Actamase Forte
Actamase Forte Uses, Dosage, Side Effects, Food Interaction and all others data.
Cefepime Hydrochloride is a preparation of Cefepime. It is a fourth generation broad-spectrum cephalosporin antibiotic. Cefepime acts by inhibition of bacterial cell wall synthesis. It is highly resistant to hydrolysis by most beta-lactamases and exhibits rapid penetration into gram-negative bacterial cells.
Cefepime has been shown to be active against most strains of the following microorganisms:
Gram-Positive Microorganisms:
Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Viridans group streptococci, Staphylococcus epidermidis, Staphylococcus saprophyticus, Staphylococcus hominis, Streptococcus agalactiae.
Gram-Negative Microorganisms:
Enterobacter, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Acinetobacter calcoaceticus, Citrobacter diversus, Citrobacter freundii, Enterobacter spp., Haemophilus influenzae (including beta-lactamase producing strains), Haemophilus parainfluenzae, Hafnia alvei, Klebsiella oxytoca, Moraxella catarrhalis (including beta-lactamase producing strains), Morganella morganii, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Serratia marcescens, Neisseria meningitidis.
Anaerobes:
Tazobactam is an antibiotic of the beta-lactamase inhibitor class that prevents the breakdown of other antibiotics by beta-lactamase enzyme producing organisms. It is combined with Piperacillin and Ceftolozane for the treatment of a variety of bacterial infections.
Piperacillin-tazobactam was initially approved by the FDA in 1994, and ceftolozane-tazobactam was approved by the FDA in 2014, providing wider antibacterial coverage for gram-negative infections. In June 2019, ceftolozane-tazobactam was approved by the FDA for treating hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia, which are significant causes of morbidity and mortality in hospitalized patients.
Tazobactam inhibits the action of bacterial beta-lactamase producing organisms, which are normally resistant to beta-lactam antibiotics. This augments the effects of antibiotics which would otherwise not be effective in treating certain infections. These antibiotics contain a beta-lactam ring in their chemical structure, which is destroyed by beta-lactam resistant organisms. When combined with other antibiotics, a variety of infections, including serious and life-threatening infections may be treated.
Trade Name | Actamase Forte |
Generic | Tazobactam + Cefepime |
Weight | 2g |
Type | Injection |
Therapeutic Class | |
Manufacturer | Zydus Cadila Healthcare Ltd |
Available Country | India |
Last Updated: | September 19, 2023 at 7:00 am |
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Uses
Cefepime Hydrochloride is used for the treatment of the following infections:
• Pneumonia (moderate to severe)
• Uncomplicated and Complicated Urinary Tract Infections (including pyelonephritis)
• Uncomplicated Skin and Skin Structure Infections
• Complicated Intra-abdominal Infections
• Empiric Therapy for Febrile Neutropenic Patients.
Tazobactam is a beta lactamase inhibitor administered with antibiotics such as piperacillin and ceftolozane to prevent their degradation, resulting in increased efficacy.
Tazobactam is used in combination with piperacillin or ceftolozane to broaden the spectrum of piperacillin antibacterial action, treating susceptible infections. As with any other antibiotic, tazobactam should only be used for infections that are either proven or strongly suspected to be susceptible to the tazobactam containing drug.
Tazobactam-piperacillin
When combined with piperacillin, it is used to treat a variety of infections, including those caused by aerobic and facultative gram-positive and gram-negative bacteria, in addition to gram-positive and gram-negative anaerobes. Some examples of infections treated with piperacillin-tazobactam include cellulitis, diabetic foot infections, appendicitis, and postpartum endometritis infections. Certain gram-negative bacilli infections with beta-lactamase producing organisms cannot be treated with piperacillin-tazobactam, due to a gene mutation conferring antibiotic resistance.
