Zinacef

Zinacef is a systemic antibacterial drug. It belongs to the category of 2nd generation cephalosporins.

Indications Zinacepha

It is used to eliminate infectious diseases caused by bacteria that are hypersensitive to cefuroxime. In addition, it is used to treat infectious pathologies for which the pathogen has not yet been identified. Among the diseases identified are:

• in the respiratory system: acute or chronic bronchitis, as well as infected bronchiectasis, viral pneumonia, pulmonary abscess, as well as infections in the sternum that arise as a result of surgical intervention;
• in the nose and throat area: tonsillitis with sinusitis, and also pharyngitis;
• organs of the urinary system: cystitis, as well as pyelonephritis in the acute or chronic stage, and in addition, asymptomatic development of bacteriuria;
• soft tissue area: erythema multiforme, cellulitis, and wound infections;
• joints and bone structure: septic form of arthritis, as well as osteomyelitis;
• obstetric and gynecological diseases: inflammation and infection in the pelvic area. Also gonorrhea (especially in situations where the patient cannot use penicillin);
• other infections: this includes various diseases, including meningitis with septicemia.

The drug is also used to prevent the occurrence of infectious complications after operations in the peritoneum and sternum, and in addition in the pelvic area, as well as during vascular, orthopedic or cardiovascular operations.

Often, monotherapy using the drug gives high results, but sometimes it is allowed to be used in combination with aminoglycosides or metronidazole (both in the form of suppositories or injections, and orally).

If a mixed type of disease (anaerobic and aerobic) is expected to develop or is being treated (in cases of such disorders as pulmonary (brain, pelvic) abscess, peritonitis or aspiration pneumonia), and also in case of a high risk of developing such an infection (for example, as a result of gynecological operations or surgery in the colon), Zinacef should be combined with the substance metronidazole.

During the treatment of an exacerbation of chronic bronchitis, as well as pneumonia, the drug is allowed to be used, if necessary, before taking Zinnat (cefuroxime axetil) orally.

Release form

Available in powder form, ready for injection solution, in glass vials.

Pharmacodynamics

The component cefuroxime is a bactericidal antibiotic belonging to the cephalosporin group. It has a wide range of activity against many gram-positive and gram-negative microbes (including strains that produce the substance β-lactamase). Cefuroxime is resistant to the influence of β-lactamases, as a result of which it can affect many ampicillin- or amoxicillin-resistant strains. The bactericidal effect is based on the destruction of binding processes inside the cell walls of microbes.

Acquired antibiotic resistance varies regionally and may change over time, and may vary significantly between strains. It is recommended to obtain local drug susceptibility data, if possible. This is especially important when treating severe infections.

Zinacef demonstrates high activity rates against the following bacteria: Staphylococcus aureus and coagulase-negative staphylococci (strains sensitive to the substance methicillin). In addition, against Klebsiella, pyogenic streptococcus, Pfeiffer's bacillus, Enterobacter, Escherichia coli, Clostridia, Streptococcus mitis (from the viridians group), Proteus mirabilis and Proteus rettgeri. High activity is also observed against Salmonella typhi, intestinal salmonella and other salmonella strains, as well as Shigella, Neisseria (this includes gonococcus strains that produce β-lactamase) and Bordet-Gengou bacteria.

Moderate activity is observed against Proteus vulgaris, Morgan's bacteria, and Bacteroides fragilis.

Bacteria that are completely resistant to cefuroxime: pseudomonas, legionella, clostridium difficile, campylobacter, Acinetobacter calcoaceticus, as well as strains of coagulase-negative staphylococci and Staphylococcus aureus that are not sensitive to methicillin.

Individual strains of these groups have shown resistance to the drug: Enterococcus faecalis, Morgan's bacillus, Proteus vulgaris, Enterobacter with Citrobacter, as well as Serratia and Bacteroides fragilis.

In vitro, the drug in combination with aminoglycosides has minimal additive properties, in some cases with manifestations of synergism.

Pharmacokinetics

Peak serum levels of cefuroxime are observed 30-45 minutes after injection. The half-life of the substance after intravenous and intramuscular injection is approximately 70 minutes. When combined with probenecid, excretion of cefuroxime slows down, causing its serum levels to increase.

The substance is synthesized with plasma protein by 33-50%.

Within 24 hours from the moment of injection, the drug is almost completely (85-90%) excreted (unchanged) in the urine, and most of it is excreted in the first 6 hours.

The cefuroxime component is not metabolized and is excreted via tubular secretion and glomerular filtration.

