Dalteparin sodium

The international name:
Dalteparin sodium (Dalteparin sodium)

Group Affiliation:
Direct anticoagulant

Description of the active substance (INN):
Dalteparin sodium

Dosage form:
injection

Mode of action:
Direct-acting anticoagulant, is associated with plasma antithrombin III, inhibits certain coagulation factors, especially factor Xa and thrombin, but suppresses the formation of thrombin is somewhat less conventional heparin. Virtually no effect on clotting time. Little effect on the adhesion of platelets (compared with heparin) and, thus has less effect on primary hemostasis. also has fibrinolytic, koronarodilatiruyuschee, hypolipidemic and immunosuppressive effects, suppresses trombokinazu. Effect develops rapidly and lasts 4-6 hours

Indications:
Acute deep vein thrombosis, pulmonary embolism, unstable angina, acute myocardial infarction (without Q wave on ECG). Prevention of clotting in the extracorporeal circulation during long-term hemodialysis, prevention of thrombosis during surgical operations.

Contraindications:
Hypersensitivity, hypocoagulation (various origins), hemophilia, erosive and ulcerative lesions GIT (exacerbation) with a tendency to bleeding, pulmonary tuberculosis, liver cirrhosis, nefrourolitiaz, renal and hepatic failure, bacterial endocarditis, trauma central nervous system, organs of vision, surgical intervention these organs, spinal and epidural punktsii.C caution. Thrombocytopenia, BPD.

Side effects:
Bleeding (when used in high doses), thrombocytopenia, allergic reactions (rash, itching, rare - anaphylactic shock), osteoporosis, spontaneous fractures, increased activity of "liver" transaminases, alopecia, skin necrosis, hematoma in the field vvedeniya.Peredozirovka. Symptoms: Hemorrhagic syndrome. Treatment: Introduction protamine (1 mg protamine inhibits dalteparina 100 IU).

Dosage and administration:
Prevention of clotting in the extracorporeal circulation during hemodialysis or hemofiltration in patients with chronic renal failure with or without the risk of bleeding - in / jet at a dose of 30-40 IU / kg followed by infusion at a rate of 10-15 IU / kg / h (duration hemodialysis at least 4 h is also possible once in / jet introduction to the doses of 5 thousand m). The activity of factor Xa in plasma should be 0.5-1 IU / ml. In acute renal failure in patients at high risk of bleeding - in / on 5-10 IU / kg in the jet, then drip at a rate of 4-5 IU / kg / h, the activity of factor Xa in plasma should be 0.2-0.4 IU / ml. In acute DVT and / or pulmonary embolism (usually with indirect anticoagulants - vitamin K antagonists) - n / a dose of 200 IU / kg once , or 100 IU / kg every 12 hours (at an increased risk of bleeding). The maximum single dose - 18 tys.ME. The activity of factor Xa in plasma should not exceed 0.5-1 IU / ml. Duration of treatment - 5 days (up to normalization of the prothrombin index). Prevention of thrombosis in surgical interventions (factor Xa activity must be 0.1-0.4 IU / ml). Patients at risk for thromboembolic complications - n / a 2.5 thousand m for 2 h before surgery and then every morning with the same dose throughout the period of bed rest, usually - 5-7 days. If there are additional risk factors for thromboembolism (in m . h. malignant tumors) and during orthopedic surgery (including the endoprosthetics) in the case of initiation of therapy up to 1 day before surgery - S / by 5 thousand m night before the operation, then - to 5 thousand m night after surgery, with early treatment on the day of operation - n / a 2,500 IU for 2 h before operation and after 8-12 h (but not earlier than 4 h) after surgery at the same dose, then daily in the morning five thousand m . After 4-8 hours (no earlier than 4 h) after orthopedic surgery sc injected 2.5 thousand m, then - to 5 thousand m daily. The course of treatment in the presence of additional risk factors for thromboembolism - for the duration of bed rest (usually 5-7 days), and orthopedic operations - for 5 weeks. At a myocardial infarction (without Q-wave on ECG) and unstable angina (usually in combination to ASA in a dose of 75-325 mg / d) - n / a, 120 IU / kg every 12 hours for women weighing less than 80 kg and men weighing less than 70 kg - 5 thous.m sc every 12 h, women with body weight over 80 kg or more and men with a body weight of 70 kg or more - by 7.5 thousand m every 12 h. The maximum dose - 10 thousand m every 12 hours therapy is carried out to stabilize the clinical condition (usually not less than 6 days but not more than 45 days). The activity of factor Xa should be within 0.5-1 IU / ml. In elderly patients the dose is reduced.

