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l Zidovudine (ZDV) short course 3 страница
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Precautions and Contraindications: Administration of iron for longer than 6 months should be avoided except in patients with continued bleeding, menorrhagia, or repeated pregnancies. Iron should not be used to treat hemolytic anemias unless an iron-deficient state also exists, since excess storage of iron with possible secondary hemochromatosis can result. Iron should not be administered to patients receiving repeated blood transfusions, since there is a considerable amount of iron in the hemoglobin of transfused erythrocytes.
Antiasthmatics
Albuterol (Salbutamol), Metaproterenol (Orciprenalin), and terbutaline have been used safely in pregnancy. There is no increased risk of congenital malformation associated with these agents. Limited data are available on the use of oral beta-agonists in early pregnancy. All beta-agonists have been used in the third trimester to prevent premature labor; however, in therapeutic doses, they do not appear to prolong labor term. Hyperglycemia may be present transiently, and neonatal hyperglycemia can also occur.
Albuterol (Albuterol sulfate, Salbutamol)
Description: Antiasthmatic drug, beta-mimetic agent, short-acting ß 2-agonist.
Indications: Albuterol is used as a bronchodilator in the symptomatic relief of bronchospasm in reversible, obstructive airway disease.
Dosage: Albuterol sulfate is administered by oral inhalation via a metered-dose inhaler to prevent or arrest an attack of a disease. For the symptomatic relief of acute episodes of bronchospasm or prevention of asthmatic symptoms, the usual dosage of orally inhaled albuterol administered via a metered-dose aerosol for adults is 180 mcg (2 inhalations) every 4-6 hours.
Side Effects: overdosage leads to mild tachycardia, tremor of muscles.
Precautions: Caution in patient with thyrotoxicosis, essential hypertension, paroxysmal tachycardia, pregnancy.
Astmopent (Alupent)
Description: Antiasthmatic drug, beta-mimetic agent.
Indications: Astmopent is used as a bronchodilator in the symptomatic relief of bronchospasm in reversible, obstructive airway disease.
Dosage: Astmopent is used by oral inhalation via a metered-dose inhaler to arrest an attack of asthma. Usually 1-2 inhalations at the moment of attack are made.
Side Effects: dry mouth, nausea.
Precautions: the same as in albuterol.
Ephedrine (adrenaline), Ephedrine hydrochloride, Ephedrine sulfate
Description: Ephedrine is a sympathomimetic agent that occurs naturally in plants of the genus Ephedra; ephedrine stimulates both a- and ß -adrenergic receptors.
Indications: Bronchospasm, asthma and chronic obstructive pulmonary disease, hypotension and shock, cardiac arrhythmias and heart block, allergic reactions. Ephedrine is used parenterally to produce cardiac stimulation and vasoconstriction as an adjunct to correct hemodynamic imbalances in the treatment of shock which persists after adequate fluid volume replacement. Epinephrine has been theorized to reduce uterine blood flow, and some studies have shown an increase in congenital malformations with its use. Other studies have not demonstrated this increase. Generally, the severity of disease in women requiring epinephrine is worse than in those who do not receive this drug, and epinephrine may indeed be the causative factor in this association. Epinephrine is, therefore, only relatively contraindicated in pregnancy and may be used when other agents fail.
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Dosage: For subcutaneous introduction, IV/IM, use 0. 3- ml of 0. 1% solution. In case of cardiac arrest intracardiac injection should be used.
Side Effects: Tachycardia, cardiac rhythm disturbances, hypertension, stenocardia.
Precautions: Caution in patient with stenocardia, essential hypertension, paroxysmal tachycardia, diabetes mellitus, thyrotoxicosis, pregnancy.
Theophylline (Dimethylxanthine, Theobromine)
Description: spasmolytic agent, purine derivative.
Indications: bronchospasm, coronary insufficiency, congestive heart failure, congestive edema.
Theophylline compounds are considered safe during pregnancy. There is no increase demonstrated in congenital malformations. Theophylline may accumulate during the third trimester as a result of decreased clearance. Thus, maternal drug levels should be followed closely. There are reports of neonatal transient theophylline toxicity as well. Current asthma practice suggests that theophylline should be used for pregnant patients whose asthma is otherwise not controlled.
Dosage: For PO, use 0. 01-0. 02 g every 12–6 hours.
Side Effects: nausea, vomiting, pyrosis, diarrhea.
