Broad-spectrum antibiotic of the aminoglycoside. Bacteriostatic testosterone enanthate vs cypionate. Highly active against testosterone enanthate vs cypionate gram-negative bacteria (Pseudomonas aeruginosa, Acinetobacter spp., Esherichia coli, Klebsiella spp., Serratia spp., Providencia spp., Enterobacter spp., Proteus spp., Salmonella spp., Shigella spp.), As well as some gram microorganisms: Staphylococcus spp. (including those resistant to penicillins, cephalosporins), certain strains of Streptococcus spp.Aminoglycosides in combination with penicillins or cephalosporins some effective for treating infections caused by Pseudomonas aeruginosa and Enterococcus faecalis.
After intramuscular administration of the drug is rapidly distributed to organs and tissues. It penetrates through the placenta. Maximum serum concentration is detected through 40-90 minutes after administration; drug when administered intramuscularly at a dose of 1 mg / kg of patient body weight maximum plasma concentration of 3-7 mg / l. Therapeutic concentration is maintained for 8 hours. The half-life (T1 / 2) with normal renal function – 2 hours. 80-84% of the administered dose is excreted through the kidneys in unchanged form, 10-20% – through the intestines.
T1 / 2 in newborns – 5-8 hours, in children older – 2.5-4 h final T1 / 2-more than 100 hours (release from intracellular stores).. In patients with renal insufficiency T1 / 2 varies depending on the degree of failure – to 100 hours, and testosterone enanthate vs cypionate in patients with cystic fibrosis – 2.1 hours, in patients with burns and hyperthermia may be shorter compared to the average performance owing to the increased ground clearance. In hemodialysis removes 25-70% of the administered dose.
Indications for use.
Infectious diseases caused by sensitive microflora: biliary tract infections, bone and joints (including osteomyelitis), central nervous system (including meningitis), abdominal (including peritonitis) respiratory (including pneumonia, empyema, lung abscess), skin and soft tissues (including infected burns), urinary tract infections (including pyelonephritis, pyelitis, cystitis), sepsis, post-operative infections .
Hypersensitivity to tobramycin and other aminoglycoside antibiotics, neuritis of the auditory nerve, severe chronic renal failure (CRF), pregnancy, lactation.
Precautions – Renal insufficiency, botulism, myasthenia gravis, Parkinson’s disease, dehydration, advanced age, impaired hearing.
Application of pregnancy and lactation.
If tobramycin is used during pregnancy, or pregnancy occurs during treatment with tobramycin, the patient should be informed about the possible hazard to the fetus as well as testosterone enanthate vs cypionate antibiotics aminoglycoside cross the placenta and can cause the development of total irreversible bilateral deafness in newborns.
If necessary, the appointment during lactation, breast-feeding should be discontinued during treatment.
Dosage and administration.
The drug is administered intramuscularly and intravenously.
Intramuscular administration – the contents of the vial were dissolved in 3 – 5 ml of a 0.5% solution of procaine or water for injection.
When administered intravenously – diluted in 100-200 ml of 0.9% sodium chloride or 5% dextrose solution, are administered for 20-60 min.
Single dose for adults and children older than 1 year – 1 mg / kg body weight, sutochnaya- 3 mg / kg of body weight; maximum daily dose-5 mg / kg body weight.
Children aged 1 week to 1 year: 6-7.5 mg / kg per day, parameter separated by 3-4 identical doses (at 2-2.5 mg / kg every 8 hours or 1.5-1.89 mg / kg every 6 hours) or newborn .Nedonoshennye to 1 week life. to 4 mg / kg per day, divided into 2 equal doses every 12 hours usual duration of the treatment – 10.7 days. In severe and complicated infections is possible over a longer course of therapy (under the control of renal function, state of hearing and vestibular apparatus, as a manifestation of neurotoxicity is most likely in excess of the course of treatment of 10 days).
In chronic renal failure and in patients in the elderly should reduce the dose and increase the intervals between doses. the dose is calculated as follows: the interval between injections in hours equal to the concentration of creatinine in serum, multiplied by 8; dose are the same as in normal kidney function; the initial single dose similar to the dose administered to patients with normal testosterone enanthate vs cypionate renal function, and is 1 mg / kg body weight.