Tazobactam-ceftolozane
Tazobactam-ceftolozane combined with metronidazole is used to treat complicated urinary tract infections (UTI) and complicated intra-abdominal infections, as well as ventilator-associated bacterial pneumonia and hospital-acquired bacterial pneumonia.. This combination increases efficacy against infections with gram-negative bacilli.
Actamase Forte is also used to associated treatment for these conditions: Bacterial Infections, Complicated Intra-Abdominal Infections, Complicated Urinary Tract Infection, Febrile Neutropenia, Meningitis, Bacterial, Pyelonephritis, Severe Pneumonia, Uncomplicated Urinary Tract Infections, Moderate Pneumonia, Uncomplicated skin and subcutaneous tissue bacterial infectionsAnimal bite, Cellulitis, Complicated Appendicitis, Cutaneous Abscess, Diabetic Foot Ulcers (DFU), Pelvic Inflammatory Disease (PID), Peritonitis, Pneumonia, Hospital-Acquired, Postpartum Endometritis, Surgical Site Infections, Ventilator-Associated Pneumonia (VAP), Complicated Bacterial Urinary Tract Infections, Complicated Pyelonephritis, Complicated intra-abdominal bacterial infections, Moderate Bacterial Infections, Moderate Community acquired pneumonia, Moderate Nosocomial pneumonia, Severe Bacterial Infections, Severe Nosocomial pneumonia, Uncomplicated skin and subcutaneous tissue bacterial infections
How Actamase Forte works
Cephalosporins are bactericidal and have the same mode of action as other beta-lactam antibiotics (such as penicillins). Cephalosporins disrupt the synthesis of the peptidoglycan layer of bacterial cell walls. The peptidoglycan layer is important for cell wall structural integrity, especially in Gram-positive organisms. The final transpeptidation step in the synthesis of the peptidoglycan is facilitated by transpeptidases known as penicillin binding proteins (PBPs).
Tazobactam broadens the spectrum of piperacillin and ceftolozane by making them effective against organisms that express beta-lactamase and would normally degrade them. This occurs through the irreversible inhibition of beta-lactamase enzymes. In addition, tazobactam may bind covalently to plasmid-mediated and chromosome-mediated beta-lactamase enzymes. Tazobactam is predominantly effective against the OHIO-1, SHV-1, and TEM groups of beta-lactamases, but may also inhibit other beta-lactamases.
Tazobactam shows little antibacterial activity by itself, and for this reason, is generally not administered alone.
Dosage
Actamase Forte dosage
Recommended dosage schedule for adults with normal renal function
Type of Infection Dose Frequency Duration (Days)
Moderate to severe Pneumonia 1-2 g IV q12h 10
Empiric Therapy for Febrile Neutropenic Patients 2 g IV q8h 7
Mild to moderate Uncomplicated or Complicated Urinary 0.5-1 g IV/IM q12h 7-10
Tract Infections (including pyelonephritis)
Severe Uncomplicated or Complicated Urinary 2 g IV q12h 10
Tract Infections (including pyelonephritis)
Moderate to severe Uncomplicated Skin and Skin Structure 2 g IV q12h 10
Infections
Complicated Intra-abdominal Infections 2 g IV q12h 7-10
Pediatric Patients (2 months up to 16 years)
The maximum dose for pediatric patients should not exceed the recommended adult dose.
Type of Infection Pediatric patients up to 40 kg in weight
Dose Frequency Duration
(Days)
Uncomplicated and Complicated Urinary Tract Infections 50 mg/kg q12h 7-10
(including pyelonephritis)
Uncomplicated Skin and Skin Structure Infections 50 mg/kg q12h 10
Pneumonia 50 mg/kg q12h 10
Febrile Neutropenic Patients 50 mg/kg q8h 7
Impaired Hepatic Function - No adjustment is necessary for patients with impaired hepatic function.
