Азаран Порошок, 10 шт, 1 гр, для внутривенного и внутримышечного введения

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Оказывает бактерицидное действие за счет угнетения синтеза клеточной стенки бактерий. Ацетилирует мембраносвязанные транспептидазы, нарушая таким образом перекрестную сшивку пeптидогликанов, необходимую для обеспечения прочности и ригидности клеточной стенки.\nУстойчив к действию бета-лактамаз, продуцируемых большинством грамположительных и грамотрицательных бактерий.\nАктивен в отношении грамположительных аэробов — Staphylococcus aureus. Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus viridans, Streptococcus bovis;\nграмотрицательных аэробов — Acinetobacter Iwoffii, Acinetobacter anitratus, Aeromonas hydrophila,\nAlcaligenes faecalis, Alcaligenes odorans, Citrobacter spp., Enterobacter spp. (некоторые штаммы резистентны), Escherichia coli, Haemophilus ducreyi, Haemophilus influenzae (в т.ч. штаммы, образующие пенициллиназу), Haemophilus parainfluenzae, Klebssiella spp. (в т.ч. 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Хорошо проникает в ткани и жидкости организма: в дыхательные пути, кости, суставы, мочевыводящий тракт, кожу, подкожную клетчатку и органы брюшной полости. Стабильная концентрация препарата в крови достигается в течение 4 суток. Максимальная концентрация (С max) после в/м введения наступает через 2-3 ч., после внутривенного (в/в) введения — в конце инфузии. С max после в/м введения 0.5 г, 1 г — 38 мкг/мл, 76 мкг/мл, соответственно. При в/в 500 мг, 1 г, 2 г — 82 мкг/мл, 151 мкг/мл, 257 мкг/мл, соответственно. У взрослых через 2-24 ч после введения 50 мг/кг концентрация в спинномозговой жидкости (СМЖ) во много раз превосходит минимальную подавляющую концентрацию для наиболее распространенных возбудителей менингита. Хорошо проникает в СМЖ при воспалении менингеальных оболочек. Обратимо связывается с альбуминами плазмы (83-95%). Препарат проходит через плаценту в небольших количествах.\nПериод полувыведеиш (Т1/2) составляет 6-9 ч, что позволяет применять препарат один раз в сутки. Т1/2 после в/в введения в дозе 50-75 мг/кг у детей с менингитом — 4.3-4.6 ч; у больных находящихся на гемодиализе (клиренс креат инина КК 0-5 мл/мин) — 14.7 ч., при КК — 5-15 мл/мин — 15.7 ч, при КК — 16-30 мл/мин — 11.4 ч, при КК — 31-60 мл/мин— 12.4 ч. Объем распределения — 0.12-0.14 л/кг (5.78-13.5 л), у детей 0.3 л/кг., плазменный клиренс — 0.58-1,45 л/ч, почечный — 0.32-0.73 л/ч. Т1/2 значительно удлиняется у людей старше 75 лет, новорожденных и у больных с нарушением функций почек и печени. Выводится в течение 48 ч почками 50-60% в неизмененном виде и с желчью — 40-50% в кишечник, где происходит превращение в неактивный метаболит. У новорожденных детей через почки экскретируется около 70% препарата. Гемодиализ не эффективен."}}]},{"id":4,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Инфекционно-воспалительные заболевания, вызванные чувствительными к препарату микроорганизмами: инфекции верхних и нижних отделов дыхательных путей (в т.ч. пневмония, абсцесс легких, эмпиема плевры); инфекции кожи и мягких тканей; инфекции костей и суставов; инфекции мочевыводящих путей (в т.ч. пиелонефрит); инфекции органов брюшной полости (перитонит, инфекции желудочно-кишечного тракта (шигеллез, сальмонеллез), желчевыводящих путей, в т.ч. холангит, эмпиема желчного пузыря); инфекционно — воспалительные заболевания органов малого таза; профилактика и лечение инфекций при хирургических вмешательствах; бактериальный менингит и эндокардит; сепсис; острая неосложненная гонорея; болезнь Лайма."}}]},{"id":5,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к цефтриаксону и другим цефалоспоринам, пенициллинам, карбапенемам.\nС осторожностью при нарушении функций печени и/или почек; у недоношенных и у новорожденных детей с гипербилирубинемией; при неспецифическом язвенном колите, энтерите или колите, связанном с применением антибактериальных препаратов."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Препарат Азаран следует применять внутримышечно или внутривенно струйно или капельно!\nСтандартное дозирование.\nВзрослые и дети старше 12 лет: обычная доза составляет 1-2 г в сутки (каждые 24 ч).