Cefuroxime

Indication

Cefuroxime is indicated  in the treatment  of

1. Upper respiratory tract infections: For example, ear, nose and throat infections such as otitis media, sinusitis, tonsillitis and pharyngitis.

2. Lower respiratory tract infections: For example, acute bronchitis, acute exacerbations of chronic bronchitis and pneumonia.

3. Skin and sft tissue infections: Such as furunculosis, pyoderma and impetigo.

4. Genilo-urinary tract infections: Such as pyelonephritis, urethritis and cystitis.

5. Gonorrhoea: Acute uncomplicated gonococcal urethritis and cervicitis.

6. Early lyme disease and subsequent prevention of late Lyme disease.

Pharmacology

Cefuroxime is a well-characterized and effective antibacterial agent, which has broad-spectrum  bactericidal activity against a wide range of common pathogens, including β-lactamase producing strains. Cefuroxime has good stability to bacterial β-lactamase and consequently, is active against many ampicillin-resistant and amoxycillin-resistant strains.

Composition  

Cefuroxime 125 mg tablet: Each film coated tablet contains Cefuroxime 125 mg as Cefuroxime axetil BP.

Cefuroxime 250 mg tablet: Each film coated tablet contains Cefuroxime 250 mg as Cefuroxime axetil BP.

Cefuroxime 500 mg tablet: Each film coated tablet contains Cefuroxime 500 mg as Cefuroxime axetil BP.

Cefuroxime powder for suspension (70 ml): Each 5 ml reconstituted suspension contains 125 mg Cefuroxime, as Cefuroxime axetil BP.

Cefuroxime 750 mg IM/IV injection: Each vial contains Cefuroxime 750 mg, as Cefuroxime sodium BP.

Cefuroxime 1.5 gm IV injection: Each vial contains Cefuroxime 1.5 gm, as Cefuroxime sodium BP.

Dosage and Administration

 

Adults: Most infections well respond to 250 mg b.i.d. In mild to moderate lower respiratory tract infections e.g bronchitis 250 mg b.i.d. should be given. For more severe lower respiratory tract infections or if pneumonia is suspected then 500 mg b.i.d. should be given.

For urinary tract infections a dose of 125 mg b.i.d. is usually adequate, in pyelonephritis the recommended dose is 250 mg b.i.d. A single dose of one gram is recommended for the treatment of uncomplicated gonorrhea.

Lyme disease in adults and children over the age of 12 years: The recommended dose is 500 mg b.i.d. for 20 days.

Children: The usual dose is 125 mg b.i.d. or 10 mg/kg b.i.d. to a maximum of 250 mg daily.

For otitis media, in children less than two years of age the usual dosage is 125 mg b.i.d. or 10 mg/kg b.i.d. to a maximum of 250 mg daily and in children over two years of age 250 mg b.i.d. or 15 mg/kg b.i.d. to a maximum of 500 mg daily.

There is no experience in children under three months of age. The usual course of therapy in seven days. Cefuroxime should be taken after food for optimum absorption.

Parental Dosage

Adults: Cefuroxime 750 mg to 1.5 g IM or IV every 8 hourly, usually 50 to 10 days.

Preoperative prophylaxis: For clean contaminated or potentially contaminated surgical procedures, administer 1.5 g IV prior to surgery ( half to one hour before ). Thereafter, give 750 mg iV or IM every 8 hours when the procedure is prolonged.

Infants and Children (>3 months): 50 to100 mg/kg/day in equally divided doses every 6 to 8 hours. Use 100 mg/kg/day (not to exceed the maximum adult dose) for more severe or serious infections.

Bone and Joint Infections: 150 mg/kg/day (not to exceed the maximum adult dose) in equally divided doses every 8 hours.

Bacterial meningitis: Initially 200 to 240 mg/kg/day IV in divided doses every 8 hours.