Cautions:
The application is only possible under the supervision of active suppression of factor Xa by anti-Xa analysis using the chromogenic protein substrate. Clotting time varies slightly. At the level of activity suppression factor Xa more than 1.5 IU / ml dramatically increased risk of bleeding. Health and Safety during pregnancy and lactation not established.

Interactions:
ASA, indomethacin and other NSAIDs, indirect anticoagulants, inhibitors of platelet aggregation (including ticlopidine), thrombolytics (alteplase, streptokinase, urokinase) vitamin K antagonists, dipyridamole, dextran, fenilbutazon, sulfinpirazon, blockers tubular secretion, ethacrynic acid , cytostatics (with in / in the introduction) increase anticoagulant effect (risk of bleeding), antihistamine drugs, cardiac glycosides, tetracyclines, ascorbic acid - decrease.

Calcium folinate

The international name:
Folinat Calcium (Calcium folinate)

Group Affiliation:
Vitamin

Description of the active substance (INN):
Calcium folinat

Dosage form:
capsule lyophilisates for solution for intravenous and intramuscular injection, solution for intravenous and intramuscular injection, tablets

Mode of action:
Folinievaya acid, which is a reduced form of folic acid is easily converted into other recovered derivatives of folic acid (dihydro-and then to tetrahydrofolic) required for synthesis of thymine and purines and, hence, DNA, RNA and proteins. Contributes to the shortfall in the body of folic acid. Has hematopoietic action, stimulates growth of tissues quickly updated (including the mucosa of the gastrointestinal tract). As an antidote to folic acid antagonist, prevents the damage of bone marrow hematopoiesis provides safety and allows the use of cytostatics, including methotrexate and 5-fluorouracil required for tumor chemotherapy with high doses. The initial effect develops in 20-30 minutes after ingestion, after 10-20 minutes - after i / m administration, less than 5 minutes - after i / v administration and lasts for 3 - 6 h regardless of route of administration.

Indications:
Oral and parenteral administration - intoxication folic acid antagonists (methotrexate, trimethoprim and pyrimethamine). Parenteral - megaloblastic anemia against a background of folic acid deficiency when oral therapy is ineffective (including against the background of malabsorption syndrome, malnutrition, pregnancy, sprue, in early childhood with congenital dihydrofolate reductase deficiency). Cancer of the large intestine, including the rectum (as adjuvant). Local - ulcer-necrotic stomatitis on a background of metotreksatae

Contraindications:
Hypersensitivity, megaloblastic anemia caused by vitamin A deficiency B12.C caution. Predisposition to the development of epileptic seizures in children with chronic renal failure.

Side effects:
Allergic reactions: skin rash, hives, itching and anaphylactic shock.