\nВ тяжелых случаях максимальная суточная доза для взрослых 4 г.\nНоворожденным в возрасте до 14 дней — 20-50 мг/кг массы тела 1 раз в сутки. Максимальная суточная доза не должна превышать 50 мг/кг массы тела.\nПри определении дозы не делают различия между доношенными и недоношенными детьми. Детям в возрасте от 15 дней до 12 лет — 20-80 мг/кг массы тела 1 раз в сутки.\nДетям с массой тела свыше 50 кг назначают дозы для взрослых.\nВнутривенные дозы, равные или превышающие 50 мг/кг массы тела, следует применять в виде инфузий в течение не менее 30 минут.\nПродолжительность курса обычно не превышает 10 дней. Введение препарата рекомендуют продолжать еще в течение 2-3 дней после нормализации температуры тела и исчезновения симптомов.\nДозирование в особых случаях.\nДля профилактики послеоперационных осложнений — однократно, 1-2 г (в зависимости от степени инфекционного риска) за 30-90 мин до начала операции. При операциях на толстой и прямой кишке рекомендуют дополнительное введение {но раздельное) препарата из группы 5-нитроимидазолов.\nПри острой, неосложненной гонорее — в/м однократно, 250 мг.\nБоррелиоз Лайма — 50 мг/кг массы тела (высшая суточная доза — 2 г) взрослым и детям, один раз в сутки в течение 14 дней.\nПри бактериальном менингите у грудных детей и детей младшего возраста — 100 мг/кг\nмассы тела (но не более 4 г) 1 раз в сутки. Продолжительность леченая зависит от возбудителя и может составлять от 4 дней для Neisseria meningitidis до 10-14 дней для чувствительных штаммов Enterobacteriaceae.\nПациентам с нарушением функции почек нет необходимости уменьшать дозу, если функция печени остается нормальной. Суточная доза Азарана не должна превышать 2 г, лишь а случаях претерминальной почечной недостаточности (клиренс креатинина менее 10 мл/мин).\nУ пациентов с нарушением функции печени нет необходимости уменьшать дозу, если\nфункция почек остается нормальной.\nПри сочетании тяжелой почечной и печеночной недостаточности следует регулярно\nопределять концентрацию цефтриаксона в плазме и при необходимости корректировать его дозу.\nБольным на диализе дополнительного введения препарата после диализа не требуется, т. к. цефтриаксон не удаляется при гемодиализе. Однако следует контролировать концентрацию цефтриаксона в сыворотке на предмет возможной коррекции дозы, поскольку скорость выведения у этих больных может снижаться.\nПравила приготовления и введения растворов: следует использовать только свежеприготовленные растворы.\nПриготовление раствора для внутримышечного введения:\n1000 мг препарата растворяют в 3,6 мл воды для инъекций, 1 мл полученного раствора содержит около 250 мг в пересчете на цефтриаксон. Если возникает необходимость можно использовать более разбавленный раствор.\n1000 мг препарата растворяют в 3,5 мл 1% раствора лидокаина.\nПолученный раствор вводят глубоко в относительно крупную мышцу (ягодицу или в мышцу бедра). Не следует вводить более 1000 мг препарата в одну мышцу.\nРастворы, содержащие лидокаин нельзя вводить внутривенно!\nПриготовление раствора для внутривенного введения:\n1000 мг препарата растворяют в 9,6 мл воды для инъекций, 1 мл подученного раствора содержит около 100 мг в пересчете на цефтриаксон. Раствор вводят медленно и течение 2-4 минут.\nПриготовление раствора для внутривенной инфузии:\n2 г препарата растворяют в 40 мл воды для инъекций или одного из инфузионных растворов, не содержащих в своем составе кальция (0,9% раствор натрия хлорида, раствор 0,45% натрия хлорида + 2.5% раствор декстрозы, 5% или 10% раствор декстрозы, 6% раствор декстрана в 5% растворе декстрозы, 6-10% раствор гидроксиэтилированного крахмала).\nДлительность инфузии должна составлять не менее 30 минут.\nПриготовленный раствор хранить в темном месте при комнатной температуре (25 ºС) и использовать в течение 6 часов или в тёмном месте при температуре от 2 до 8 ºС и использовать в течение 24 часов."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Аллергические реакции: крапивница, озноб, или лихорадка, зуд, редко — бронхоспазм, эозинофилия, эритема экссудативная мультиформная (в том числе синдром Стивенса-Джонсона), анафилактический шок, сывороточная болезнь.