In case of dialysis procedure, a decrease in cefuroxime levels in serum is observed.

The substance reaches values exceeding the MIC values for most common pathogenic bacteria, inside the synovium, bone tissue, and also the intraocular fluid. In addition, cefuroxime passes through the BBB if there is inflammation of the meninges.

Dosing and administration

The medicinal solution can be administered only by intramuscular or intravenous injection.

Because cefuroxime, among other things, also exists in the form of a drug for internal use - axetil cefuroxime (the drug Zinnat), it is permitted to consistently switch from parenteral treatment with Zinacef to internal administration of the active substance (but only if there is appropriate clinical feasibility).

A maximum of 750 mg of the substance may be administered via a single intramuscular injection into one area of the body.

Treatment regimen and dose sizes for adults.

When treating most infections, it is necessary to administer the solution intravenously or intramuscularly - 750 mg 3 times a day. If a more severe infection is observed, it is necessary to increase the dose to a 3-fold administration of the drug in the amount of 1.5 g. If necessary, it is allowed to increase the frequency of injections to 4 procedures per day (with an interval of 6 hours). In this case, the total daily dose will increase to 3-6 g.

If necessary, individual diseases may be treated according to the following regimen: administer 750 mg or 1.5 g of solution twice a day (i.m. or i.v.), and then take Zinnat orally.

Children (this also includes infants).

It is necessary to administer 30-100 mg/kg per day (divide into 3-4 administrations). For most diseases, it is sufficient to administer 60 mg/kg of the drug per day.

Newborns.

Administration per day 30-100 mg/kg (divide this dose into 2-3 administrations). It is also necessary to take into account that the half-life of the active component of the drug in the first weeks of an infant's life may exceed adult indicators by 3-5 times.

Treatment of gonorrhea.

Administer intramuscularly 1.5 g (1 injection) or 750 mg (2 injections into both buttocks) of the drug.

Treatment of meningitis.

In cases of bacterial meningitis caused by drug-sensitive strains, Zinacef is used as a monotherapeutic agent.

Daily dose size:

• for adults: administer 3 g at intervals of 8 hours;
• for children (also infants): 200-240 mg/kg (divided into 3-4 injections). This dose can be reduced to 100 mg/kg after 3 days of treatment or when symptoms of improvement appear;
• for newborns: the initial dosage is 100 mg/kg. If the condition improves, the dosage can be reduced to 50 mg/kg.

For prevention.

The standard dosage is 1.5 g at the stage of inducing anesthesia in preparation for surgery in the orthopedic, pelvic and abdominal area. It is allowed to supplement it with an injection of 750 mg of the drug intramuscularly after 8 and 16 hours.

In the case of operations on the esophagus, heart, blood vessels, and lungs, the standard dose is 1.5 g. It is administered at the stage of inducing anesthesia, after which 750 mg of the drug is additionally administered intramuscularly by injection three times a day for the next 24-48 hours.

During total joint replacement, cefuroxime powder (1.5 g) must be mixed with methyl methacrylate cement-polymer (1 packet) before adding liquid monomer to it.

With consistent treatment.

Pneumonia: intravenous or intramuscular injection of 1.5 g of solution 2-3 times a day for 48-72 hours, then switch to internal use - taking Zinnat in an amount of 0.5 g twice a day for 7-10 days.

Chronic bronchitis in the acute stage: administer 750 mg of the drug 2-3 times a day (intramuscularly or intravenously) for 48-72 hours, and then begin oral administration of Zinnat - 0.5 g twice a day for 7 days.

The duration of the oral and parenteral course is determined taking into account the health status of the patient, as well as the severity of the disease.

Functional renal disorders.

Since cefuroxime is excreted through the kidneys, people who have problems with their work need to reduce the dosage of the drug to compensate for its slower excretion. The usual dosage does not need to be reduced (three times a day 750-1500 mg of the drug) with CC indicators that are more than 20 ml / minute. For adults with severe functional renal disorders (CC level within 10-20 ml / minute), the dose should be 750 mg twice a day. If the disorder is even more severe (CC level less than 10 ml / minute), it is necessary to administer 750 mg of the solution once a day.

During hemodialysis, an intravenous or intramuscular injection of the drug (750 mg) is required at the end of each such session. Parenteral injection of the substance is allowed to be added to the fluid for peritoneal dialysis (250 mg of Zinacef for every 2 liters of fluid). Persons undergoing intensive care and program hemodialysis or high-flow hemofiltration procedures are required to administer 750 mg of the solution twice a day. Persons undergoing low-flow hemofiltration are required to be prescribed dosages that are used for people with kidney disorders.