Direction for Reconstitution

Cefuroxime 750 mg intramuscular Injection: Add 3 ml water for injection BP and shake gently for dispersion

For 750 mg intravenous injection: Add 6 ml water for injection BP and shake gently for dispersion.

For 1.5 mg intravenous injection: Add 16 ml water for injection BP and shake gently for dispersion.

For Suspension: shake the bottle well before adding water. Then add 35 ml of boiled and cooled water (with the help of the provided cup from different company) to the bottle. Then continue shaking the bottle until the powder is dissolved property.

Contraindication

Cefuroxime is contraindicated in patients with known allergy to Cephalosporins.

Side Effect

Cefuroxime has been associated with nausea and vomiting in a small number of patients.

Acute Over dosage

Excessively large dosage of all cephalosporins can cause cerebral irritation and may cause convulsions. This complication is unlikely to occur in routine practice unless the patient is in renal failure hemodialysis or peritoneal dialysis can remove Cefuroxime.

Precaution

As with antibiotics, prolonged use of Cefuroxime may result in the over growth of non-susceptible organisms (e.g. Canada enterococci, Clostridium difficult), which may require interruption of treatment.

Use in Pregnancy and Lactation

While all antibiotics should be avoided in the first trimester if possible. Cefuroxime has been safety used in later pregnancy to treat urinary and other infections. The placental transfer of Cefuroxime into the fetus was studied in 20 women and therapeutically active concentrations were found in the serum of infants for up to 6 hours after delivery. Cefuroxime is excreted in human milk and consequently caution should be exercised when Cefuroxime is administered to a nursing mother.

Drug Interaction

No potentially hazardous interactions have been reported.

Storage Condition

Tablet: Store below 30 degree C, protected from light and moisture.

Suspension: Store below 25 degree C, protected from light and moisture.

Injection: Store below 25 degree C, protected from light and moisture. Use reconstituted solution immediately. The reconstituted solution is stable for 2 hours at room temperature and for 12 hours when refrigerated at 2 degree to 8 degree Celsius.

How Supplied from different companies

Cefuroxime 125 mg tablet: Box containing 20 tablets in blister pack.

Cefuroxime 250 mg tablet: Box containing 20 tablets in blister pack.

Cefuroxime 500 mg tablet: Box containing 20 tablets in blister pack.

Cefuroxime powder for suspension (70 ml): Bottle containing 70 ml suspension (after reconstitution).

Cefuroxime 750 mg IM/IV injection: Pack of 1 vial containing Cefuroxime 750 mg as Cefuroxime sodium BP accompanied by a solvent ampoule of 10 ml water for injection. It also contains a complementary pouch comprised of disposable syringe (10 ml) needle, alcohol pad and first aid bandage.

Cefuroxime 1.5 gm IV injection: Pack of 1 vial containing Cefuroxime 1.5 gm as Cefuroxime sodium BP accompanied by two solvent ampoule of 10 ml water for injection in each. It also contains a complementary pouch comprised of disposable syringe (20 ml) needle alcohol pad and first aid bandage.

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Bromazepam

Description :

Bromazepam is a global anxiolytic with smooth and supprior efficacy. It is one of the benzodiazepines having no side-effects like other benzodiazepines. It effectively manages anxiety and also removes anxiety related various physiological  problems.

Mode of action: 

Bromazepam binds with the specific site on the GABA receptor/chloride channel complex and potentiates the effect of GABA, an important inhibitory transmitter in the CNS which acts by opening chloride ion channels into cells.

Pharmacokinetics:

Peak plasma concentration of Bromazepam is achieved within two hours after oral administration. The absolute bioavailability of the unchanged substance is 60%. On an average 70% of Bromazepam is metabolized in the liver. Bromazepam has an elimination half-life around 20 hours, but the half-life may be longer in elderly subjects. The metabolites are excreted in the urine mainly in conjugated form.