\nСо стороны нервной системы: головная боль, головокружение.\nСо стороны мочевыделительной системы: нарушение функции почек (азотемия, повышение содержания мочевины в крови, гиперкреатининемия, глюкозурия, цилиндрурия, гематурия), олигурия, анурия,\nСо стороны пищеварительной системы: тошнота, рвота, нарушение вкуса, метеоризм, диарея или запор, абдоминальные боли, стоматит, глоссит, псевдомембранозный энтероколит, нарушение функции печени (повышение активности «печеночных» трансаминаз, реже — щелочной фосфатазы или билирубина, холестатическая желтуха), псевдохолелитиаз желчного пузыря («sludge»-синдром), дисбактериоз.\nСо стороны органов кроветворения: анемия, лейкопения, лейкоцитоз, лимфопения, нейтропения, гранулоцитопения, тромбоцитоз, тромбоцитопения, гемолитическая анемия, гипокоагуляция, снижение концентрации плазменных факторов свертывания крови (II, VII, IX, X), удлинение протромбинового времени.\nМестные реакции: при в/в введении — флебиты, болезненность по ходу вены; в/м введение — болезненность в месте введения и инфильтрат.\nПрочие: носовое кровотечение, кандидомикоз и др. суперинфекции."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При передозировке гемодиализ и перитонеальный диализ не снизят концентрации препарата. Специфического антидота нет. Лечение передозировки симптоматическое."}}]},{"id":9,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Цефтриаксон и аминогликозиды обладают синергизмом в отношении многих грамотрицательных бактерий (в том числе Pseudomonas aeruginosa), оба препарата необходимо вводить раздельно в рекомендованных для них дозах.\nНесовместим с этанолом (см. раздел Особые указания)\nЦефтриаксон, подавляя кишечную флору, препятствует синтезу витамина К. При одновременном назначении с препаратами, снижающими агрегацию тромбоцитов (нестероидные противовоспалительные средства, салицилаты, сульфинпиразон) увеличивается риск развития кровотечений.\nПри одновременном назначении с антикоагулянтами отмечается усиление действия последних. При одновременном применении с «петлевыми» диуретиками и др. нефротоксичными препаратами возрастает риск развития нефротоксического действия.\nФармацевтически несовместим с растворами, содержащими другие антибиотики (в т.ч. ванкомицин и аминогликозиды), так и растворами, содержащими флуконазол.\nЦефтриаксон нельзя смешивать с растворами, содержащими кальций (например, раствор Рннтера)."}}]},{"id":10,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Применять только в стационарных медицинских учреждениях!\nПри одновременной тяжелой почечной и печеночной недостаточности, у больных, находящихся на гемодиализе, следует регулярно определять концентрацию препарата в плазме.\nПри длительном лечении необходимо регулярно контролировать картину периферической крови, показатели функционального состояния печени и почек.\nВ редких случаях при УЗИ желчного пузыря отмечаются затемнения, которые исчезают после прекращения лечения (даже если это явление сопровождается болями в правом подреберье, рекомендуют продолжение назначения антибиотика и проведение симптоматического лечения).\nВо время лечения противопоказано употребление этанола — возможны дисульфирамоподобные эффекты (покраснение лица, спазм в животе и в области желудка, тошнота, рвота, головная боль, снижение АД, тахикардия, одышка).\nНесмотря на подробный сбор анамнеза, что является правилом и для других цефалоспориновых антибиотиков, нельзя исключить возможность развитая анафилактического шока, который требует немедленной терапии — сначала внутривенно вводят эпинефрин, затем глюкокортикостероиды.\nИсследования in vitro показали, что подобно другим цефалоспориновым антибиотикам, цефтриаксон способен вытеснять билирубин, связанный с альбумином сыворотки крови. Поэтому у новорожденных с гипербилирубинемией и, особенно, у недоношенных новорожденных, применение цефтриаксона требует еще большей осторожности.\nПожилым и ослабленным больным может потребоваться назначение витамина К."}}]},{"id":11,"name":"Условия хранения","slug":"storage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Список Б.\nХранить в защищенном от света месте при температуре от 15 до 25°С.