Corticosteroids
Aerosolized corticosteroids are the preparation of choice for pregnant patients. Beclomethasone dipropionate has been studied most, but all are considered safe. A spacer device should be used to enhance respiratory tract penetration and minimize oral deposition and systemic effects. Corticosteroids are indicated for the treatment of severe asthma in pregnancy. The current literature neither confirms nor excludes adverse effects of systemic steroids on the incidence of low birth weight or preeclampsia. Some steroids are used to enhance pulmonary lung maturity. The use of steroids when necessary to control asthma is considered significantly more beneficial than the risk of uncontrolled disease in the pregnant patient.
Anticoagulants
Anticoagulant therapy is used during pregnancy for prevention and treatment of venous thromboembolism or, in patients with mechanical heart valves, for prevention and treatment of systemic embolism. Anticoagulation (e. g., with heparin) is also used alone or in combination with aspirin for prevention of pregnancy loss in women with antiphospholipid antibodies (APLAs) or thrombophilia and previous pregnancy losses. If anticoagulant therapy is required in pregnant women, especially during the first trimester, therapy with unfractionated or low molecular weight heparin generally is recommended since these drugs do not cross the placenta. However, at least one low molecular weight heparin (enoxaparin) has been associated with maternal and fetal deaths in some pregnant women with prosthetic heart valves who were receiving thromboprophylaxis with the low molecular weight heparin.
Heparin Sodium
Description: Heparin, an anionic, sulfated glycosaminoglycan anticoagulant, acts as a catalyst to markedly accelerate the rate at which antithrombin III (heparin cofactor) neutralizes thrombin and activated coagulation factor X (Xa).
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Indications: Heparin is used for prophylaxis and treatment of venous thrombosis and its extension; prophylaxis of postoperative deep-vein thrombosis and pulmonary embolism in patients undergoing major abdominal or thoracic surgery who are at risk for thromboembolism; prophylaxis and treatment of pulmonary embolism; treatment of embolization associated with atrial fibrillation and/or prosthetic heart valve replacement; diagnosis and treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation); and in prophylaxis and treatment of peripheral arterial embolism. In addition, the drug is used as an in vitro anticoagulant in blood transfusions and in blood samples drawn for laboratory purposes. Heparin also has been used as adjunctive antithrombotic therapy in patients with unstable angina or non-ST-segment elevation/non-Q-wave myocardial infarction. Heparin does not cross the placenta and is of no direct risk to the fetus. It is the anticoagulant of choice in the pregnant patient. There may be a significantly increased risk of antepartum hemorrhage.
Dosage: For full-dose therapy, heparin is administered by IV infusion, intermittent IV injection, or deep subcutaneous (intrafat) injection. For fixed low-dose therapy, heparin is usually administered by deep subcutaneous injection. Heparin should not be administered IM because of the frequency of irritation, pain, and hematoma at the injection site.
For subcutaneous introduction, IV, use 20. 000- 50. 000 IU/d every 4–6 hours (depending on indications). Full-dose heparin therapy is generally continued for 7-10 days in patients with acute venous thrombosis, pulmonary embolism, or myocardial infarction, although some evidence suggests that a shorter duration of therapy (e. g., 3-5 days) may be adequate in some patients. When heparin is used for the treatment of disseminated intravascular coagulation (DIC), some clinicians recommend heparin sodium doses of 50-100 units/kg for adults given by IV infusion or IV injection every 4 hours. If there is no improvement after 4-8 hours, the drug should be discontinued.
Side Effects: local hematoma, localized pain, hemorrhages, failure of blood coagulation.
Precautions and Contraindications: heparin is contraindiciated in patients with hemorrhagic diathesis, leucoses, increased permeability of vessels, gastric and duodenal ulcer. Heparin is generally contraindicated in patients who are hypersensitive to the drug. Heparin is contraindicated in patients with uncontrollable bleeding, unless such bleeding is secondary to disseminated intravascular coagulation. The drug is also contraindicated whenever suitable blood coagulation tests cannot be performed at required intervals. Heparin should be used during pregnancy only when clearly needed. When anticoagulant therapy is required in pregnant or nursing women, most clinicians recommend that heparin be used, since the drug does not cross the placenta and is not distributed into milk. However, heparin should be used with caution during pregnancy, especially during the last trimester and the immediate postpartum period because of the risk of maternal hemorrhage. Bleeding at the uteroplacental junction is also possible. In an at-term woman who is receiving unfractionated heparin, heparin therapy should be discontinued 24 hours prior to elective induction of labor. If spontaneous labor occurs during heparin therapy, careful monitoring (e. g., aPTT or heparin concentrations) is required.
