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Концентрации цефтазидима превышающие минимальные подавляющие концентрации для большинства распространенных патогенных микроорганизмов могут быть достигнуты в костной ткани тканях сердца желчи мокроте синовиальной жидкости внутриглазной плевральной и перитонеальной жидкостях. Легко проникает через плацентарный барьер и выделяется с грудным молоком. При отсутствии воспалительного процесса в менингеальных оболочках цефтазидим плохо проникает через гематоэнцефалический барьер концентрация препарата в спинномозговой жидкости (СМЖ) низкая. При менингите в спинномозговой жидкости достигаются терапевтические концентрации цефтазидима составляющие 4 - 20 мг/л и выше. Цефтазидим не метаболизируется в организме. Период полувыведения около 2 ч у новорожденных - в 3-4 раза больше чем у взрослых. Цефтазидим выводится в неизменном виде почками путем клубочковой фильтрации. Приблизительно 80-90 % дозы выделяется почками в течение 24 ч. Менее 1 % препарата выводится с желчью. При нарушении функции почек скорость выведения цефтазидима снижается. При гемодиализе период полувыведения составляет 3-5 ч."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Препарат назначается взрослым и детям для лечения следующих инфекционных заболеваний вызванных чувствительными к препарату микроорганизмами:"}},{"type":"paragraph","data":{"text":"тяжелые инфекции включая внутрибольничные (септицемия бактериемия перитонит менингит инфекции у пациентов со сниженным иммунитетом инфицированные ожоги); инфекции костей и суставов: септический артрит остеомиелит бактериальный бурсит;"}},{"type":"paragraph","data":{"text":"инфекции дыхательных путей: острый и хронический бронхит инфицированные бронхоэктазы пневмонии вызванная грамотрицательными бактериями абсцесс легких эмпиема плевры инфекции легких у больных муковисцидозом;"}},{"type":"paragraph","data":{"text":"инфекции мочевыводящих путей: острый и хронический пиелонефрит пиелит простатит цистит уретрит (только бактериальный) абсцесс почки;"}},{"type":"paragraph","data":{"text":"инфекции кожи и мягких тканей: мастит раневые инфекции кожные язвы флегмона рожа; инфекции желудочно-кишечного тракта брюшной полости и желчных путей: энтероколит забрюшинные абсцессы дивертикулит воспаления органов малого таза холецистит холангит эмпиема желчного пузыря;"}},{"type":"paragraph","data":{"text":"инфекции женских половых органов;"}},{"type":"paragraph","data":{"text":"инфекции уха горла носа: средний отит синусит мастоидит и др.;"}},{"type":"paragraph","data":{"text":"гонорея (особенно при повышенной чувствительности к антибактериальным препаратам из группы пенициллинов)."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к цефтазидиму и другим компонентам препарата; повышенная чувствительность к другим цефалоспориновым антибиотикам и пенициллинам."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Почечная недостаточность период новорожденности колит в анамнезе синдром мальабсорбции (повышен риск снижения протромбиновой активности особенно у лиц с выраженной почечной и/или печеночной недостаточностью) одновременное введение с \"петлевым\" диуретиками и аминогликазидами."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"При беременности применяют только в случае если предполагаемая польза для матери превышает потенциальный риск для плода. При применении препарата в период лактации кормление грудью следует прекратить."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Цефтазидим применяют только парентерально. Доза препарата устанавливается индивидуально с учетом тяжести течения заболевания локализации вида возбудителя и его чувствительности к препарату возраста пациента и функции почек. Препарат вводят внутривенно или глубоко внутримышечно в область верхнего наружного квадранта большой ягодичной мышцы или в область латеральной части бедра. Раствор цефтазидима можно вводить непосредственно в вену или в трубку инфузионной системы."}},{"type":"paragraph","data":{"text":"Обычная доза для взрослых и детей старше 12 лет составляет 1 г внутримышечно или внутривенно каждые 8-12 ч."