Impaired Renal Function - In patients with impaired renal function (creatinine clearance <60 ml/min), the dose of Cefepime should be adjusted. The recommended initial dose of Cefepime should be the same as in patients with normal renal function except in patients undergoing hemodialysis. The recommended doses of Cefepime in patients with renal insufficiency are presented in the following table:
Creatinine Clearance Recommended Maintenance Schedule
(ml/min)
>60 500 mg q12h 1g q12h 2g q12h 2g q8h
Normal recommended
dosing schedule
30-60 500 mg q24h 1g q24h 2g q24h 2g q12h
11-29 500 mg q24h 500 mg q24h 1g q24h 2g q24h
<11 250 mg q24h 250 mg q24h 500 mg q24h 1g q24h
CAPD 500 mg q48h 1g q48h 2g q48h 2g q48h
Hemodialysis 1g on day 1, then 500 mg q24h thereafter 1g q24h
Preparation of Solutions of Cefepime Hydrochloride
Single-dose vial Administration Amount of diluent to be added
500 mg IM 1.3 ml
500 mg IV 5 ml
1 gm IM 2.4 ml
1 gm IV 10 ml
These solutions may be stored up to 24 hours at room temperature or 7 days in a refrigerator.
Cefepime Hydrochloride is compatible at concentrations between 1 and 40 mg/ml with the following IV infusion fluids: (1) 0.9% Sodium chloride, (2) 5% and 10% Dextrose.
IV infusion: Add 5 mL, 10 mL, or 10 mL of a compatible IV soln to a vial labeled as containing 500 mg, 1 g, or 2 g, respectively, to provide soln containing approx 100 mg/mL, 100 mg/mL, or 160 mg/mL of the drug, respectively. The appropriate dose of the drug should then be added to a compatible IV soln.
IM inj: Add 1.3 mL or 2.4 mL of an appropriate diluent (e.g. sterile water for inj, NaCl 0.9%) to a vial labeled as containing 500 mg or 1 g respectively, to provide a soln containing approx 280 mg/mL.
Side Effects
Generally Cefepime is well tolerated. However, few side-effects including rash, pruritus, urticaria, fever, headache, nausea, vomiting, diarrhea, dizziness, oral moniliasis may occur.
Toxicity
Symptoms of overdose include seizures, encephalopathy, and neuromuscular excitability.
Overdose
Post-marketing reports have been made of overdose cases with piperacillin/tazobactam. Nausea, vomiting, and diarrhea are frequent manifestations of an overdose. Neuromuscular excitability or seizures may also occur with high intravenous doses or renal failure. There is no specific antidote. Provide supportive measures in case of an overdose. Anticonvulsive agents may be indicated when neuromuscular excitability or seizures occur. If anaphylaxis occurs, traditional measures should be taken to manage hypersensitivity (for example, adrenaline, antihistamines, corticosteroids, and oxygen/airway maintenance). Similar measures should be taken after a ceftolozane-tazobactam overdose. Hemodialysis can be used to remove the drug from the circulation .
A note on nephrotoxicity
Cases of life-threatening nephrotoxicity have been seen in critically ill patients receiving piperacillin-tazobactam. Alternative therapy and/or renal monitoring should be considered in critically ill patients.
Carcinogenesis/Mutagenesis
Tazobactam tested negative for genotoxic effects in the Ames assay, an after in vitro chromosomal aberration and point mutation assay in the Chinese hamster, an various other assays.
Use in pregnancy
Tazobactam has been found cross the placenta in rats. No data on human studies are available, however, rat studies have shown no teratogenetic effects at doses 6-14 times the equivalent maximum recommended human dose.
Use in lactation
There are no data on the presence of tazobactam in human breastmilk. No data are currently available on the effects of tazobactam on the infant, or how it affects milk production. Use clinical judgement and consider the maternal need for the drug and the benefits of breastfeeding the infant before administration during lactation. Small concentrations of piperacillin-tazobactam have been found in the breastmilk and can lead to hypersensitivity in a breastfeeding infant. In some cases, breastfeeding may have to be discontinued temporarily.