Features of solution preparation.

Before injection, add 3 ml of injection liquid to 750 mg of powder and then shake the bottle to form an opaque suspension.

Also, 750 mg powder can be dissolved in at least 6 ml of injection liquid.

Infusion solutions, which should be administered for a maximum of half an hour, are prepared as follows: 1.5 g of powder is dissolved in 50-100 ml of injection liquid.

Prepared solutions must be administered immediately intravenously or through a dropper tube (when performing infusion treatment).

During storage of prepared solutions, their color saturation may change.

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Use Zinacepha during pregnancy

There is no information on the teratogenic and embryotoxic effects of cefuroxime, but it should be prescribed with great caution in early pregnancy.

Since the substance is excreted in breast milk, breastfeeding should be discontinued during treatment.

Contraindications

Main contraindications:

• hypersensitivity to cefuroxime or other components of the drug, as well as to cephalosporins;
• history of severe hypersensitivity (eg, anaphylactic reactions) to other β-lactam antibiotics (such as monobactams, penicillins, and carbapenems).

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Side effects Zinacepha

The use of the solution may cause some side effects:

• pathologies of an infectious or invasive nature: occasionally, increased growth of resistant microbes (such as Candida) is observed;
• manifestations from the systemic blood flow, as well as lymph: eosinophilia or neutropenia often develop. Sometimes leukopenia occurs, and in addition, a positive Coombs test result or a decrease in hemoglobin levels is noted. Thrombocytopenia occasionally appears. Isolated cases of hemolytic anemia;
• immune disorders: manifestations of hypersensitivity - sometimes itching, rash or urticaria. Rarely, drug fever. Isolated - vasculitis on the skin, anaphylaxis and tubulointerstitial nephritis;
• Gastrointestinal dysfunction: sometimes there is discomfort in the gastrointestinal tract. Pseudomembranous colitis is observed occasionally;
• manifestations in the hepatobiliary system: often a transient increase in liver enzyme levels is noted. Sometimes - a temporary increase in bilirubin values. Basically, such disorders developed in people who already have liver disease, but there is no information about a negative effect on the liver;
• skin disorders and disorders of the subcutaneous layer: erythema multiforme, TEN or Stevens-Johnson syndrome appear sporadically;
• manifestations of the urinary system: an increase in serum creatinine values, as well as urea nitrogen, is occasionally noted, and in addition, a decrease in CC values;
• injection site reactions and systemic disorders: disorders at the injection site often occur (including thrombophlebitis and pain).

Overdose

As a result of intoxication with cephalosporins, signs of irritation in the brain area may appear, which can cause the development of seizures.

The levels of the substance in the body can be reduced through sessions of peritoneal dialysis or hemodialysis.

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Interactions with other drugs

Since Zinacef is an antibiotic, it is able to change the intestinal flora, which reduces estrogen reabsorption and weakens the effect of combined oral contraception.

During treatment with Zinacef, it is necessary to determine plasma and blood sugar levels using hexose kinase or glucose oxidase methods.

The drug does not affect the effectiveness of enzymatic methods for detecting glucosuria.

The effect of the drug on the effectiveness of methods based on copper reduction processes (such as the Clintest, Fehling's test or Benedict's test) is insignificant. It does not cause the appearance of false-positive data, as with the use of other cephalosporins.

Cefuroxime does not interfere with alkaline picrate creatinine tests.

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Storage conditions

Zinacef in powder form should be stored in a place inaccessible to children, at a temperature of maximum 25°C. The diluted and ready-to-use solution should be kept in the refrigerator (at a temperature of maximum 4°C).

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Special instructions

Reviews

Zinacef is considered one of the most effective antibiotics, which is why it is often used to treat various diseases. The drug has a large number of positive reviews.

It is often prescribed to both children and adults – to eliminate pathologies of infectious origin. Most often, situations are described when the drug is used to eliminate diseases in the respiratory system (such as pneumonia or bronchitis, etc.). The course of treatment does not last long – about 10 days. During this period of time, good tolerance of the drug is observed.

However, there are also cases of increased sensitivity to the drug. Among the acute symptoms is hearing loss. As a result, the treatment had to be stopped, although it was effective.

Shelf life

Zinacef is allowed to be used for a period of 2 years from the date of manufacture of the medicine. The diluted product at room temperature can retain its properties for no more than 5 hours, and it is allowed to be kept in the refrigerator for a maximum of 48 hours.