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Vancorous
Vancoros is an antimicrobial systemic drug. Included in the category of glycopeptide antibiotics.
Indications of the vankorousu
It is used for bacterial infections that occur in severe form and are provoked by microbes that are sensitive to the drug (also with bacterial resistance to cephalosporins with penicillins or patients with hypersensitivity to drug data):
- sepsis with endocarditis;
- inflammation of the lungs and pulmonary abscess;
- osteomyelitis or enterocolitis with meningitis.
Pharmacodynamics
Vancomycin is an antibiotic that is produced by Amycolatopisorientalis. Has a bactericidal effect and prevents the binding of the walls of microbial cells that are sensitive to the drug.
It has an effective effect on gram-positive bacteria: staphylococci (this includes penicillinase-forming bacteria, as well as microbial strains resistant to methicillin), streptococci (among them penicillin-resistant strains), and in addition to clostridia and corynebacteria.
Resistance to the drug has virtually all gram-negative microbes, and at the same time, viruses with fungi and protozoa. The drug does not have cross-resistance with other antibiotics.
Pharmacokinetics
The peak value for IV infusion of 500 mg of the drug is 49 μg / ml after half an hour after the administration and 20 μg / kg after 1-2 hours. With IV infusion of the 1st g of drugs, this figure reaches 63 μg / ml after 1 hour, and up to 23-30 μg / ml after 1-2 hours. The synthesis index with plasma protein is 55%.
The medicinal level of the substance is observed inside the pericardial, pleural, peritoneal and serous fluid, as well as in synovia, the tissues of the ear of the atria and urine. The component does not pass through the intact GEB (but with meningitis it can penetrate into the cerebrospinal fluid in medicinal concentrations). In addition, the component is able to pass through the placental barrier. It is excreted into the mother's milk. Almost not exposed to metabolism.
The half-life with healthy kidney work is:
- approximately 6 hours (within 4-11 hours) in adults;
- 6-10 hours for newborns;
- 4 hours for infants;
- 2-3 hours for older children.
The same indicator for kidney failure in chronic form is 6-10 days in an adult.
In the case of multiple use of the solution, cumulation can occur.
About 75-90% of the substance is excreted through the kidneys with the help of powerful filtration during the first 24 hours. In people with missing or excised kidney excretion is slow, and the mechanism of this process is not defined. Moderate or small amounts of the substance can be excreted with bile. A small part of the component is excreted by peritoneal dialysis or hemodialysis.
Side effects of the vankorousu
Due to the use of the medicine, the following side effects may develop:
- postinfusion manifestations (due to the rapid introduction of infusion): anaphylactoid symptoms (such as bronchial spasms, lowering blood pressure, itching, skin rash and dyspnea) and red neck syndrome that occurs due to the release of histamine. It manifests itself in the form of fever, chills, muscle spasms in the region of the back with the sternum, and in addition the rapid rhythm of the heartbeat and hyperemia in the face and upper body;
- disorders in the urinary system: the development of nephrotoxicity (reaching renal failure), which occurs mainly when combining drugs with aminoglycoside antibiotics or due to the administration of large doses for more than 3 weeks. The disorder manifests itself under the guise of an increase in the level of urea nitrogen, as well as creatinine. Occasionally, tubulointerstitial nephritis appears;
- disorders in the work of the digestive tract: the development of pseudomembranous colitis or nausea;
- reactions of the senses: the appearance of ototoxicity - hearing impairment, ear ringing and vertigo;
- disorders of the hematopoietic system: curable neutropenia or temporary thrombocytopenia; occasionally there is agranulocytosis;
- allergic manifestations: the appearance of nausea, fever and chills, and with it rashes (this includes the exfoliative form of dermatitis), eosinophilia, Stevens-Johnson syndrome, and also Lyell, and in addition vasculitis;
- local disturbances: phlebitis, the appearance of pain or the death of tissues at the site of administration.
Dosing and administration
The solution is introduced exclusively in / in the method. The optimal concentration is a maximum of 5 mg / ml (infusion rate of the solution is a maximum of 10 mg / min). The duration of the procedure should not exceed 1 hour.
The size of the adult dose is 0.5 g or 7.5 mg / kg every 6 hours, or 1 g or 15 mg / kg every 12 hours.
For newborns at the first week of life, the initial dosage is 15 mg / kg, and then 10 mg / kg every 12 hours. Since the second week, the same dosage is required every 8 hours. Children from the 1st month should be given 10 mg / kg of medication every 6 hours or 20 mg / kg every 12 hours.
In persons with disorders of excretory renal function, the initial dose size is 15 mg / kg, after which the regimen is adjusted depending on the QC parameters (for anuria, the intervals between procedures are up to 10 days):
- the level of CC is more than 80 ml / minute - the standard dose is administered;
- the QC value within the range of 50-80 ml / minute - on the 1st g at intervals of 1-3 days;
- the QC value in the range of 10-50 ml / minute - enter 1 g at intervals of 3-7 days;
- the level of CC is less than 10 ml / min - for 1 g at intervals of 1-2 weeks.
Manufacture of an infusion solution:
It is required to dissolve the powder in injectable water in the proportion: for 500 mg of the drug, 10 ml of water is required; for 1 g of drugs - 20 ml of water (with a solution concentration of 50 mg / ml). This mixture is then diluted with a solution of sodium chloride (0.9%) or dextrose (5%) until a concentration of at most 5 mg / ml is obtained (proportions: 500 mg - 100 ml, 1 g 200 ml). The solution must be applied immediately.
Making an oral solution:
It is allowed to use Vancomycin for oral administration (to eliminate the pseudomembranous form of colitis, triggered by clostridium Diffile, and in addition to staphylococcal food-borne toxicity). The required dose should be prepared in 30 ml of water. Adults need to take 0.5-2 g of substance 3-4 times per day, and children - 0.04 g / kg at the same multiplicity.
The duration of the therapeutic course is within 7-10 days.
Interactions with other drugs
In the case of combined use of medication and local anesthetics in children, the appearance of erythematous rash or flushing of the skin on the face is possible. In adults, blockade of intracardiac conduction develops.
Combination with ototoxic or nephrotoxic drugs (such as carmustine with aminoglycosides, aspirin and other salicylates, as well as amphotericin B and capreomycin with bumetanide and bacitracin, cisplatin with cyclosporine, paromomycin, loop diuretics and polymyxin B with ethacrynic acid) requires constant monitoring of the possible occurrence symptoms of the disorder.
Kolestyramin weakens the effect of vancomycin.
Meclosin and thioxanthenes with antihistamine drugs and phenothiazines are able to mask the signs of the ototoxic effect of the drug (vertigo and ear noise).
Systemic anesthetics with vecuronium bromide may trigger a decrease in blood pressure or blockade of neuromuscular transmission. The infusion is allowed at least 1 hour before the use of the above medicines.
The drug solution has a weak pH, which can lead to chemical or physical instability during mixing with other medicinal solutions. It is forbidden to combine with solutions of alkalis.