3a Sul

Uses

• Cefotime is used for the treatment of patients with serious infections caused by susceptible strains of the designated microorganisms in the diseases listed below.

• Lower respiratory tract infections, including pneumonia, acute or chronic bronchitis, bronchiectasis, lung abscess and post-operative chest infections.

- Urinary tract infections, including acute and chronic pyelonephritis, cystitis and asymptomatic bacteriuria.

- Obstetric & gynecological infections, including pelvic inflammatory disease.

- Septicemia / Bacteremia

- Skin and soft tissue infections, such as - cellulitis, wound infections.

- Intra-abdominal infections including peritonitis.

- Bone and joint infections, e.g. osteomyelitis, septic arthritis.

- Central nervous system infections, e.g. meningitis.

- Uncomplicated gonorrhea, particularly when penicillin has failed or is unsuitable.

- Surgical prophylaxis: The administration of Cefotaxime prophylactically may reduce the incidence of certain post-operative infections in patients undergoing surgical procedures that are classified as contaminated or potentially contaminated or in clean operation where infection would have serious effects.

Sulbactam is an beta-lactamase inhibitor antibiotic combined with other antibiotics to treat a variety of susceptible bacterial infections.

Sulbactam is currently available in combination products with ampicillin. Within this formulation it is indicated for the treatment of infections due to susceptible strains of the designated microorganisms in the conditions listed below. Skin and Skin Structure Infections caused by beta-lactamase producing strains of Staphylococcus aureus, Escherichia coli, Klebsiella spp. (including K. pneumoniae), Proteus mirabilis, Bacteroides fragilis, Enterobacter spp., and Acinetobacter calcoaceticus. Intra-Abdominal Infections caused by beta-lactamase producing strains of Escherichia coli, Klebsiella spp. (including K. pneumoniae), Bacteroides spp. (including B. fragilis), and Enterobacter spp. Gynecological Infections caused by beta-lactamase producing strains of Escherichia coli, and Bacteroides spp. (including B. fragilis).

3a Sul is also used to associated treatment for these conditions: Animal bite, Bacteremia, Bacterial Infections, Bacterial Peritonitis, Bacterial Pneumonia, Bacterial Sepsis, Bacterial Sinusitis, Bacterial Urinary Tract Infections, Bone and Joint Infections, CNS ventriculitis, Central Nervous System Infections, Community Acquired Pneumonia (CAP), Endometritis, Gonococcal arthritis, Gonorrhea, Gynaecological infection, Intra-Abdominal Infections, Lower respiratory tract infection bacterial, Lyme Neuroborreliosis, Meningitis bacterial, Pelvic Inflammatory Disease (PID), Pelvic cellulitis, Postoperative Infections, Skin and Subcutaneous Tissue Bacterial InfectionsAnimal bite, Bacterial Infections, Bacterial Infections caused by Beta lactamase producing bacteria, Bacterial Sinusitis, Bites, Human, Catheter Related Infections, Community Acquired Pneumonia (CAP), Gynaecological infection, Infective Endocarditis, Intra-Abdominal Infections, Nosocomial Pneumonia, Postoperative Infections, Postoperative Wound Infection, Skin and Subcutaneous Tissue Bacterial Infections, Complicated Bacterial Infections caused by Beta lactamase producing bacteria, Moderate Bacterial Infections, Severe Bacterial Infections

How 3a Sul works

The bactericidal activity of cefotaxime results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs). Cefotaxime shows high affinity for penicillin-binding proteins in the cell wall including PBP Ib and PBP III.

Sulbactam is an irreversible inhibitor of β-lactamase; by binding and inhibiting β-lactamase produced by bacterial cells, sulbactam is thereby able to prevent it from reducing antibiotic activity. Although sulbactam alone possesses little useful antibacterial activity, except against the Neisseriaceae, whole organism studies have shown that sulbactam restores ampicillin activity against beta-lactamase producing strains. In particular, sulbactam has good inhibitory activity against the clinically important plasmid mediated beta-lactamases most frequently responsible for transferred drug resistance. The presence of sulbactam in formulations with ampicillin effectively extends the antibacterial spectrum of ampicillin to include many bacteria normally resistant to it and to other beta-lactam antibacterials. Thus, products with ampicillin + sulbactam possess the properties of a broad-spectrum antibacterial and a beta-lactamase inhibitor.

Dosage

3a Sul dosage

Adults:

The recommended dosage for mild to moderate infections is 1 gm every 12 hourly. However, dosage may be varied according to the severity of infection, sensitivity of causative organisms and condition of the patient. In severe infections dosage may be increased up to 12 gm daily given in 3 or 4 divided doses. For infections caused by sensitive Pseudomonas spp. daily doses of greater than 6 gm will usually be required.

Children:

The usual dosage range is 100-150 mg/kg/day in 2 to 4 divided doses. However, in very severe infections doses of up to 200 mg/kg/day may be required.

Neonates:

The recommended dosage is 50 mg/kg/day in 2 to 4 divided doses. In severe infections 150-200 mg/kg/day in divided doses have been given.

Gonorrhoea:

A single injection of 1 gm may be administered intramuscularly or intravenously.

Surgical Prophylaxis:

Immediately prior to surgery, a single dose of 1 gm is suitable for most of the procedures. For procedures longer than 4 hours a dose of 2 gm is recommended.