\nХранить в недоступном для детей!"}}]},{"id":12,"name":"Срок годности","slug":"expiry_date","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"3 года.\nНе использовать по истечении срока годности, указанного на упаковке."}}]},{"id":13,"name":"Условия отпуска","slug":"release_condition","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"По рецепту врача."}}]}],"source":null},"description_toggle":false,"short_description":"Азаран — цефалоспориновый антибиотик Ш поколения широкого спектра действия для парентерального введения. Оказывает бактерицидное действие за счет угнетения синтеза клеточной стенки бактерий. Ацетилирует мембраносвязанные транспептидазы, нарушая таким образом перекрестную сшивку пeптидогликанов, необходимую для обеспечения прочности и ригидности клеточной стенки. Устойчив к действию бета-лактамаз, продуцируемых большинством грамположительных и грамотрицательных бактерий. Активен в отношении грамположительных аэробов — Staphylococcus aureus. Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus viridans, Streptococcus bovis; грамотрицательных аэробов — Acinetobacter Iwoffii, Acinetobacter anitratus, Aeromonas hydrophila, Alcaligenes faecalis, Alcaligenes odorans, Citrobacter spp., Enterobacter spp. (некоторые штаммы резистентны), Escherichia coli, Haemophilus ducreyi, Haemophilus influenzae (в т.ч. штаммы, образующие пенициллиназу), Haemophilus parainfluenzae, Klebssiella spp. (в т.ч. Klebssiella pneumoniae), Moraxella spp., Morganella morganii, Neisseria gonorrhoeae (в т.ч. штаммы, образующие пенициллиназу), Neisseria meningitidis, Plesiomonas shigelloides, Proteus mirabilis, Proteus vulgaris, Providencia spp., Salmonella spp. (в т.ч. Salmonella typhi), Serratia spp. (в т.ч. Serratia marcescens), Shigella spp., Vibrio spp. (в т.ч. Vibrio cholerae), Yersinia spp. (в т.ч. Yersinia enterocolitica), Pseudomonas aeruginosa; анаэробов — Bacteroides spp. (в т.ч. некоторые штаммы Bacteroides fragilis), Clostridium spp. (кроме Clostridium difficile), Fusobacterium spp. (кроме Fusobacterium mortiferum и Fusobacterium varium), Peptococcus spp., Peptostreptococcus spp. К цефтриаксону резистентны штаммы Staphylococcus spp., устойчивые к метициллину, штаммы Enterococcus spp. (Enterococcus faecalis), Clostridium difficile, многие штаммы Bacteroides spp., продуцирующие бета-лактамазы. После внутримышечного (в/м) введения быстро и полностью всасывается. Биодоступность 100%. Хорошо проникает в ткани и жидкости организма: в дыхательные пути, кости, суставы, мочевыводящий тракт, кожу, подкожную клетчатку и органы брюшной полости. Стабильная концентрация препарата в крови достигается в течение 4 суток. Максимальная концентрация (С max) после в/м введения наступает через 2-3 ч., после внутривенного (в/в) введения — в конце инфузии. С max после в/м введения 0.5 г, 1 г — 38 мкг/мл, 76 мкг/мл, соответственно. При в/в 500 мг, 1 г, 2 г — 82 мкг/мл, 151 мкг/мл, 257 мкг/мл, соответственно. У взрослых через 2-24 ч после введения 50 мг/кг концентрация в спинномозговой жидкости (СМЖ) во много раз превосходит минимальную подавляющую концентрацию для наиболее распространенных возбудителей менингита. Хорошо проникает в СМЖ при воспалении менингеальных оболочек. Обратимо связывается с альбуминами плазмы (83-95%). Препарат проходит через плаценту в небольших количествах. Период полувыведеиш (Т1/2) составляет 6-9 ч, что позволяет применять препарат один раз в сутки. Т1/2 после в/в введения в дозе 50-75 мг/кг у детей с менингитом — 4.3-4.6 ч; у больных находящихся на гемодиализе (клиренс креат инина КК 0-5 мл/мин) — 14.7 ч., при КК — 5-15 мл/мин — 15.7 ч, при КК — 16-30 мл/мин — 11.4 ч, при КК — 31-60 мл/мин— 12.4 ч. Объем распределения — 0.12-0.14 л/кг (5.78-13.5 л), у детей 0.3 л/кг., плазменный клиренс — 0.58-1,45 л/ч, почечный — 0.32-0.73 л/ч. Т1/2 значительно удлиняется у людей старше 75 лет, новорожденных и у больных с нарушением функций почек и печени. Выводится в течение 48 ч почками 50-60% в неизмененном виде и с желчью — 40-50% в кишечник, где происходит превращение в неактивный метаболит. У новорожденных детей через почки экскретируется около 70% препарата. 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