Composition:

Bromazepam tablet: Each tablet contains Bromazepam BP 3 mg

                                                                                         

Indications:

Emotional disturbances: Anxiety and tension states, as adjuvant therapy for anxiety in depressed patients, nervous, tension, restlessness, anxiety and tension related insommia. As an adjuvant to the treatment of an underlying disease responsible for functional or psychosomatic impairments of various organs caused or exacerbated by anxiety and tension.

Cardiovascular and respiratory systems: Pseudo angina pectoris, precordial anxiety, tachycardia, emotiogenic hypertension, dyspnea and hyperventilation; Gastrointestinal tract: irrible bowel syndrome, ulcerative colitis, epigastric pain, spasm, meteorism and diarrhea.

Urogential tract: Irritable bladder, urinary frequency, dysmenorrhoea; Other psychosomatic disturbances: Psychogenic headache, psychogenic dermatoses.

Bromazepam is also suitable for treatment  of anxiety and tension states due to chronic organic diseases and as an adjuvant to psychotherapy in psychoneuroses, acute alcohol withdrawal, adjunct for the relief of muscle spasm.

Dosage and Administration :

1.50mg to 12 mg three times daily according to condition or patient response and  side-effect profile.

Average outpatient dosage: 1.5 mg to 3 mg three times daily.

Severe cases: 6 mg to 12 mg two to three times daily.

Contraindications:

Bromazepam should not be used in case of hypersensitivity of benzodiazepines, respiratory depression, severe hepatic impairment, myasthenia gravis and infant.

Side Effects:

Drowsiness, lightheadedness in the next day; confusion, ataxia and ammesia may occur.

Use in pregnancy and lactation:

The administration of Bromazepam is rarely justified in woman of childbearing potential. Bromazepam should be  avoided during breast-feeding.

Precautions:

Bromazepam should be used cautiously in respiratory diseases, muscle weakness and history of alcohol or drug abuse.

Drug Interactions:

Phenothiazines, barbiturates, MAO inhibitors and psychoactive drugs may potentiate the action of Bromazepam and should not usually be given concurrently.

Overdosage:

Manifestations of overdoage include somnolence, confusion and respiratory and cardiovascular depression with coma in severe cases. 

Storage:

Store in a cool and dry place, protected from light and children’s.

  

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Ciprofloxacin

    

Ciprofloxacin : Which is a synthetic anti-infective agent. Ciprofloxacin

Has broad spectrum of activity. It is active against most gram-negative aerobic bacteria including enterobacteriaceae and pseudomonas aeruginosa. Ciprofloxacin is also active against gram-positive aerobic bacteria including penicilinase producing and methicilin resistant staphylococci, although many strains of streptococci are relatively resistant to the drug. The bactericidal action of Ciprofloxacin results from interference with the enzyme DNA gyrase needed for the synthesis of bacterial DNA. Following oral administration it is rapidly and well absorbed from the G.I tract. It is widely distributed into body tissues and fluids. The half-life is about 3.5 hours. About 30% to 50% of an oral dose of Ciprofloxacin is excreted in the urine within 24 hours as unchanged drug and biologically active metabolites.

Indication: Ciprofloxacin is used adults for the treatment of urinary tract infections, lower respiratory tract infections, shin and soft tissue infections, bone and joint infections and G.I infections, caused by susceptible gram-negative and gram-positive aerobic bacteria. It is also used for the treatment of uncomplicated gonorrhea caused by penicillinase producing neisseria gonorrhea. Ciprofloxacin 750 tablet is specially indicated for the treatment of pseudomonal infections of lower respiratory tract, severe infections particularly due to pseudomonas, staphylococcus and streptococci. Ciprofloxacin 750 is also indicated in surgical prophylaxis.

Composition:

Ciprofloxacin-250 each film coated tablet contains Ciprofloxacin USP 250 mg as hydrochloride.

Ciprofloxacin-500 each film coated tablet contains Ciprofloxacin USP 500 mg as hydrochloride.

Ciprofloxacin-750 each film coated tablet contains Ciprofloxacin USP 750 mg as hydrochloride.