}},{"type":"paragraph","data":{"text":"- при неосложненных инфекциях мочевыводящих путей внутримышечно или внутривенно по 250 мг каждые 12 ч;"}},{"type":"paragraph","data":{"text":"- при осложненных инфекциях мочевыводящих путей внутримышечно или внутривенно по 500 мг-1 г каждые 8-12 ч;"}},{"type":"paragraph","data":{"text":"- при неосложненной пневмонии инфекциях кожи и мягких тканей внутримышечно или внутривенно по 500 мг - 1 г каждые 8 ч;"}},{"type":"paragraph","data":{"text":"- при муковисцидозе инфекциях дыхательных путей вызванных Pseudomonas spp. от 100 до 150 мг/кг/сутки кратность введения - 3 раза в сутки (применение дозы до 9 г/сутки у таких пациентов не вызывало осложнений);"}},{"type":"paragraph","data":{"text":"- при инфекциях костей и суставов внутривенно по 2 г каждые 12 ч;"}},{"type":"paragraph","data":{"text":"- при тяжелых инфекциях включая внутрибольничные внутривенно по 2 г каждые 8 ч;"}},{"type":"paragraph","data":{"text":"- при крайне тяжелых или жизнеугрожающих инфекциях внутривенно по 2 г каждые 8 ч. Пациентам пожилого возраста максимальная суточная доза не должна превышать 3 г."}},{"type":"paragraph","data":{"text":"Пациентам с почечной недостаточностью требуется снижение дозы так как цефтазидим выводится почками в неизменном виде."}},{"type":"paragraph","data":{"text":"Начальная доза составляет 1 г. Поддерживающую дозу подбирают в зависимости от скорости гломерулярной фильтрации."}},{"type":"paragraph","data":{"text":"Поддерживающие дозы цефтазидима при почечной недостаточности представлены в таблице."}},{"type":"paragraph","data":{"text":"КЛИРЕНС КРЕАТИНИНА"}},{"type":"paragraph","data":{"text":"ДОЗА"}},{"type":"paragraph","data":{"text":"> 50 мл/мин (083 мл/сек)"}},{"type":"paragraph","data":{"text":"Смотрите раздел \"Обычная доза для взрослых и детей старше 12 лет\""}},{"type":"paragraph","data":{"text":"35-50 мл/мин (052 - 083 мл/сек)"}},{"type":"paragraph","data":{"text":"По 1 г каждые 12 ч"}},{"type":"paragraph","data":{"text":"16-30 мл/мин (027 - 050 мл/сек)"}},{"type":"paragraph","data":{"text":"По 1 г каждые 24 ч"}},{"type":"paragraph","data":{"text":"6-15 мл/мин (010 - 025 мл/сек)"}},{"type":"paragraph","data":{"text":"По 500 мг каждые 24 ч"}},{"type":"paragraph","data":{"text":"< 5 мл/мин (008 мл/сек)"}},{"type":"paragraph","data":{"text":"По 500 мг каждые 48 ч"}},{"type":"paragraph","data":{"text":"Пациенты которым проводят гемодиализ"}},{"type":"paragraph","data":{"text":"По 1 г после каждого сеанса гемодиализа"}},{"type":"paragraph","data":{"text":"Пациенты которым проводят перитонеальный диализ"}},{"type":"paragraph","data":{"text":"По 500 мг каждые 24 ч"}},{"type":"paragraph","data":{"text":"Пациентам с тяжелыми инфекциями можно увеличить поддерживающую дозу на 50 % или увеличить частоту введения препарата. В этом случае следует контролировать уровень цефтазидима в сыворотке крови сывороточная концентрация цефтазидима при этом не должна превышать 40 мг/л."}},{"type":"paragraph","data":{"text":"Для детей клиренс креатинина рассчитывается в соответствии с идеальной массой или площадью поверхности тела."}},{"type":"paragraph","data":{"text":"Период полувыведения препарата во время гемодиализа составляет 3-5 ч. Соответствующую дозу препарата следует повторять после каждого периода диализа."}},{"type":"paragraph","data":{"text":"При перитонеальном диализе препарат цефтазидим можно включать в диализный раствор в дозе от 125 мг до 250 мг на 2 л диализного раствора. У пациентов с почечной недостаточностью находящихся на непрерывном гемодиализе с использованием артериовенозного шунта и у пациентов находящихся на гемофильтрации высокой скорости в отделении интенсивной терапии рекомендуемые дозы - 1 г в сутки ежедневно (за одно или несколько введений)."}},{"type":"paragraph","data":{"text":"У пациентов находящихся на гемофильтрации низкой скорости назначают дозы рекомендуемые при нарушении функции почек."}},{"type":"paragraph","data":{"text":"Обычная доза для детей:"}},{"type":"paragraph","data":{"text":"Детям в возрасте до 2 месяцев назначают 25 - 60 мг/кг в сутки (в 2 введения)."