Tercef

Tercef is an antimicrobial drug with a wide range of therapeutic effects (administered parenterally). It contains the component ceftriaxone, which is a cephalosporin antibiotic that has a strong bactericidal effect.

Ceftriaxone is resistant to most β-lactamases, making it effective against infections caused by bacteria that produce penicillinase and other β-lactamases. Ceftriaxone kills microbes by inhibiting protein binding that occurs within microbial cells. [ 1 ]

Indications Tercef

It is used in the treatment of infections with different localizations caused by strains sensitive to ceftriaxone.

For example, it is used for lesions of the respiratory and urinary systems, musculoskeletal system (this includes soft tissue infections with bones) and ENT system, as well as for meningitis, disseminated tick-borne borreliosis, abdominal infections, septicemia, STDs (including gonorrhea) and infected wounds.

The medication can be used to prevent infections during operations.

Release form

The drug is released in the form of a lyophilisate for parenteral liquid - inside vials with a capacity of 1 or 2 g; there are 5 such vials in a pack.

Pharmacodynamics

With respect to the effect exerted by ceftriaxone, strains of gram-positive and -negative bacteria demonstrate sensitivity. Among them:

• Staphylococcus aureus and Staphylococcus epidermidis, Pneumococcus, Clostridium with Enterobacter, Streptococci from categories A and B, Peptostreptococci with Peptococci, Viridans Streptococci and Streptococcus bovis from subcategory D, as well as Escherichia coli;
• Ducray bacilli, Klebsiella, Haemophilus influenzae, Morgan bacteria and Haemophilus parainfluenzae, Moraxella caratalis with gonococci and meningococci;
• Salmonella, Pseudomonas with Proteus, Shigella, Serratia marcescens and Acinetobacter calcoaceticus.

The drug also effectively affects Borrelia burgdorferi, which leads to the development of tick-borne borreliosis. [ 2 ]

It should be taken into account that strains that are resistant to cephalosporins with penicillins, as well as methicillin, are not affected by ceftriaxone.

Pharmacokinetics

After intramuscular injection of the drug, the plasma level of Cmax of ceftriaxone is recorded after 2 hours; the active ingredient maintains therapeutic indicators for 24 hours with a single use.

Ceftriaxone overcomes the BBB and the hematoplacental barrier; the highest values of the substance inside the synovium are observed in individuals with inflammation affecting the meninges. A small part of the drug is involved in metabolic processes.

Excretion of the medicinal substance is mainly realized through the kidneys, and some of it is excreted with bile. The half-life of the drug is within 6-9 hours.

In people with liver/kidney problems, and also in newborns, the half-life of the drug may be prolonged.

Dosing and administration

The medicine is used for intravenous injections or intramuscular injections.

To prepare the liquid for the intramuscular procedure, dissolve the powder from the vial in 3.6 or 7.2 ml (the volume of solvent depends on the size of the ceftriaxone portion - 3.6 ml / 1 g) of 1% lidocaine solution. Before the procedure, the patient's sensitivity to ceftriaxone with lidocaine must be tested. The liquid is injected immediately after its preparation, deep into the gluteal muscle. It should be remembered that no more than 1000 mg of ceftriaxone can be used per single injection.

To prepare a liquid for jet intravenous injection, it is necessary to dissolve the lyophilisate in 9.6 or 19.2 ml (9.6 ml/1 g) of injection water. Jet intravenous injection is performed at a low speed - over 2-5 minutes.

When preparing a liquid for intravenous administration through a dropper, first prepare a solution according to the scheme for a jet procedure, and then dilute the resulting liquid in 50 or 100 ml of injection water, 0.9% NaCl, 5% (10%) glucose or 5% levulose. Through a dropper, the drug is usually administered over 15-30 minutes. Portion sizes and duration of therapy are individually selected by the doctor.

On average, patients require 1-2 g of the drug at 24-hour intervals. If the infection is severe, the dose can be increased to 1-2 g of the drug at 12-hour intervals. Adults and adolescents can use no more than 4 g of Tercef per day.

For people with uncomplicated gonorrhea, 0.25 g of the drug is usually administered intramuscularly once.

As a prophylactic element, the drug is used intravenously at a dosage of 1000 mg, 0.5-2 hours before surgery.

For persons under 12 years of age, it is necessary to administer 50-75 mg/kg with 24-hour breaks. The specified age group can be administered a maximum of 2000 mg of the drug per day.

Premature and newborn infants require administration of 20-50 mg/kg of the drug at 24-hour intervals.

In case of meningitis, the dose of the drug may be increased to 0.1 g/kg with 24-hour intervals. In this case, no more than 4 g of ceftriaxone may be used per day.