Warfarin Sodium
Description: Warfarin sodium is a coumarin-derivative anticoagulant that alters the synthesis of blood coagulation factors II (prothrombin), VII (proconvertin), IX (Christmas factor or plasma thromboplastin component), and X (Stuart-Prower factor) in the liver by interfering with the action of vitamin K.
Indications: Warfarin sodium is used for prophylaxis and treatment of venous thrombosis and its extension, prophylaxis and treatment of pulmonary embolism, prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, and as an adjunct in the treatment of coronary occlusion.
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Dosage: Adjusted-dose therapy with warfarin (initial dosage of 5 mg daily and subsequent daily dosage adjusted to prolong the prothrombin time to an INR of 2-3) is generally administered as follow-up anticoagulant therapy (for at least 3 months).
Precautions and Contraindications: Warfarin should be used with caution in any condition where added risk of hemorrhage, necrosis, and/or gangrene is present. All patients receiving warfarin should be under close medical supervision, and adequate laboratory facilities for monitoring therapy and measures for treating hemorrhage must be available. Warfarin should be used with caution in patients with heparin-induced thrombocytopenia and deep-vein thrombosis because of the risk of venous limb ischemia, necrosis, and gangrene occurring when heparin treatment is discontinued and warfarin therapy started or continued in such patients.
Warfarin is generally considered contraindicated during pregnancy, although the drug has been used in certain pregnant women (e. g., those with mechanical prosthetic heart valves) considered at high risk for thrombosis. Potential risks of warfarin therapy to the fetus include bleeding and teratogenicity. Fetal or neonatal hemorrhage and intrauterine death have occurred, even when maternal PT values were within the generally accepted therapeutic range. Hypoplastic nasal structures and other abnormalities (e. g., stippled epiphyses) consistent with a diagnosis of chondrodysplasia punctata have occurred rarely in children whose mothers received warfarin during the first trimester of pregnancy. CNS abnormalities also have been reported, including dorsal midline dysplasia characterized by agenesis of the corpus callosum.
Thrombolytics
There is limited information on the use of thrombolytics in pregnancy. Though there have been successful case reports, the complications of these agents are well known and the risk of antepartum hemorrhage is significant.
Streptokinase
Description: Streptokinase, a nonenzymatic protein produced by group C ß -hemolytic streptococci, is a thrombolytic agent.
Indications: Streptokinase is used as a thrombolytic agent in selected cases of acute evolving transmural myocardial infarction, acute massive pulmonary embolism, acute deep-vein thrombosis, acute arterial thrombosis and embolism, and occluded arteriovenous cannulae. The drug is generally most effective in lysing recently formed thrombi. The potential risk of serious hemorrhage must be weighed against the possible benefits of streptokinase therapy. Adequate anticoagulation, instituted soon after streptokinase therapy is discontinued, has been used to minimize the risk of rethrombosis and recurrent emboli in patients with venous thrombosis, pulmonary embolism, or arterial thrombosis or embolism. Streptokinase has been used to treat chronic arterial occlusions, retinal vessel thrombosis, and various other diseases associated with thromboembolic phenomena, but further study is necessary to determine if these are valid indications for streptokinase therapy.
Dosage: For lysis of acute coronary artery thrombi associated with evolving transmural myocardial infarction, the usual IV streptokinase dose currently recommended is 1. 5 million units infused over 60 minutes. Although intracoronary thrombolytic therapy generally has been replaced by IV therapy, if this route is employed, intracoronary streptokinase has been initiated with a bolus dose of 15, 000-20, 000 units (range: 10, 000-30, 000 units) in a small volume of suitable diluent (e. g., 3-20 ml of 5% dextrose or 0. 9% sodium chloride injection) administered selectively into the thrombosed coronary artery over 15 seconds to 2 minutes, followed by a maintenance infusion of 2000-4000 units/minute.
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Precaution and Contraindications: Streptokinase is contraindicated in patients with active internal bleeding (menstruation is not included), intracranial neoplasm, severe uncontrolled hypertension, acute pericarditis, previous cerebral hemorrhage, aortic dissection, intracranial vascular disease (e. g., aneurysm, arteriovenous malformation), previous hemorrhagic stroke, other recent (within 1 year) strokes or cerebrovascular events, or recent (within 2 months) intracranial or intraspinal surgery. Streptokinase may be contraindicated in patients with a history of a previous severe allergic reaction to the drug or who present a substantial risk of an allergic response. Relative contraindications to streptokinase therapy include recent (within 3-4 weeks) surgery, organ biopsy, obstetrical delivery, or previous puncture of noncompressible vessels; hypertension (i. e., systolic blood pressure exceeding 180 mm Hg and/or diastolic pressure exceeding 110 mm Hg; recent (within 6 months) genitourinary or GI bleeding; other recent active internal bleeding; recent (within 2-4 weeks) serious trauma (including head trauma); recent (within 10 days) minor trauma (e. g., cardiopulmonary resuscitation).