}},{"type":"paragraph","data":{"text":"Детям от 2 месяцев до 12 лет назначают 30 - 100 мг/кг в сутки (в 2 - 3 введения) детям со сниженным иммунитетом муковисцидозом и менингитом - 150 мг/кг в сутки (в 3 введения)."}},{"type":"paragraph","data":{"text":"Максимальная суточная доза для детей составляет 6 г."}},{"type":"paragraph","data":{"text":"Продолжительность лечения"}},{"type":"paragraph","data":{"text":"Длительность лечения цефтазидимом составляет 7-14 дней. При инфекциях вызванных Pseudomonas aeruginosa (пневмония муковисцидоз менингит) курс лечения может быть увеличен до 21 дня"}},{"type":"paragraph","data":{"text":"Приготовление растворов"}},{"type":"paragraph","data":{"text":"1. \"ПЕРВИЧНОЕ\" РАЗВЕДЕНИЕ"}},{"type":"paragraph","data":{"text":"ДОЗИРОВКА"}},{"type":"paragraph","data":{"text":"ОБЪЕМ РАСТВОРИТЕЛЯ ПРИ ВНУТРИМЫШЕЧНОМ ВВЕДЕНИИ"}},{"type":"paragraph","data":{"text":"ОБЪЕМ РАСТВОРИТЕЛЯ ПРИ ВНУТРИВЕННОМ ВВЕДЕНИИ"}},{"type":"paragraph","data":{"text":"500 мг"}},{"type":"paragraph","data":{"text":"15 мл воды для инъекций или 05 % или 1 % раствора лидокаина гидрохлорида"}},{"type":"paragraph","data":{"text":"5 мл воды для инъекций"}},{"type":"paragraph","data":{"text":"10 г; 20 г"}},{"type":"paragraph","data":{"text":"3 мл воды для инъекций или 05 % или 1 % раствора лидокаина гидрохлорида"}},{"type":"paragraph","data":{"text":"10 мл воды для инъекций"}},{"type":"paragraph","data":{"text":"2. \"ВТОРИЧНОЕ\" РАЗВЕДЕНИЕ"}},{"type":"paragraph","data":{"text":"Для внутривенного КАПЕЛЬНОГО введения полученный вышеописанным способом раствор препарата дополнительно разводят в 50 - 100 мл одного из следующих растворителей предназначенных для внутривенного введения:"}},{"type":"paragraph","data":{"text":"- 09% раствор натрия хлорида"}},{"type":"paragraph","data":{"text":"- раствор Рингера"}},{"type":"paragraph","data":{"text":"- 5 % 10 % раствор глюкозы (декстрозы)"}},{"type":"paragraph","data":{"text":"- 5% раствор глюкозы (декстрозы) с 09 % раствором натрия хлорида."}},{"type":"paragraph","data":{"text":"При растворении порошка выделяется двуокись углерода. После введения растворителя флакон необходимо встряхивать чтобы получился прозрачный раствор. В полученном готовом растворе препарата могут присутствовать небольшие пузырьки двуокиси углерода."}},{"type":"paragraph","data":{"text":"Полученный раствор может иметь цвет от светло-желтого до темно-желтого. Если соблюдены все рекомендуемые правила разведения препарата то его эффективность не зависит от оттенка."}},{"type":"paragraph","data":{"text":"Использовать только свежеприготовленный раствор!"}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Аллергические реакции: крапивница озноб или лихорадка сыпь зуд бронхоспазм мультиформная экссудативная эритема (в т.ч. синдром Стивенса-Джонсона) токсический эпидермальный некролиз (синдром - Лайелла) ангионевротический отек анафилактический шок."}},{"type":"paragraph","data":{"text":"Со стороны нервной системы: головная боль головокружение парестезии судорожные припадки энцефалопатия \"порхающий\" тремор."}},{"type":"paragraph","data":{"text":"Со стороны мочеполовой системы: кандидозный вагинит."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы: нарушение функции почек токсическая нефропатия."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: тошнота рвота диарея боль в животе колит холестаз орофарингеальный кандидоз метеоризм дисбактериоз стоматит глоссит псевдомембранозный колит."}},{"type":"paragraph","data":{"text":"Со стороны органов кроветворения: эозинофилия лейкопения нейтропения агранулоцитоз тромбоцитопения лимфоцитоз гранулоцитопения гемолитическая анемия геморрагии."}},{"type":"paragraph","data":{"text":"Лабораторные показатели: гиперкреатининемия повышение концентрации мочевины ложноположительная реакция мочи на глюкозу повышение активности \"печеночных\" трансаминаз и щелочной фосфатазы гипербилирубинемия ложноположительная прямая реакция Кумбса увеличение протромбинового времени."}},{"type":"paragraph","data":{"text":"Местные реакции: при внутривенном введении флебит; при внутримышечном введении - болезненность жжение уплотнение в месте инъекции."}},{"type":"paragraph","data":{"text":"Прочие: носовые кровотечения суперинфекция."