Dosage and administration:
V / m, in / in, inside (hereinafter all doses of calcium folinata given in terms of base). After i / v infusion of methotrexate in high doses (12-15 g / sq m) and multiple dose administration of calcium folinata determined by the state renal excretory function in a systematic (at least 1 time per day) control the concentration of creatinine and methotrexate in plasma. In the normal breeding (the concentration of methotrexate in plasma - approximately 10 mmol 24 h after injection, 1 mmol - 48 hours and less than 0.2 mmol - 72 hrs), calcium folinat prescribe a dose of 15 mg (approximately 10 mg / m) inside , in / or / m every 6 h for 60 h (starting 24 hours after methotrexate). In the case of reducing "late" removal (methotrexate concentration above 0.2 mmol - 72 hrs and 0.05 micromol - after 96 hours after introduction) - inside, in / m or i / c, 15 mg every 6 h up to as long as the concentration of methotrexate does not become lower than 0.05 mmol. In "early" decline excretion (concentration of methotrexate - 50 uM and above 24 h , 5 uM and above - 48 hours or increase the content of creatinine in plasma by 100% or more within 24 hours after methotrexate) - a / c, a dose of 150 mg every 3 h up to as long as the concentration of methotrexate to be below 1 uM, and then - I / O and 15 mg every 3 hours until the concentration of methotrexate in plasma becomes lower than 0.05 mmol. At the same time to prevent the development of CRF spend hydration (3 l / day) and injected sodium bicarbonate to maintain pH urine at a level 7 or higher. With the development of toxic reactions expressed by the introduction of methotrexate should be extended for an additional 24 h in subsequent courses (total number - 24 doses within 84 h). In case of accidental overdose of methotrexate calcium folinat injected immediately after an overdose (or slow breeding methotrexate - within 24 hours) in / in / m or oral (expressed in gastrointestinal events apply only to parenteral administration) to 10 mg / m every 6 hours until methotrexate level becomes less than 0.01 uM. Determination of the concentration of creatinine and methotrexate should be carried out every 24 h. When 24 h creatinine content in plasma increased by 50% or the concentration of methotrexate than 5 uM, or the concentration of methotrexate after 48 h more than 0.9 uM, calcium folinat injected into / in a dose of 100 -150 mg / m every 3 h up to as long as the concentration of methotrexate in plasma becomes lower than 0.01 mmol. When ulcer-necrotic stomatitis during treatment with methotrexate - locally, at the ulcerated surface of the oral mucosa (avoid swallowing the solution for injection). In megaloblastic anemia, deficiency of folic acid - inside the / m or i / v, 1 mg / day. In cancer, colon and rectum - in / slowly, for not less than 3 min, 200 mg / m, followed by a / in the introduction of fluorouracil at a dose of 370 mg / m or i / v, 20 mg / m, followed by a / in the injection of fluorouracil at a dose of 425 mg / sqm. The course of treatment - 1 times a day for 5 days. Repeated courses are held at intervals of 4 weeks for 2 courses, then - at intervals of 4-5 weeks, depending on the toxic effect of the previous year. When the manifestation of hematological or gastrointestinal toxicity of fluorouracil to reduce the dose (at a moderate toxicity in 20%, with severe - 30%). When tolerance to fluorouracil in the previous course of its dose should be increased. In the absence of toxicity from the previous year dose increased by 10%. The dose of calcium folinata depending on the toxicity does not change.

Cautions:
When using large doses dissolved with sterile water for injection (a solution not be stored). The prepared solution should be used within 12 hours Do not use the medication in pernicious and other megaloblastic anemia due to deficiency of cyanocobalamin, because during treatment, along with improved haematological parameters, neurological phenomena continue to progress. may increase the frequency of epileptic seizures in children prone to them due to reduce the effect of antiepileptic drugs (phenytoin and primidona). Doses above 25 mg should be given by injection, as ingestion doses are not absorbed.

Interactions:
Reduces the effect of folic acid antagonists. Reduces toxic effect of methotrexate, anticonvulsant activity of phenobarbital, phenytoin and primidona. Strengthens the toxicity of fluorouracil.

DALERON® C

Pharmacological properties: The product contains paracetamol and ascorbic acid (vitamin C). Paracetamol inhibits the synthesis of prostaglandins in the CNS, leading to lower fever and reduce pain. Since paracetamol does not irritate the stomach lining, it can be used in patients with diseases of the stomach, including peptic ulcer and duodenal ulcer. Daleron C contains Vitamin C which enhances the nonspecific resistance of the body, promotes more rapid recovery and improves the taste of the drug. The drug in the form of warm drink is easy to use in patients with inflammatory diseases of the oropharynx.

Paracetamol is rapidly absorbed into the digestive tract, binds to plasma proteins. The half - 1-4 pm Metabolised in the liver to form glucuronide and sulfate of paracetamol. Provided by the kidneys mainly as conjugates, less than 5% excreted in an unaltered state.

INDICATIONS: to reduce elevated body temperature during fever caused by bacterial and viral infections, for reduction of myalgia and arthralgia with influenza and other acute respiratory viral infection, to reduce mild to moderate pain of various origin (headache, toothache, after injuries and medical interventions) especially in patients with concomitant diseases of the stomach.

USE: Adults and children over the age of 12 years shall designate the contents of 1 sachet 4-6 times a day. The interval between doses must be at least 4 hours The maximum daily dose - the contents of eight bags.

To prepare the drink spilled contents of one packet into a glass, add 150 ml of warm water or tea and stir well. Drink a warm drink.

CONTRAINDICATIONS: Hypersensitivity to paracetamol, ascorbic acid or other components of the drug, acute renal failure or liver.

SIDE EFFECTS: Sometimes - nausea, skin hypersensitivity reactions (skin rash, itching, rash).

SPECIAL INSTRUCTIONS: for moderate renal or hepatic insufficiency Daleron with applicable only under medical supervision.

Do not exceed recommended dose.

You should not assign Daleron C for more than 3 days without re-examination of the patient.

The drug should be used with caution in debilitated patients and patients with chronic alcoholism.

