenia (in some cases - deep) and thrombocytopenia, as well as positive Coombs reaction. Substances from the category of cephalosporins can be absorbed through the surface of erythrocyte membranes, and also interact with antibodies. As a result, the probability of anemia in the hemolytic form increases, as well as the positive Coombs reaction;
- immune reactions: hypersensitivity (this includes hives with itching and rashes, and in addition anaphylaxis, drug fever and serum sickness);
- reactions of NS: dizziness with headaches;
- Gastrointestinal organs: gastroenterological disorders, including abdominal pain, nausea, diarrhea, vomiting and pseudomembranous form of colitis;
- reactions of the hepatobiliary system: the development of hepatitis or jaundice (mainly cholestatic), as well as transient increase in liver enzymes (ALT, LDH and AST);
- subcutaneous layers and skin: Lyell's syndrome or Stevens-Johnson, and in addition the multiform erythema.
Dosing and administration
Sensitivity to the antibiotic varies with the region, as well as the time interval. If there is such a need, it is worthwhile to study local information regarding sensitivity to drugs.
Often, the course of therapy lasts 1 week. That the medicine is better absorbed, it is recommended to use it after eating.
Dose regimen for adults:
- at the most infectious processes - 250 mg LS twice a day;
- infection in the area of the organs of urination - 125 mg of the drug twice a day;
- infectious processes in the respiratory system (moderate degree: for example, bronchitis) - 250 mg LS twice a day;
- more severe forms of infections in the respiratory tract or suspected pulmonary inflammation - 500 mg twice a day;
- pyelonephritis - 250 mg twice a day;
- Gonorrhea in uncomplicated form - a one-time intake of the 1st g medication.
In tick-borne borreliosis in adolescents aged 12 and adults, 500 mg of LS twice a day for a period of 20 days.
Cefuroxime can be produced in the form of sodium salt, which is used for parenteral administration. Due to this, it is possible to perform sequential treatment with a single antibiotic in the case of a transition from the parenteral method to internal reception (in the presence of medicinal indications).
Cefuroxime axetil effectively acts during the sequential therapy of pulmonary inflammation, and with it exacerbations of the chronic form of bronchitis in cases when the parenteral introduction of cefuroxime sodium was performed prior to this.
Consecutive treatment:
- with pulmonary inflammation: 2-3 times a day to enter in / m or / in the injection of cefuroxime in the amount of 1.5 grams in a period of 48-72 hours. Then take Cetyl at a rate of 500 mg twice a day during the first week;
- with exacerbation of bronchitis in chronic form: 2-3 times a day to inject cefuroxime IM or in / in the way - at a rate of 750 mg for 48-72 hours. Then use the oral form of the drug - 500 mg twice a day in the period of 5-7 days.
The duration of oral and parenteral therapy is determined taking into account the patient's state of health, as well as the severity of the infection process.
Children.
The standard dose is 125 mg or 10 mg / kg twice per day (for a day, you can take no more than 250 mg of the drug). When eliminating the inflammation of the middle ear in a child less than 2 years, it is necessary to take drugs at a rate of 125 mg or 10 mg / kg twice a day (250 mg per day). A child older than 2 years - 250 mg or 15 mg / kg twice a day (daily dose is not more than 500 mg).
For children less than 2 years old, it is required to use cefuroxime axetil as a drug suspension.
People with kidney failure.
Excretion of cefuroxime occurs through the kidneys, so people suffering from severe disorders of renal function need to reduce the dosage of drugs - to compensate for its slow excretion:
- QC level ≥30 ml / minute (half-life 1.4-2.4 hours) - a standard dosage of 125-500 mg twice a day can be taken;
- QC level 10-29 ml / minute (half-life 4.6 hours) - designate an individual standard dosage every 24 hours;
- level of CC <10 ml / minute (half-life 16.8 hours) - the standard dose is determined individually during the 48-hour period;
- with hemodialysis (half-life 2-4 hours) - after each procedure it is required to take an additional standard portion of medicines.
Interactions with other drugs
Drugs that reduce the pH of gastric juice, can reduce the bioavailability of cefuroxime axetil, and in addition can eliminate the effect of increased absorption of drugs after eating.
Similarly to other antibiotics, Cetyl is able to affect the intestinal flora, resulting in reduced estrogenic reabsorption, and also weakened the effectiveness of combined oral contraception.
Because ferrocyanide analysis can demonstrate a false negative result in detecting sugar values inside plasma and blood in people treated with cefuroxime axetil, it is necessary to use a hexokinase or glucose oxidase assay method. Cefuroxime does not affect the alkaline-picrate test when determining the creatinine values.
Combination with a probenicide for 50% increases the AUC values inside the serum. The serum cefuroxime level can be reduced by dialysis.
During treatment with the use of cephalosporins, data were received on the positive Coombs reaction. This phenomenon can affect the cross-sectional test in determining blood compatibility.