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, which is why it is effective against infections associated with bacteria that produce penicillinase and other β-lactamases. Ceftriaxone promotes microbial death by suppressing protein binding within microbial cells. [1]

Indications Tercef

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

For example, it is used for lesions of the respiratory and urinary system, ODA (this includes infections of soft tissues with bones) and ENT systems, and in addition, for meningitis, disseminated , tick-borne borreliosis , infections in the abdomen, septicemia , STDs (among them gonorrhea ) and infected wound lesions.

The medication can be used to prevent the appearance of infections during operations.

Release form

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

Pharmacodynamics

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

• aureus and epidermal staphylococci, pneumococci, clostridia with enterobacteria, streptococci from categories A and B, peptostreptococci with peptococci, streptococci viridans and Streptococcus bovis from subcategory D, as well as Escherichia coli;
• Dukrey's bacillus, Klebsiella, Haemophilus influenzae, Morgan bacteria and Haemophilus parainfluenzae, moraxella karatalis with gonococci and meningococci;
• Salmonella, Proteus Pseudomonas, Shigella, Serrata Marcescens and Acinetobacter calcoaceticus.

Also, the drug effectively affects Burgdorfer borrelia, which leads to the development of tick-borne borreliosis. [2]

It must be borne in mind that strains that are resistant to cephalosporins with penicillins, as well as methicillin, are not affected by ceftriaxone.

Pharmacokinetics

After an i / m injection of the drug, the plasma level Cmax of ceftriaxone is recorded after 2 hours; the active element retains its therapeutic performance for 24 hours with a single use.

Ceftriaxone crosses the BBB and the blood-placental barrier; the highest values of the substance inside the synovium are observed in individuals with inflammation affecting the lining of the brain. A small part of the drug is involved in metabolic processes.

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

In people with problems in the functioning of the liver / kidneys, and in addition, in newborns, the term half-life of the drug may be prolonged.

Dosing and administration

The medicine is used for intravenous injections or intramuscular injections.

To make a liquid for an intramuscular procedure, you need to dissolve the powder from the bottle in 3.6 or 7.2 ml (the volume of the solvent depends on the portion size of ceftriaxone - 3.6 ml / 1 g) of 1% lidocaine solution. Before starting the procedure, the patient's sensitivity to ceftriaxone with lidocaine should be tested. The liquid is injected immediately after its preparation, deep inside the muscles of the buttocks. It should be remembered that no more than 1000 mg of ceftriaxone can be used for a single administration.

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

When making a liquid for intravenous administration through a dropper, first prepare a solution according to the scheme for a jet procedure, and then the resulting liquid is diluted in 50 or 100 ml of injection water, 0.9% NaCl, 5% (10% -th) glucose or 5% levulose. The medicine is usually administered through a dropper over a period of 15-30 minutes. Serving sizes and duration of therapy are personalized by the doctor.

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

Individuals with gonorrhea, which proceeds without complications, are usually administered 1-fold intramuscularly by 0.25 g of the drug.

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

For persons under 12 years of age, it is required to administer 50-75 mg / kg at 24-hour intervals. For this age group, a maximum of 2000 mg of the drug per day can be used.

Premature and newborn infants need to be administered at 20-50 mg / kg of the drug at 24-hour intervals.

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

Treatment usually lasts within 4-10 / 14 days (taking into account the type of pathogen bacteria and the nature of the pathology). It is necessary to continue treatment until negative indications of microbiological studies are obtained, or for another 2-3 days from the moment the symptoms of the disease disappear.

In the case of a simultaneous disorder of hepatic and renal activity, it is necessary to monitor the plasma parameters of ceftriaxone.

People who are on dialysis need to use a maximum of 2000 mg of medication per day.

• Application for children

It is forbidden to administer the medication by the intramuscular route to children under 2 years of age.

It is necessary to use Tercef very carefully in newborns and premature babies, especially if the child is sick with jaundice, accompanied by acidosis or hypoalbuminemia.

Use Tercef during pregnancy

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

Breastfeeding should also be stopped during treatment. It is allowed to resume GW at least after 2-3 days from the moment of using the last portion of the drug.

Contraindications

The medication is not used in the presence of severe intolerance to cephalosporins and penicillins. IM injections should not be given to people who have hypersensitivity to lidocaine and other local anesthetics.

You can not use the medicine together with fluids containing Ca, and in addition, use ceftriaxone in persons who take substances with Ca content (also on parenteral nutrition).

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

Caution is necessary when using in persons with coagulation disorders, colitis (also present in history) and disorders of hepatic / renal activity, and in addition in people who have been using verapamil for a long time.

Side effects Tercef

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

• problems with the gastrointestinal tract and hepatobiliary system: vomiting, glossitis, symptoms of dyspepsia, diarrhea, nausea, stomatitis, anorexia, taste disturbances, pain in the epigastric or abdominal zone, upset intestinal flora, jaundice, increased activity of intrahepatic enzymes and problems with liver function. Colitis of the pseudomembranous type and pancreatitis are occasionally observed, in which it is necessary to stop using drugs and perform specific therapeutic procedures. Together with this, precipitates of ceftriaxone can form inside the gallbladder;
• dysfunctions of the circulatory system and CVS: hot flashes, arrhythmia, agranulocytosis, palpitations, thrombocytosis, leuko- or neutropenia, nosebleeds, anemia, eosinophilia and an increase in PTT;
• disorders of the National Assembly: headaches, vertigo and convulsions;
• lesions of the urinary tract: oliguria, hematuria, renal failure, glucosuria, an increase in creatinine values, anuria and the formation of kidney stones;
• signs of allergy: TEN, bronchial spasm, urticaria, SS, anaphylaxis, Quincke's edema and exanthema;
• others: hyperthermia, hyperazotemia, weakening of visual acuity, chills, hyperhidrosis and the appearance of superinfection. With intravenous injections, phlebitis may appear.

The introduction of a medication can provoke a false positive reaction with Coombs' test or non-enzymatic determination of sugar in urine.

Overdose

The introduction of large portions of drugs leads to an increase in the likelihood of the appearance and potentiation of the intensity of negative signs. For example, hyperthermia, leukopenia, kidney failure, hemolytic anemia in the active phase, decreased appetite, disordered spatial orientation, impaired digestive function and dyspnea may develop.

Tercef has no antidote. If too large a dosage is used, it is required to monitor the patient's condition and take symptomatic and supportive actions, if necessary.

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

Interactions with other drugs

You cannot combine the medication with fluids that contain the Ca element, because this can lead to the formation of precipitates (you must observe at least a 48-hour break between procedures).

The joint administration of the drug with aminoglycosides can potentiate the intensity of the nephrotoxic and ototoxic effect. If you need to administer these drugs together, you need to maintain a minimum of 2 hours.

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

Bacteriostatic substances weaken the effect of ceftriaxone.

Combination with loop-type diuretics or potentially nephrotoxic drugs increases the risk of the nephrotoxic effect of ceftriaxone.

The medication can weaken the medicinal effects of oral contraception.

It is forbidden to mix the medicine with other parenteral substances (except for liquids that are used specifically for the manufacture 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 the range of 2-8 ° C is 24 hours.

Analogs

The analogs of the drug are the substances Ceftriaxone, Lendacin, Cefaxon with Loraxon, Emssef and Sulbactomax with Cefogram, and in addition Blicef, Medaxon, Rocefin and Oframax.