The product contains sugar, so it is not recommended to assign patients with diabetes mellitus. The contents of a bag corresponds to 3,9 g of sugar.

Security reception Dalerona C during pregnancy and lactation have not been established, and the drug can be used only on doctor's advice, for a short period of time preferably once.

INTERACTION: caution is used in combination with metoclopramide, domperidone, kolestiraminom and warfarin.

You should not assign Daleron C simultaneously with barbiturates, antiepileptic drugs, rifampicin and chloramphenicol, as well as with preparations containing paracetamol.

OVERDOSE: Symptoms of overdose may occur only a few days. Paracetamol in toxic doses can cause nausea, vomiting, provide Hepatotoxic effects, especially in patients with kidney or liver disease.

Storage: Store in a dry place at temperatures below 30 ° C.

Clindamycin

The international name:
Clindamycin (Clindamycin)

Group Affiliation:
Antibiotic Lincosamides

Description of the active substance (INN):
Clindamycin

Dosage form:
granules for the preparation of syrup, capsule, solution for intravenous and intramuscular

Mode of action:
Antibiotic group Lincosamides. It has a wide spectrum of activity, bakteriostatik, binds to the 50S ribosomal subunit of the membrane and inhibits protein synthesis in the microbial cell. In a number of gram-positive cocci may bactericidal action. It is active against Staphylococcus spp. (Including Staphylococcus epidermidis, penicillinase-producing), Streptococcus spp. (Except Enterococcus spp), Streptococcus pneumoniae, Corynebacterium diphtheriae, spore and asporogenous anaerobes and microaerophilic gram positive cocci (including Peptococcus spp. And Peptostreptococcus spp.), Clostridium perfringens, Clostridium tetani, Mycoplasma spp., Bacteroides spp. (Including Bacteroides fragilis and Prevotella melaninogenica), Fusobacterium spp., Propionibacterium spp., Eubacter spp., Actinomyces spp. Most strains of Clostridium perfringens susceptible to clindamycin, however, since other types of clostridia (Clostridium sporogenes, Clostridium tertium) resistant to clindamycin , then with infections caused by Clostridium spp., recommended definition antibiotikogrammy. Clinically ineffective against Mycoplasma pneumoniae, Haemophilus influenzae, Helibacter pylori, Neisseria meningitidis, Neisseria gonorrhoeae, Ureaplasma urealyticum. between clindamycin and lincomycin there cross-resistance. It is effective for the treatment of asymptomatic carriers of diphtheria (one-week course of therapy, oral).

Indications:
Bacterial infections caused by susceptible organisms: infections of the ENT organs (including tonsillitis, pharyngitis, sinusitis, otitis media), infections of the respiratory system (bronchitis, pneumonia, lung abscess, empyema, fibrosing alveolitis), infections of the bones and joints ( osteomyelitis, septic arthritis), abscesses of skin and soft tissue (including Acne, boils, abscess, impetigo, whitlow, infected wounds, abscesses, erysipelas), sepsis (especially anaerobic), pelvic infections and intraabdominal infections ( including peritonitis, abscesses of the abdominal cavity with the simultaneous use of drugs, active against gram-negative aerobic microbes), gynecological diseases (endometritis, adnexitis, colpitis, abscesses of the fallopian tubes and ovaries, salpingitis, pelvioperitonit) infection of oral cavity (in including periodontal abscess), Toxoplasma encephalitis, malaria (caused by Plasmodium falciparum), pneumonia (caused by Pneumocystis carinii), sepsis, endocarditis, chlamydia, scarlet fever, diphtheria.

Contraindications:
Hypersensitivity, children's age (up to 1 month). C care. Myasthenia gravis, asthma, ulcerative colitis (in history), severe renal and / or hepatic insufficiency, pregnancy, lactation.

Side effects:
Of the nervous system: rarely - a violation of neuromuscular conduction. On the part of the digestive system: stomach pain, nausea, diarrhea, vomiting, esophagitis, pseudomembranous enterocolitis, hepatotoxicity, hyperbilirubinemia, jaundice, dysbacteriosis. From the side of hematopoiesis: leukopenia, neutropenia, agranulocytosis, thrombocytopenia. On the part of the SSA: the rapid i / v administration - lowering blood pressure, until the collapse. Allergic reactions: seldom - maculopapular rash, urticaria, pruritus, and in some cases - and exfoliative dermatitis vezikulobullezny, eosinophilia, anaphylactoid response. Local reaction : pain (where i / m injection), thrombophlebitis (in place in / injection). Other: the development of superinfection.