Treatment usually lasts for 4-10/14 days (depending on the type of causative bacteria and the nature of the pathology). Treatment should be continued until negative microbiological test results are obtained, or for another 2-3 days after the signs of the disease disappear.

In case of simultaneous liver and kidney dysfunction, plasma levels of ceftriaxone should be monitored.

People on dialysis need to take a maximum of 2000 mg of the drug per day.

• Application for children

It is prohibited to administer the medication intramuscularly to children under 2 years of age.

Tercef should be used with extreme caution in newborns and premature infants, especially if the child has jaundice accompanied by acidosis or hypoalbuminemia.

Use Tercef during pregnancy

During pregnancy, Tercef is used only if there are strict indications.

During treatment, it is also necessary to stop breastfeeding. Breastfeeding can be resumed at least 2-3 days after the last dose of the drug was taken.

Contraindications

The drug is not used in the presence of severe intolerance to cephalosporins and penicillins. Intramuscular injections cannot be given to people who have increased sensitivity to lidocaine and other local anesthetics.

The drug should not be used together with liquids containing Ca, and in addition, ceftriaxone should not be used in people who take substances containing Ca (also those who are on parenteral nutrition).

Tercef should not be prescribed as a prophylactic agent in neurosurgery.

Caution is required when used in individuals with coagulation disorders, colitis (also present in the anamnesis) and hepatic/renal disorders, as well as in people using verapamil for a long time.

Side effects Tercef

The medication is often tolerated without complications. Sometimes side effects associated with the action of ceftriaxone may be observed:

• problems with the gastrointestinal tract and hepatobiliary system: vomiting, glossitis, dyspepsia symptoms, diarrhea, nausea, stomatitis, anorexia, taste disturbance, pain in the epigastric or abdominal area, intestinal flora disorder, jaundice, increased activity of intrahepatic enzymes and problems with the liver. Pseudomembranous colitis and pancreatitis are observed sporadically, in which case it is necessary to stop using the drug and perform specific treatment procedures. At the same time, ceftriaxone precipitates may form inside the gallbladder;
• disorders of the blood system and cardiovascular system: hot flashes, arrhythmia, agranulocytosis, palpitations, thrombocyto-, leuko- or neutropenia, nosebleeds, anemia, eosinophilia and increased PT indices;
• disorders of the nervous system: headaches, vertigo and convulsions;
• urinary tract lesions: oliguria, hematuria, renal failure, glucosuria, increased creatinine levels, anuria and formation of kidney stones;
• signs of allergy: TEN, bronchial spasm, urticaria, SJS, anaphylaxis, Quincke's edema and exanthema;
• Others: hyperthermia, hyperazotemia, decreased visual acuity, chills, hyperhidrosis and the appearance of superinfection. Phlebitis may occur with intravenous injections.

The introduction of the drug may provoke a false-positive reaction in the Coombs test or non-enzymatic determination of sugar in urine.

Overdose

The introduction of large doses of drugs leads to an increase in the probability of occurrence and potentiation of the intensity of negative signs. For example, hyperthermia, leukopenia, renal failure, hemolytic anemia in the active phase, loss of appetite, spatial orientation disorder, digestive dysfunction and dyspnea may develop.

Tercef has no antidote. If too high a dosage is used, the patient's condition must be monitored and symptomatic and supportive measures must be taken if necessary.

Peritoneal or hemodialysis procedures are ineffective in case of Tercef poisoning.

Interactions with other drugs

The medication should not be combined with liquids that contain the element Ca, as this may lead to the formation of precipitates (it is necessary to observe at least a 48-hour break between procedures).

Co-administration of the drug with aminoglycosides may potentiate the intensity of the nephrotoxic and ototoxic effects. If it is necessary to administer these drugs together, it is necessary to maintain at least a 2-hour interval.

The combination of drugs with substances that are vitamin K antagonists, antiplatelet agents or non-narcotic analgesics increases the likelihood of bleeding.

Bacteriostatic substances weaken the effect of ceftriaxone.

Combination with loop diuretics or potentially nephrotoxic drugs increases the risk of nephrotoxic effects of ceftriaxone.

The medication may weaken the medicinal effect of oral contraception.

It is prohibited to mix the drug with other parenteral substances (except for liquids that are used specifically for the preparation of intravenous or intramuscular injections of Tercef).

Storage conditions

Tercef must be stored at temperatures in the range of 15-25°C.

Shelf life

Tercef can be used for a period of 36 months from the date of manufacture of the therapeutic product. The shelf life of the finished liquid at temperatures within 2-8 °C is 24 hours.

Analogues

The analogs of the drug are Ceftriaxone, Lendacin, Cefaxone with Loraxone, Emsef and Sulbactomax with Cefogram, as well as Blitsef, Medaxone, Rocephin and Oframax.