Precaution
In patients with impaired renal function (creatinine clearance <60 ml/min), the dose of Cefepime should be adjusted. Cefepime should be prescribed with caution in individuals with a history of gastrointestinal diseases, particularly colitis.
Interaction
Increased potential for nephrotoxicity and ototoxicity of aminoglycosides. Increased risk of nephrotoxicity with potent diuretics (e.g. furosemide).
Volume of Distribution
- 18.0 ±2.0 L
- 0.3 ±0.1 L/kg [Pediatric]
18.2 L when given with piperacillin
13.5-18.2 L when given with ceftolozane
Piperacillin-tazobactam is widely distributed in body tissues and fluids. These may include but are not limited to the intestine, gallbladder, lung, female reproductive organs, and the bile. Meningeal distribution of piperacillin-tazobactam increases with inflammation, but is otherwise low.
Elimination Route
The absolute bioavailability of cefepime after an IM dose of 50 mg/kg was 82.3 (±15)% in eight patients.
Tazobactam is coadministered with piperacillin or ceftolozane, pharmacokinetic information will be provided for these combinations.
Piperacillin-tazobactam
Peak plasma concentrations occur immediately after the completion of intravenous infusion. Following several doses of piperacillin-tazobactam infusions every 6 hours, peak concentrations were similar to those that were measured after the initial dose.
Ceftolozane-piperacillin
AUC: 24.4-25 mcg•h/mL
Peak concentrations are reached on day 1 after the first dose and range from 18 to 18.4 mcg/mL.
Half Life
2.0 (± 0.3) hours in normal patients. The average half-life in patients requiring hemodialysis was 13.5 (± 2.7) hours and in patients requiring continuous peritoneal dialysis was 19.0 (± 2.0) hours.
Piperacillin-tazobactam
After a single dose in healthy volunteers, the plasma half-life of piperacillin and tazobactam was in the range of 0.7 to 1.2 hours.
Ceftolozane-tazobactam
0.91-1.03 hours
Clearance
- 120 mL/min [Healthy adult male receiving a single 30-minute IV infusions of cefepime]
- 3.3 +/-1.0 mL/min/kg [Petriatic patients (2 months – 11 years of age) receiving a single IV dose]
Because tazobactam is cleared by the kidneys and is a substrate of the transporters OAT1 and OAT3, inhibitors of these transporters should be avoided to ensure efficacy. Dosage adjustments of piperacillin-tazobactam and ceftolozane-tazobactam must be made for patients with impaired renal clearance.
The mean clearance rate of tazobactam was found to be 48.3-83.6 mL/min in patients admitted to the intensive care unit who were given renal replacement therapy and receiving intravenous piperacillin-tazobactam.
The clearance of tazobactam is dependent on renal function, as determined by renal clearance.
Elimination Route
Elimination of cefepime is principally via renal excretion with an average (±SD) half-life of 2 (±0.3) hours and total body clearance of 120 (±8) mL/min in healthy volunteers. Cefepime is excreted in human milk.
Tazobactam and its metabolite are mainly eliminated by the kidneys with about 80% of the administered dose eliminated as unchanged drug. The remaining drug is excreted as a single metabolite.
Pregnancy & Breastfeeding use
Pregnancy: There are no adequate and well-controlled studies of Cefepime use in pregnant women. Cefepime should be used during pregnancy only if clearly needed.
Lactation: Cefepime is excreted in human breast milk in very low concentrations. Caution should be exercised when Cefepime is administered to a nursing woman.
Contraindication
Hypersensitivity to cefepime or other cephalosporins.
Acute Overdose
Patients who receive an overdose should be carefully observed and given supportive treatment. Symptoms of overdose include encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), myoclonus, seizures, and neuromuscular excitability.
Storage Condition
Cefepime Hydrochloride should be stored in a cool & dry place and protected from light.
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