Dosage and administration:
Inside, adults: 150 mg every 6 hours, in severe infections single dose may be increased to 300-450 mg. Children: 8-25 mg / kg / day (depending on the severity of infection), divided into 3-4 reception. When treating obesity, caused by Chlamydia trachomatis, appoint 450 mg 4 times per day within 10-14 days. / m or / v: adults - 300 mg 2 times a day. In moderate infections - 150-300 mg 2-4 times a day, in severe infections - 1.2-2.7 g / day for 2-4 introduction. In life-threatening infections in / dose may be increased to 4.8 g / day. Children appoint 10-40 mg / kg / day, divided into 3-4 reception. For iv administration to throw until the concentration no higher than 6 mg / ml diluted solution is introduced in / infusion over 10-60 min. dilution scheme and the duration of infusion: dose, volume of solvent and the duration of infusion (respectively): 300 mg - 50 ml - 10 min, 600 mg - 100 ml - 20 min , 900 mg - 150 ml - 30 min, 1200 mg - 200 ml - 45 min. We do not recommend the introduction of more than 1.2 g for 1 h infusion. The solution is used within 24 hours after cooking. In the treatment of colitis caused by Clostridium difficile, once appropriate to combine assignment with vancomycin for 10 days at 500 mg - 2 g per day, divided into 3 or 4 equal doses. Patients with severe renal / hepatic failure require dosage adjustment.

Cautions:
Pseudomembranous colitis may occur against the background of receiving clindamycin, and 2-3 weeks after cessation of treatment (3-15% of cases) manifested by diarrhea, leukocytosis, fever, abdominal pain (sometimes accompanied with the release of faecal mass of blood and mucus). If you experience these effects in mild cases rather discontinuation of treatment and application of ion exchange resins (kolestiramin, colestipol), in severe cases showed recovery of loss of fluid, electrolytes and protein, the appointment of vancomycin at a dose of 125-500 mg 4 times per day, or bacitracin in a dose of 25 tys.ED 4 times / day for 7-10 days, or metronidazole 500 mg 3 times / day. Do not use drugs which inhibit intestinal motility. Safety of the drug in neonates is not established. Solution contains benzyl alcohol, which can lead to asphyxiation syndrome in preterm infants. In "real life" testimony newborn appoint a dose of 15-20 mg / kg / day in 3-4 receiving, in some cases it may be efficient and smaller dose. During prolonged therapy of children requires periodic monitoring of the blood and liver functional state. In the appointment of the drug in high doses is necessary to monitor the concentration of clindamycin in plasma. There should be appointed for the treatment of meningitis. Quick to / in the introduction may lead to the development of acute left ventricular failure and lower blood pressure.

Interactions:
Incompatible with solutions containing a complex of vitamins B, aminoglycosides, ampicillin, phenytoin, barbiturates, aminophylline, calcium gluconate and magnesium sulfate. Shows antagonism with erythromycin and chloramphenicol. Enhances the action of competitive muscle relaxants. With simultaneous use of opioid (narcotic) analgesics may be caused by increased of respiratory depression (up to apnea). Simultaneous with the appointment of antidiarrhoeal drugs that reduce gastrointestinal motility, increases the risk of pseudomembranous colitis. Aminoglycosides broaden the spectrum of antimicrobial action; increases (relatively) the effect of rifampicin.

DALACIN C PHOSPHATE

Pharmacological properties: clindamycin - a semisynthetic antibiotic produced from lincomycin by replacing 7 - (R)-hydroxyl group of 7 - (S)-chloro. In vitro active against the following microorganisms:

- Aerobic Gram-positive cocci, including Staphylococcus aureus, Staphylococcus epidermidis (including strains producing and not producing penicillinase; in vitro saw a rapid development of resistance to the drug in some strains that are resistant to erythromycin); Streptococcus spp. (Except Streptococcus faecalis), Streptococcus pneumoniae;

- Anaerobic Gram-negative bacteria, including Bacteroides spp. (Including B. fragilis, B. melaninogenicus), Fusobacterium spp.;

- Anaerobic Gram-positive asporogenous bacteria, including Propionibacterium, Eubacterium, Actinomyces spp.;

- Anaerobic and microaerophilic Gram-positive cocci, including Peptococcus spp., Peptostreptococcus spp., Microaerophilic streptococci.