It is not known whether the drug can cause fetal harm when administered to pregnant women or can affect reproduction capacity. Streptokinase should be used during pregnancy only when clearly needed. To prevent premature separation of the placenta, streptokinase should not be administered during the first 18 weeks of pregnancy.
Anticonvulsants
The risk of birth defects in healthy pregnant women is 2% to 4% and rises to 4% to 6% in pregnant women taking one antiepileptic drug. Exposure to these agents presents the greatest risk to the fetus from the third to eighth week after conception. The teratogenic effects are worsened with the use of combination therapy. Women who require medication should be maintained on the most effective agent with the lowest teratogenic potential. Generalized seizures during pregnancy may cause an increased risk of spontaneous abortion or hypoxic injury.
Phenytoin (Dipheninum)
Phenytoin is considered a human teratogen. It is estimated that 7% to 10% of children exposed will develop intrauterine growth retardation, motor and developmental delays, facial dysmorphia, and limb abnormalities. As many as 3% may have major malformations, including cleft lip or palate and microcephaly. Neonatal coagulopathy as a result of deficiency of the vitamin K–dependent coagulation factors is another complication of phenytoin therapy. It may be prevented by administration of vitamin K to the mother during the last trimester or to the infant after birth. Phenytoin also decreases serum folic acid levels, which is reported to cause megaloblastic anemia and neural cord defects. This responds well to folic acid supplementation.
Carbamazepine (Amizepin, Finlepsin)
Description: anticonvulsant agent, it has a specific analgetic effect in case of trigeminal neuralgia.
Indications: epilepsy, trigeminal neuralgia.
Dosage: 0. 2-0. 3 PO every 8 hours.
Side Effects: nausea, hypersomnia, dizziness, allergic reactions, leukocytopenia, thrombocytopenia.
Precautions: There have been reports of craniofacial defects, hypoplastic fingernails, and developmental delays in infants exposed to carbamazepine. As with phenytoin, folic acid deficiency may lead to neural tube defects; folate should be supplemented and antenatal alpha-fetoprotein testing considered. Thus, it cannot be used in pregnant with early (1-3months) terms of pregnancy.
Phenobarbital
Description: hypnotic agent.
Indications: epilepsy, trigeminal neuralgia, spastic paralysis, essential hypertension, stenocardia, neurovegetative diseases.
Dosage: 0. 05g PO every 12 hours, progressively step up the dose, but not to exceed 0. 6 g/d.
Side effects: Phenobarbital may contribute to folic acid deficiency and coagulation defects, as phenytoin does. Neonatal depression and withdrawal syndromes may also be seen. The literature implicating phenobarbital as a teratogen is inconclusive, with one large study showing no evidence of teratogenic risk. Therefore, phenobarbital is probably considered safe in pregnant epileptics. The drug should be used during pregnancy only in life-threatening situations or severe disease for which safer drugs cannot be used or are ineffective. When the drug is administered during pregnancy or if the patient becomes pregnant while receiving the drug, the patient should be informed of the potential hazard to the fetus.
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Clonazepam
Description: Clonazepam is a benzodiazepine derivative that is used both as an anticonvulsant and for the treatment of panic disorder with or without agoraphobia.
Indications: Clonazepam is used in the prophylactic management of petit mal variant epilepsy and akinetic and myoclonic seizures. The drug may also be used in the management of absence (petit mal) seizures in patients who have not responded to succinimides. In some patients, use of clonazepam may permit reduction in dosage or discontinuance of other anticonvulsants.
Dosage and Administration: Clonazepam is administered orally. For the management of panic disorder in adults, the recommended initial dosage of clonazepam is 0. 25 mg twice daily. For the management of seizure disorders initial adult dosage of clonazepam should not exceed 1. 5 mg daily. Dosage may be increased in increments of 0. 5-1 mg every third day until seizure control is achieved with minimal adverse effects.
Side Effects: The most frequent adverse effects of clonazepam are sedation or drowsiness, ataxia or hypotonia, and behavioral disturbances (principally in children) including aggressiveness, irritability, agitation, and hyperkinesis.