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: боль воспаление флебит в месте инъекции головокружение парестезии головная боль судороги у пациентов с почечной недостаточностью гиперкреатининемия гипербилирубинемия тромбоцитоз тромбоцитопения эозинофилия лейкопения удлинение протромбинового времени."}},{"type":"paragraph","data":{"text":"Лечение: симптоматическое в случае почечной недостаточности - перитонеальный диализ или гемодиализ."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Фармацевтически несовместим с гепарином."}},{"type":"paragraph","data":{"text":"Фармацевтически несовместим с аминогликозидами (значительная взаимная инактивация: при одновременном применении эти препараты следует вводить в разные участки тела) и ванкомицином (образует осадок в зависимости от концентрации; при необходимости вводить два препарата через одну трубку между их применением системы для внутривенного введения следует промыть). Нельзя использовать раствор натрия гидрокарбоната в качестве растворителя (образуется углерода диоксид это может потребовать выпуска газа наружу)."}},{"type":"paragraph","data":{"text":"\"Петлевые\" диуретики аминогликозиды ванкомицин клиндамицин снижают клиренс цефтазидима в результате чего возрастает риск нефротоксического действия. Бактериостатические антибиотики (в т.ч. хлорамфеникол) снижают действие препарата. Фармацевтически совместим со следующими растворами: при концентрации от до 40 мг/мл - натрия хлорид 09 % натрия лактат раствор Гартмана декстроза 5 % натрия хлорид 0225 % и декстроза 5 % натрия хлорид 045 % и декстроза 5 % натрия хлорид 09 % и декстроза 5 % натрия хлорид 018 % и декстроза 4 % декстроза 10 % декстран 40:10 % в растворе натрия хлорида 09 % декстран 40:10 % в растворе декстрозы 5 % декстран 70:6 % в растворе натрия хлорида 09 % декстран 70:6 % в растворе декстрозы 5%."}},{"type":"paragraph","data":{"text":"При концентрации от 005 до 025 мг/мл цефтазидим совместим с раствором для интраперитонеального диализа (лактат)."}},{"type":"paragraph","data":{"text":"Для в/м введения цефтазидим может быть разведен раствором лидокаина гидрохлорида 05 % или 1%. Оба компонента сохраняют активность если добавляют к следующим растворам (концентрация цефтазидима 4 мг/мл): гидрокортизон (гидрокортизона натрия фосфат) 1 мг/мл в растворе натрия хлорида 09 % или растворе декстрозы 5 % цефуроксим (цефуроксим натрия) 3 мг/мл в растворе натрия хлорида 09 % клоксациллин (клоксациллин натрия) 4 мг/мл в растворе натрия хлорида 09 % гепарин 10 МЕ/мл или 50 МЕ/мл в растворе натрия хлорида 09 % калия хлорид 10 мЭк/л или 40 мЭк/л в растворе натрия хлорида 09 %. При смешении раствора цефтазидима (500 мг в 15 мл воды для инъекций) и метронидазола (500 мг/100 мл) оба компонента сохраняют свою активность."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Пациенты имевшие в анамнезе аллергические реакции на пенициллины могут иметь повышенную чувствительность к цефалоспориновым антибиотикам. Во время лечения нельзя употреблять этанол."}},{"type":"paragraph","data":{"text":"При применении препарата и через 2-3 нед после прекращения лечения возможно развитие диареи вызванной Clostridium difficile. В лёгких случаях достаточно отмены лечения и применении йонообменных смол (колестирамин колестипол) в тяжёлых случаях показано возмещение потери жидкости электролитов и белка назначение ванкомицина бацитрацина или метронидазола. Нельзя применять лекарственные средства тормозящие перистальтику кишечника."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"В период лечения необходимо соблюдать осторожность при управлении транспортными средствами и занятии другими потенциально опасными видами деятельности требующих повышенной концентрации внимания и быстроты психомоторных реакций из-за риска возникновения головокружения."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Порошок для приготовления раствора для внутривенного и внутримышечного введения 05 г 1 г 2 г."}},{"type":"header","data":{"text":"Упаковка:","level":3}},{"type":"paragraph","data":{"text":"По 05 г 1 г активного вещества во флаконы вместимостью 10 мл или 20 мл по 2 г активного вещества во флаконы вместимостью 20 мл.