In in vitro studies found that the clindamycin susceptible strains of microorganisms such as Bacteroides melaninogenicus, B. disiens, B. bivius, Peptostreptococcus spp., Gardnerella vaginalis, Mobiluncus mulieris, M. curtisii, Mycoplasma hominis. Clostridium are more resistant to clindamycin than most other anaerobes. Most Clostridium perfringens are susceptible to clindamycin, but some species (eg C. sporogenes and C. tertium) often are resistant to clindamycin. In this connection, to conduct test for sensitivity to antibiotics.

Between lincomycin and clindamycin there cross-resistance. There is antagonism between clindamycin and erythromycin.

Offer the drug in serum after prolonged use of clindamycin hydrochloride (up to 14 days) did not find the data that could indicate a cumulation of the drug or change in its metabolism. The half-life of clindamycin from the serum slightly increased in patients with significant deterioration of renal function. Hemodialysis and peritoneal dialysis is not effective in removing clindamycin from the serum. The concentration of clindamycin in the serum increased linearly with increased dose and exceeds the minimum bacteriostatic concentration for the most common microorganisms for at least 6 hours after taking the usual recommended dose. Clindamycin is widely distributed in liquids and body tissues (including bone). The average half-life of the drug is 2.4 hours Approximately 10% of the biologically active drug is excreted in the urine and 3,6% - with the feces; the remainder of the drug appears in the form of inactive metabolites. Doses up to 2 grams of clindamycin per day for 14 days were well tolerated healthy volunteers, but with increasing doses increased the percentage of adverse reactions from the digestive tract. In the CSF concentration of clindamycin does not reach a significant level even with meningitis. Pharmacokinetic parameters (clearance, half-life, volume of distribution and AUC) in different age groups (adults and elderly) after i / v administration is different, and because there is no need to change the dosage of the drug in the treatment of elderly patients with preserved function of age, respectively, liver and kidneys.

INDICATIONS: infectious-inflammatory diseases caused by microorganisms sensitive to clindamycin:

- Infection of ENT organs, including tonsillitis, pharyngitis, sinusitis, otitis media, scarlet fever;

- Respiratory infections, including bronchitis, pneumonia, lung abscess, empyema;

- Infections of skin and soft tissues, including acne, furunculosis, abscess, impetigo, abscesses, infected wounds, specific infectious processes of the skin and soft tissues (erysipelas, and paronychia / felon);

- Infections of bones and joints, including osteomyelitis and suppurative arthritis;

- Gynecological infection, including endometritis, pelviotsellyulit, infection, vaginal cuff, ovarial abscesses, salpingitis and pelvic inflammatory disease if the drug is given with an antibiotic with activity against gram-negative pathogens, infection of the cervix, caused by Chlamydia trachomatis, clindamycin monotherapy leads to eradication agent;

- Infectious processes in the abdominal cavity, including peritonitis, abscesses of the abdominal cavity (in combination with antibiotics, acting on Gram-negative aerobes);

- Septicemia and endocarditis;

- Infection of oral cavity (including periodontitis and periodontal abscess);

- Toxoplasma encephalitis in AIDS patients (in combination with pyrimethamine in patients with intolerance to standard therapy);

- Pneumocystis pneumonia in AIDS patients (in combination with primaquine);

- Malaria, including cases of multidrug-resistant Plasmodium falciparum, as monotherapy or in combination with quinine or chloroquine;

- Prevention of endocarditis in patients with allergy to penicillin (s);

- Prevention of wound infection at operative in the field of head and neck;

- Prevention of peritonitis and intraabdominal abscesses after perforation and trauma contamination in combination with aminoglycosides (gentamicin or tobramitsinom).

APPLICATION: in / or / m In the case of pelvic infection in women, abdominal and other complications or severe infections in adults Dalatsin C Phosphate is usually prescribed at a daily dose of 2400-2700 mg divided by 2, 3 or 4 equal doses. To treat more lung infections caused by highly sensitive to clindamycin microorganisms can be assigned a lower daily dose - 1200-1800 mg divided into 3 or 4 of the introduction.

In severe cases, the daily dose can be increased to 4800 mg.

In most cases (except for some evidence) with the / m higher than the introduction of a single dose over 600 mg is not recommended. No need for dose adjustment in the treatment of elderly patients, patients with renal or hepatic insufficiency.

Use in children older than 1 month. Daily dose Dalatsina C Phosphate is 20-40 mg / kg, divided into 3 or 4 of the introduction.