Renal impairment:

Because of extra-renal elimination, it is only necessary to reduce the dosage of Cefotaxime in severe renal failure (GFR<5 ml/min = serum creatinine approximately 751 micromol/litre). After an initial loading dose of 1 gm, daily dose should be halved without change in the frequency of dosing.

Direction for reconstitution

For reconstitution purpose add water for injection BP as per the following chart:

Route 250 mg 500 mg 1 gm

IM 2 ml 2 ml 3 ml

IV 2-5 ml 2-10 ml 4-10 ml

Intravenous infusion

Cefotaxime may be administered by intravenous infusion. 1-2 grams are dissolved in 40-100 ml of water for injection BP or 0.9% Sodium Chloride injection BP or 5% Dextrose injection BP. The prepared infusion should be administered over 20-60 minutes.

Intermittent IV: Add 10 ml of sterile water for inj to a vial containing 0.5 g, 1 g or 2 g to provide a soln containing approx 50 mg, 95 mg, or 180 mg per ml, respectively.

Intermittent or continuous IV infusion: Add 50 ml or 100 ml of NaCl 0.9% inj or dextrose 5% inj to an infusion bottle containing 1 g or 2 g. Alternatively, reconstituted soln may be further diluted with 50-1,000 ml of a compatible soln. IM: Add 2 ml, 3 ml or 5 ml of sterile or bacteriostatic water for inj to a vial containing 0.5 g, 1 g or 2 g to provide a soln containing approx 230 mg, 300 mg or 330 mg per ml, respectively.

Side Effects

Adverse reactions to Cefotaxime have occurred relatively infrequently and have generally been mild and transient. Effects reported include candidiasis, rashes, fever, transient rises in liver transaminase and/or alkaline phosphatase and diarrhoea. As with all cephalosporins, pseudomembranous colitis may rarely occur during treatment. If this occurs, the drug should be stopped and specific treatment instituted. As with other cephalosporins, changes in renal function have been rarely observed with high doses of Cefotaxime. Administration of high doses of cephalosporins particularly in patients with renal insufficiency may result in encephalopathy. Hypersensitivity reactions have been reported, these include skin rashes, drug fever and very rarely anaphylaxis.

Toxicity

Adverse effects following overdosage include nausea, vomiting, epigastric distress, diarrhea, and convulsions. Oral rat LD₅₀ is over 20,000 mg/kg while intravenous rat LD₅₀ is over 7,000 mg/kg.

Precaution

Cefotaxime should be prescribed with caution in patients with a history of colitis. Because high and prolonged antibiotic concentrations can occur from usual doses in patients with transient or persistent reduction of urinary output because of renal insufficiency, the total daily dosage should be reduced when Cefotaxime is administered to such patients. Continued dosage should be determined by degree of renal impairment, severity of infection, and susceptibility of the causative organisms.

Interaction

Increased nephrotoxicity has been reported following concomitant administration of cephalosporins and aminoglycoside antibiotics.

Volume of Distribution

Penetration of both ampicillin and sulbactam into cerebrospinal fluid in the presence of inflamed meninges has been demonstrated after IV administration.

Elimination Route

Rapidly absorbed following intramuscular injection.

Peak serum concentrations are reached almost immediately following a 15-minute intravenous infusion of sulbactam + ampicillin. Mean peak serum levels for sulbactam range from 48 to 88 mcg/mL following intravenous administration of 2000 mg of ampicillin plus 1000 mg sulbactam. After an intramuscular injection of 1000 mg ampicillin plus 500 mg sulbactam, peak sulbactam serum levels ranging from 6 to 24 mcg/mL are attained.

Half Life

Approximately 1 hour.

~1 hr

Elimination Route

Approximately 20-36% of an intravenously administered dose of 14C-cefotaxime is excreted by the kidney as unchanged cefotaxime and 15-25% as the desacetyl derivative, the major metabolite.

Approximately 75 to 85% of both ampicillin and sulbactam are excreted unchanged in the urine during the first 8 hours after administration.

Pregnancy & Breastfeeding use

Cefotaxime is pregnancy category B drug. Although animal studies have not shown any adverse effect on the developing fetus, the safety of Cefotaxime in human pregnancy has not been established. So, Cefotaxime should not be administered during pregnancy especially during the first trimester, without carefully weighing the expected benefits against the possible risks. As Cefotaxime is excreted in human milk, either breast feeding or treatment of the mother should be stopped.

Contraindication

Cefotaxime is contraindicated in patients who have shown hypersensitivity to cefotaxime or the cephalosporin group of antibiotics.

Special Warning

Dosage in renal impairment: Because of extra-renal elimination, it is only necessary to reduce the dosage of Cefotaxime in severe renal failure (GFR<5 ml/min = serum creatinine approximately 751 micromol/litre). After an initial loading dose of 1 gm, daily dose should be halved without change in the frequency of dosing. In all other patients, dosage may require further adjustment according to the course of infection and the general condition of the patient.

Acute Overdose

Most cases of Cefotaxime Sodium overdosage have shown no over toxicity. The most frequent reactions were elevations of BUN and creatinine. Patients who receive an acute overdosage should be carefully observed and given supportive treatment.

Storage Condition

Store below 25° C, protected from light and moisture. Use reconstituted solution immediately. Reconstituted solution is stable for up to 24 h if stored between 2° to 8° C.

Innovators Monograph

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