From the digestive system: nausea, vomiting, diarrhea, abnormal liver function (increased activity of “liver” transaminases, LDH, hyperbilirubinemia).
From the side of blood: anemia, leukopenia, granulocytopenia, thrombocytopenia, leukocytosis.
From the nervous system: headache, neurotoxic effects (muscle twitching, paresthesia, seizures); rarely – neuromuscular blockade (difficulty in breathing, drowsiness, weakness).
From the senses: ototoxicity (partial or complete bilateral deafness, ringing hum or a feeling of “fullness” in the ears), vestibular and labyrinth disorders (discoordination, dizziness, nausea, vomiting, unsteadiness).
From the urinary system: nephrotoxicity (oliguria, cylindruria, proteinuria, a significant increase or decrease in frequency of urination, polyuria; the signs of kidney failure – increase in the concentration of creatinine and urea nitrogen, thirst, loss of appetite, nausea, vomiting).
Allergic reactions: itching, skin redness, rash, fever, angioedema, eosinophilia.
Laboratory findings: hypocalcemia, hyponatremia, hypomagnesemia.
. Overdose Symptoms: The toxic effects (hearing loss, ataxia, dizziness, urinary disorders, thirst, loss of appetite, nausea, vomiting, ringing or a sensation of laying in the ears, nefronekroz – increasing testosterone enanthate vs cypionate concentrations of urea, hypercreatininemia, proteinuria, oliguria), paralysis of the respiratory muscles. Treatment: patients with normal renal function is performed fluid infusion and forced diuresis; patients with impaired renal function – hemodialysis or peritoneal dialysis. If neuromuscular blockade – anticholinesterase drugs, calcium salts; when you stop breathing – an artificial lung ventilation (ALV), the other symptomatic and supportive therapy.
Interaction with other medicinal products.
Tobramycin enhances the action of non-depolarizing muscle relaxants.
It reduces the effect of antimiastenicheskih drugs.
Aminoglycosides, cephalosporins, vancomycin, polymyxin B, diuretics increase the risk of Oto-and nephrotoxicity.
Beta-lactam antibiotics weaken the effect.
Intravenous indomethacin reduces the renal clearance of tobramycin, povshaya concentration in the blood and increasing the half-life (T1 / 2) (may require correction dosing regimen).
Methoxyflurane increases the risk of side effects.
Medicaments for inhalation general anesthesia (halogenated hydrocarbons), narcotic analgesics, transfusion of large quantities of blood to citrate as anticoagulants preservatives, drugs that block neuromuscular transmission, increase testosterone enanthate vs cypionate neuromuscular blockade.
In the period of treatment is necessary to control the function of the kidneys, liver, vestibular and hearing (at least 1 time per week), to monitor the concentration of tobramycin in serum, which should not exceed 8 mg / ml.
When poor audiometric test dose reduce or stop treatment.
The risk of Oto-and nephrotoxicity significantly increases with long-lasting plasma concentrations above 12 mcg / mL.
The likelihood of nephrotoxicity was higher in patients with impaired renal function, as well as in high doses or for a long time (in these patients may require daily monitoring of renal function).
Aminoglycosides penetrate into breast milk in small amounts (because they are poorly absorbed from the gastrointestinal tract associated complications were reported in infants).
the development of superinfection may occur during therapy.
In the absence of positive clinical dynamics should be aware of the possibility of development of resistant organisms. In such cases it is necessary to cancel the treatment and initiate appropriate therapy.
By increasing the volume of distribution of the drug (burns, peritonitis, retroperitoneal infection) to achieve the effective concentration of the dose should be increased, and in critical conditions and in young patients with high minute volume of blood circulation (IOC) and the rate of glomerular filtration – to increase the rate of introduction.
The solution for intravenous and intramuscular administration of 40 mg / ml.
The solution in the vials with 1 ml of a point (40 mg / ml) or 2 ml (80 mg / 2 ml).
At 5 vials per blister PVC / Alu. Two blisters in a cardboard box with instruction on the medical application. shop steroids dmz prohormone steroidwithdrawal.biz