Precautions and Contraindications: clonazepam shares the toxic potential of other benzodiazepines, and the usual cautions, precautions, and contraindications of benzodiazepine therapy should be followed. The majority of women receiving clonazepam therapy deliver normal infants. Clonazepam should be used in pregnant women or women who might become pregnant only if the drug is considered essential in the management of their seizures. Anticonvulsants should not be discontinued in pregnant women in whom the drugs are administered to prevent major seizures because of the strong possibility of precipitating status epilepticus with attendant hypoxia and threat to life.
Valproic Acid
Valproic acid is teratogenic in animals and humans. It readily crosses the placenta and concentrates in the fetus. Neural tube defects occur in approximately 2. 5% of exposed pregnancies. The teratogenic effects of phenytoin, phenobarbital, or carbamazepine are worsened by the addition of valproic acid. Valproic acid should not be considered for women of childbearing age.
Trimethadione
Trimethadione is the most potent teratogenic anticonvulsant. It is associated with an 80% rate of malformation and frequent spontaneous abortions. It should not be used in pregnancy.
Diazepam (Valium)
Description: Benzodiazepine, sedative-hypnotic, anxiolytic, amnestic, anticonvulsant, skeletal muscle relaxant.
Indications: Patients with chronic neuropathic pain exhibiting sleep disturbances, anxiety and restlessness, skeletal muscle spasm.
Dosage: Start at 5 mg PO at bedtime. May be given as a TID dose for patients with daytime anxiety/ panic attack, usually not exceeding 3–4 mg/day with largest dose given at bedtime.
Side Effects: Sedation, drowsiness, increased salivation, constipation.
Precautions: Not recommended for use in patients with hepatic or renal disease, debilitated patients, or those with organic brain syndrome. Benzodiazepines readily cross the placenta and accumulate in the circulation of the embryo. The literature remains divided as to whether benzodiazepines cause an increase in congenital malformations. A recent study demonstrated no difference in the prevalence of congenital abnormalities between women taking benzodiazepines and controls. Third-trimester treatment of women with diazepam has been shown to cause apnea, hypotonia, and hypothermia in the newborn. In chronically treated patients, tremor, irritability, and hypertonia as a result of withdrawal may be seen in some infants.
New Antiepileptic Drugs
Felbamate, gabapentin, lamotrigine, and topiramate are newer agents available for the treatment of epilepsy. There is little clinical information regarding their use and safety in pregnant women.
Antimicrobials
Aminoglycosides
Description: Sulfate, Gentamicin Sulfate, Kanamycin Sulfate, Neomycin Sulfate, Paromomycin Sulfate, Streptomycin Sulfate, Tobramycin Sulfate. Aminoglycosides are antibiotics that are generally active against many aerobic gram-negative bacteria and some aerobic gram-positive bacteria and principally are used for serious infections.
Dosages: Amikacin sulfate is used in dosage: For IV/IM, use 10–15 mg/kg/d (2-3 ingections/infusions daily).
Gentamicin sulfate: IM 0. 4 mg/kg, daily dose 0. 8-1. 2 mg/kg (2-3 ingections per day). Daily dose may be increased to 2. 4-3. 2 mg/kg if needed. Caution: may produce an ototoxic and nephrotoxic effect.
Kanamycin sulfate: IM 0. 5g 2-3 times a day during 5-7 days. Caution: may produce an ototoxic (cochlear neuritis) and nephrotoxic effect (microhematuria, albuminuria).
Cephalosporins
Description: Cefaclor, Cefadroxil, Cefazolin Sodium, Cefdinir, Cefditoren Pivoxil, Cefepime Hydrochloride, Cefixime, Cefoperazone Sodium, Cefotaxime Sodium, Cefpodoxime Proxetil, Cefprozil, Ceftazidime, Ceftibuten Dihydrate, Ceftizoxime Sodium, Ceftriaxone Sodium, Cefuroxime Axetil, Cefuroxime Sodium, Cephalexin, Cephalexin Hydrochloride, Cephradine.
Cephalosporins are semisynthetic ß -lactam antibiotics that are structurally and pharmacologically related to penicillins, carbacephems (e. g., loracarbef), and cephamycins (e. g., cefotetan, cefoxitin). Cephalosporins are generally divided into 4 groups (" generations" ) based on their spectra of activity.