Application of newborns (children below the age of 1 month). Dose of Daqing C Phosphate is 15-20 ppm, divided by 3 or 4 of the introduction. In premature infants the dose may be reduced body weight, respectively.

Dosage for individual testimony

In the treatment of infections caused by β-hemolytic streptococcus, apply the above dose. Duration of treatment - not less than 10 days.

In the treatment of inflammatory diseases of the pelvic organs. Assign to 900 mg C Dalatsina phosphate / in every 8 h with a / in the introduction of an antibiotic active against gram-negative aerobes (eg gentamicin at a dose of 2.0 mg / kg with a further reduction to 1.5 mg / kg every 8 h in patients with preserved kidney function). In / in the introduction should continue for at least 4 days, and at least within 48 hours after onset of clinical effect. After parenteral administration of the drug for 6 days should continue receiving clindamycin hydrochloride inside of 450-600 mg every 6 h until the completion of 10-14-day cycle of therapy.

In the treatment of Toxoplasma encephalitis in AIDS patients. Enter in / at a dose of 600-1200 mg every 6 h for 2 weeks, followed by 300-600 mg orally every 6 hours Usually therapy is 8-10 weeks. The dose of pyrimethamine 25-75 mg orally every day for 8-10 weeks. Folinievaya acid at a dose of 10-20 mg per day should be appointed in the application of higher doses of pyrimethamine.

In the treatment of pneumonia caused by Pneumocystis carinii, in patients with AIDS. Dalatsin C Phosphate is introduced into / in to 600-900 mg every 6 hours or 900 mg every 8 hours for 21 days in combination with primaquine - by 15-30 mg orally 1 time a day.

For the prevention of surgical infection during operations in the head and neck. For intraoperative irrigation of contaminated surgical wounds in the head and neck before suturing the wounds are used 900 mg Dalatsina C phosphate, diluted in 1000 ml of isotonic p-ra sodium chloride.

Dalatsin C Phosphate should not be used in / with no dilution in the form of bolus injection. The drug should be administered by infusion over 10-60 min. Dalatsin C phosphate can be diluted in 50-100 ml of p-ra injection of dextrose 5% or sodium chloride 0.9%. The concentration of drug in the p re-infusion should not exceed 18 mg / ml, the rate of introduction - 30 mg / min . When preparing p-ra for infusion should be remembered that clindamycin phosphate is physically compatible with the p-ramie-containing sodium chloride, glucose, potassium and B vitamins in normal doses, and such antibiotics as cefalotin, kanamycin, gentamicin, penicillin or Carbenicillin. Rr Dalatsina C Phosphate is not compatible with ampicillin sodium, phenytoin sodium, barbiturates, aminophylline, calcium gluconate, magnesium sulfate, ceftriaxone sodium, and ciprofloxacin.

Commonly used are the rate of introduction:
Dose, mg

Volume p-ra, ml

Time of administration, min


300

50

10


600

50

20


900

50-100

30


1200

100

40




For once in / infusion does not exceed recommended dose of 1200 mg.

CONTRAINDICATIONS: Hypersensitivity to clindamycin, lincomycin, or to any component of product.

SIDE EFFECTS: Co of the blood system - Cases of leukopenia, neutropenia, eosinophilia, agranulocytosis and thrombocytopenia, but the true causal relationship between these changes and the drug intake was found;

by the immune system - isolated instances of anaphylactoid reactions;

from cardiovascular and respiratory systems - at too fast a / in the introduction of the drug are rare cases of cessation of breathing and heart, as well as the development of arterial hypotension;

from the digestive tract - may be a pain in the abdomen, nausea, vomiting and diarrhea, pseudomembranous colitis, and candidiasis, esophagitis and esophageal ulcer;

of the hepatobiliary system - jaundice, changes in indicators of liver function tests;

from the skin - in some cases observed maculopapular rash, urticaria, weak or moderate korepodobnaya generalized rash, isolated cases of polymorphic erythema, pruritus, vaginitis, exfoliative, and vesicle-bullous dermatitis, toxic epidermal necrolysis, local reactions - with the / m introduction the drug may experience local irritation, pain and the formation of abscesses in the introduction, with a / in the conduct of - the phenomenon of thrombosis (the frequency decreases with decrease in the use of permanent in / catheters).