По 1 5 или 10 флаконов с инструкцией по применению помещают в пачку картонную. По 50 флаконов помещают в коробку картонную с равным количеством инструкций по применению для поставки в стационары."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом защищенном от света месте при температуре не выше 25 °С. Хранить в местах недоступных для детей"}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года."}},{"type":"paragraph","data":{"text":"Не использовать по истечении срока годности указанного на упаковке!"}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Открытое акционерное общество \"Акционерное Курганское общество медицинских препаратов и изделий \"Синтез\" (ОАО \"Синтез\"), 640008, Курганская обл., г. Курган, проспект Конституции, д. 7, Россия"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ОАО \"Синтез\""}}]}],"source":null},"description_toggle":false,"short_description":"Цефалоспориновый антибиотик III поколения для парентерального применения. Действует бактерицидно (нарушает синтез клеточной стенки микроорганизмов). Обладает широким спектром действия. Устойчив к действию большинства бета-лактамаз. Действует на многие штаммы устойчивые к ампициллину и другим цефалоспоринам. Активен в отношении грамотрицательных микроорганизмов: Pseudomonas spp. в т.ч. Pseudomonas aeruginosa Klebsiella spp. в т.ч. Klebsiella pneumoniae Proteus mirabilis Proteus vulgaris Escherichia coli Enterobacter spp. включая Enterobacter aerogenes Enterobacter cloacae Citrobacter spp. включая Citrobacter diversus Citrobacter freundii meningitidis Haemophilus influenzae (включая штаммы устойчивые к ампициллину);грамположительных микроорганизмов: Staphylococcus aureus (продуцирующие и непродуцирующие пенициллиназу штаммы чувствительные к метициллину) Streptococcus pyogenes (группа А бета-гемолитический стрептококк) Streptococcus agalactiae (группа В) Streptococcus pneumoniae; анаэробных микроорганизмов: Bacteroides spp. (многие штаммы Bacteroides fragilis резистентны).Неактивен в отношении устойчивых к метициллину Staphylococcus spp. Streptococcus faecalis Enterococcus spp. Listeria monocytogenes Campylobacter spp. и Clostridium difficile. Активен in vitro против большинства штаммов следующих организмов (клиническое значение этой активности неизвестно): Clostridium perfringens не включая Clostridium difficile Acinetobacter spp. Haemophilus parainfluenzae Morganella morganii Neisseria gonorrhoeae Peptococcus spp. Peptostreptococcus spp. Providencia spp. Providencia rettgeri Salmonella spp.; Shigella spp. Staphylococcus epidermidis Yersinia enterocolitica. Максимальная концентрация (Cmax) после внутримышечного введения в дозах 05 и 1 г -17 и 39 мг/л соответственно время необходимое для достижения максимальной концентрации (TCmax) -1 ч. Сmах после внутривенного болюсного введения в дозах 05 1 и 2 г - 42 69 и 170 мг/л соответственно. Терапевтически эффективные сывороточные концентрации сохраняются через 8-12 ч после внутривенного и внутримышечного введения. Связь с белками плазмы - менее 10%. Концентрации цефтазидима превышающие минимальные подавляющие концентрации для большинства распространенных патогенных микроорганизмов могут быть достигнуты в костной ткани тканях сердца желчи мокроте синовиальной жидкости внутриглазной плевральной и перитонеальной жидкостях. Легко проникает через плацентарный барьер и выделяется с грудным молоком. При отсутствии воспалительного процесса в менингеальных оболочках цефтазидим плохо проникает через гематоэнцефалический барьер концентрация препарата в спинномозговой жидкости (СМЖ) низкая. При менингите в спинномозговой жидкости достигаются терапевтические концентрации цефтазидима составляющие 4 - 20 мг/л и выше. Цефтазидим не метаболизируется в организме. Период полувыведения около 2 ч у новорожденных - в 3-4 раза больше чем у взрослых. Цефтазидим выводится в неизменном виде почками путем клубочковой фильтрации. Приблизительно 80-90 % дозы выделяется почками в течение 24 ч. Менее 1 % препарата выводится с желчью. 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