Indications: Cephalosporins are used parenterally for the treatment of lower respiratory tract, skin and skin structure, urinary tract, and bone and joint infections caused by susceptible gram-positive or gram-negative bacteria and also are used parenterally for the treatment of meningitis and septicemia/bacteremia caused by susceptible gram-positive or gram-negative bacteria. Cephalosporins are also used parenterally for the treatment of intra-abdominal, biliary tract, and gynecologic infections (including pelvic inflammatory disease) caused by susceptible bacteria. Cefotaxime, cefoxitin, ceftizoxime, ceftriaxone, and cefuroxime are used parenterally for the treatment of uncomplicated gonorrhea or other gonococcal infections; cefazolin, cefotaxime, ceftriaxone, and cefuroxime are used parenterally for perioperative prophylaxis. Cefaclor, cefadroxil, cefdinir, cefditoren pivoxil, cefpodoxime proxetil, cefprozil, ceftibuten, cefuroxime axetil, cephalexin, and cephradine are also used orally for the treatment of mild to moderate skin and skin structure infections caused by susceptible staphylococci or streptococci.
Dosages: Cefazolin (I generation): IV/IM 1 g every 12 hours; maximum daily dose – 6 g.
Cefoxitin (II generation): IV/IM 1-2 g every 8 hours.
Cefmetazol (II generation): IM/IV 2 g every 8 hours. In severe cases: 2 g every 6 hours.
Cefotaxime (III generation): IM/IV 1-2 g 2 times a day. Maximum daily dose -12 g (divided into 3-4 injections).
Cefpirom (IV generation): IM/IV 1-2 g 2 times every 12 hours.
The duration of cephalosporin therapy depends on the type of infection. Generally, therapy should be continued for a minimum of 48-72 hours after the patient becomes asymptomatic or evidence of eradication of the infection has been obtained. In infections caused by ß -hemolytic streptococci, therapy should be continued for at least 10 days. At least 4-6 weeks of therapy may be required in serious infections such as septicemia, endocarditis, or osteomyelitis.
Miscellaneous ß -Lactams
Carbacephems
Description: Loracarbef. It is a synthetic carbacephem ß -lactam antibiotic that is structurally and pharmacologically related to cephalosporins.
Indications: Loracarbef is used orally for the treatment of mild to moderate respiratory tract infections (i. e., acute maxillary sinusitis, secondary bacterial infections of acute bronchitis, acute exacerbations of chronic bronchitis, pneumonia) caused by susceptible bacteria; acute otitis media caused by susceptible bacteria; and pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A ß -hemolytic streptococci). The drug is also used orally for the treatment of mild to moderate uncomplicated skin and skin structure infections and mild to moderate uncomplicated urinary tract infections (including uncomplicated cystitis or pyelonephritis) caused by susceptible bacteria.
Dosage: Loracarbef is administered orally, 200-400 mg every 12 hours for 7 days. In severe cases usual dosage of loracarbef is 400 mg every 12 hours.
Cephamycins
Description: Cefotetan Disodium. Cefotetan is a semisynthetic cephamycin ß -lactam antibiotic.
Indications: Cefotetan is used for the treatment of urinary tract, lower respiratory tract, skin and skin structure, bone and joint, gynecologic, and intra-abdominal infections caused by susceptible bacteria1, and are used for perioperative prophylaxis. Cefotetan should not be used in the treatment of meningitis or other CNS infection.
Dosage: Cefotetan disodium is administered by IV injection or infusion or by deep IM injection. For direct intermittent IV injection, the contents of vials labeled as containing 1 or 2 g of cefotetan should be reconstituted with 10 or 10-20 ml, respectively, of sterile water for injection to provide solutions containing approximately 97. 2 or 98. 4-179. 8 mg/ml, respectively. The vials should be shaken until the drug is dissolved and then allowed to stand until the solution is clear. The appropriate dose of reconstituted solution may then be injected directly into a vein over a 3- to 5-minute period.
Monobactams
Description: Aztreonam. It is a synthetic monocyclic ß -lactam (i. e., monobactam) antibiotic.
Indications: Aztreonam is used for the treatment of complicated and uncomplicated urinary tract infections (including pyelonephritis and cystitis), lower respiratory tract infections (including pneumonia and bronchitis), septicemia, skin and skin structure infections (including those associated with postoperative wounds or ulcers and burns), intra-abdominal infections (including peritonitis), and gynecologic infections (including endometritis and pelvic cellulitis) caused by susceptible gram-negative aerobic bacteria.
Dosage: For IV/IM use 0. 5-1. 0 g every 8-12 hours. In severe cases: 2 g every 8-12 hours.
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