Cautions: Dalatsin C Phosphate Injection contains benzyl alcohol, which can cause fatal flow Gasping syndrome in infants. Treatment of clindamycin, as well as treatment of almost all other antibiotics, may be accompanied by the development of severe pseudomembranous colitis with fatal consequences. It is important to promptly suspect this diagnosis in patients who have diarrhea occurred after the application of antibacterial drugs. Antibacterial drugs suppressed vital functions of normal microflora of the colon that can cause rapid multiplication of clostridia. Our studies indicate that the toxins produced by Clostridium, especially Clostridium difficile, are a crucial and immediate cause of colitis caused by antibiotics. In establishing the diagnosis of pseudomembranous colitis should designate an appropriate treatment. In the case of mild forms of pseudomembranous colitis may be sufficient to cease treatment clindamycin. With the development of moderate and severe forms of pseudomembranous colitis should be appropriate therapy with the appointment of fluids, electrolytes, proteins and drugs effective against Clostridium difficile. Clindamycin should not be appointed for the treatment of meningitis because the drug penetrates poorly through the BBB.

If the treatment is done for a long time, it is necessary to control the function of the liver and kidneys.

Due to clindamycin treatment may be enhanced by the microflora are not sensitive to this drug, especially yeast.

Clindamycin is able to penetrate the placenta. With prolonged use of clindamycin levels in amniotic fluid is approximately 30% concentration level of the drug in maternal blood. Clindamycin may be appointed for pregnant only in emergencies.

It has been reported about the penetration of clindamycin into breast milk in concentrations from 0,7 to 3,8 mg / ml. It is recommended to stop breast-feeding during the period of Dalatsina C phosphate.

Effect of clindamycin on the ability to drive and work with potentially dangerous machinery has not been studied sufficiently.

Interactions: There is in vitro antagonism between clindamycin and erythromycin. Because such interaction may have clinical significance, these drugs should not be given simultaneously.

Clindamycin is partly a blocker of the neuromuscular conduction and may exacerbate the effects of other muscle relaxants.

OVERDOSE: under recommended doses was not observed. Hemodialysis and peritoneal dialysis are not effective.

STORAGE: at room temperature (15-25 ° C).

Clindamycin

Trade name:
Dalatsin

The international name:
Clindamycin (Clindamycin)

Group Affiliation:
Antibiotic Lincosamides

Description of the active substance (INN):
Clindamycin

Dosage form:
gel for external use, vaginal cream, vaginal suppositories

Mode of action:
Bacteriostatic antibiotic group Lincosamides, has a broad spectrum of activity, binds to the 50S ribosomal subunit of the membrane and inhibits protein synthesis in the microbial cell. In a number of gram-positive cocci may bactericidal action. It is active against Staphylococcus spp. (Including Staphylococcus epidermidis, producing and neprodutsiruyuschih penicillinase), Streptococcus spp. (Except Enterococcus faecalis), Streptococcus pneumoniae, Corynebacterium diphtheriae, Mycoplasma spp., Anaerobic and microaerophilic gram positive cocci (including Peptococcus spp. And Peptostreptococcus spp.), Clostridium perfringens, Clostridium tetani, Bacteroides spp. (Including Bacteroides fragilis and Prevotella melaninogenica), Fusobacterium spp., Propionibacterium spp., Eubakterium and Actinomyces israelii. Most strains of Clostridium perfringens susceptible to clindamycin, but other types of Clostridium spp. (Including Clostridium sporogenes, Clostridium tertium) are resistant to its action in this connection with infections caused by Clostridium spp., Recommended definition antibiotikogrammy. Between clindamycin and lincomycin there is cross-resistance.

Indications:
Vaginal Cream - vaginitis, caused by microorganisms sensitive to drugs. Gel - acne.

Contraindications:
Hypersensitivity, pregnancy trimester I (for vaginal cream).

Side effects:
Allergic reactions. Vaginal Cream - irritation at the site of application, cervicitis, vaginitis, the development of superinfection (fungal vaginitis). Gel - irritation (in place of application), contact dermatitis. When resorption is likely to develop systemic side effects, including in rare cases - pseudomembranous enterocolitis.

Dosage and administration:
Vaginal: vaginal cream administered in a single dose - 100 mg clindamycin (1 applicator) for the night, the treatment course - 3-7 days. Outwardly: gel for topical application is applied to the affected area 2-3 times a day.

Cautions:
Vaginal Cream is not recommended for use in conjunction with other intravaginal drugs.

Interactions:
Incompatible with solutions containing a complex of vitamins B, aminoglycosides, ampicillin, calcium gluconate and magnesium sulfate. Be antagonism with erythromycin.