Ciprofloxacin-XR 1 gm each film coated extended release contains Ciprofloxacin USP 1 gm as hydrochloride.

Ciprofloxacin-250 powder for suspension: Each 5 ml contains Ciprofloxacin USP 250 mg as hydrochloride.

Dosage and Administration

Ciprofloxacin may be given orally without regard to meals. Patients receiving Ciprofloxacin-should be well hydrated and should be instructed to drink fluids liberally. Because of the risk of crystalluria. It is recommended that the usual dosage of the drug should not be exceeded. For the treatment of urinary tract infections, the usual adult oral dosage of Ciprofloxacin for mild to moderate infections is 250 mg every 12 hours and the adult dosage for complicated infections, caused by organisms not highly susceptible to drug is 500 mg every 12 hours. The usual adult oral dosage of Ciprofloxacin for infectious diarrhea is 500 mg every 12 hours. The usual adult dosage for mild to moderate lower respiratory tract, skin and soft tissue or bone and joint infections is 500 mg every 12 hours; a dosage of 750 mg every 12 hours may be needed, especially in bone and joint infections or when infections are severe or complicated. In severe infections particularly due to pseudomonas, staphylococcus and streptococci, the higher dosage of Ciprofloxacin 750 tablet twice daily should be used. For surgical prophylaxis a single dose of Ciprofloxacin 750 is given 60-90 minutes before the procedure. For the treatment of uncomplicated urethral, endocervical or rectal gonorrhea caused by penicillinase producing strains of neisseria gonorrhea (PPNG) or non-penicillinase producing strains of the organism, adults should receive a single 500 mg oral dose of Ciprofloxacin followed by oral doxycycline therapy for possible coexisting Chlamydia infection in the treatment of chancroid, 500 mg orally twice daily for 3 day’s is required. The duration of therapy depends on the type and severity of infection and should be determined by the clinical and bacteriologic response of the patients. For most infections, therapy should be continued for at least 48 hours after the patients become asymptomatic. Theusual duration is 1-2 weeks but severe or complicated infections may require more prolonged therapy, Ciprofloxacin-therapy may need to be continued for 4-6 weeks or longer for the treatment of bone and joint infections, infectious diarrhea generally is treated for 3-7 day’s, although less prolonged therapy may beadequate. Modification of the usual dosage Ciprofloxacin-generally is unnecessary in patients with creatinine clearance greater than 50 ml/minute. In patients with creatnine clearance of 50 ml/minute or less, doses and/or frequency of administration of Ciprofloxacin should be modified in response to the degree of renal impairment and the site and severity of infection. Adults with creatinine clearance of 30-50 ml/minute can receive 250-500 mg of Ciprofloxacin every 12 hours and adults with creatinine clearance of 5-29 ml/minute can receive 250-500 mg every 18 hours. Patients with severe infections and severe renal impairment may be given 750 mg of Ciprofloxacin every 12 or 18 hours. However, these patients should be monitored carefully and serum Ciprofloxacin concentrations determined periodically.

Precaution and Warning:  It should be used with caution in patients with suspected or known CNS disorders such as arteriosclerosis or epilepsy or other factors which predispose to seizures and convulsion

Information for patients:

Ciprofloxacin may be talen with or without meals and to drink fluids liberally.

Concurrent administration of Ciprofloxacin should be avoided with magnesium/aluminum antacids or sucralfate or with other products containing calcium, iron or zinc. These products may be taken two hours after or six hours before Ciprofloxacin.

Ciprofloxacin should not be taken concurrently with milk or yogurt alone, since absorption of Ciprofloxacin may be significantly reduced. Dietary calcium is a part of a meal, however, does not significantly affect the Ciprofloxacin absorption.

Pregnancy, Lactation and Children: Not to be used in pregnancy and nursing stage. Though not recommended for the children where benefit out-weighs risk a dosage of 7.5-15 mg/kg/day in two divided doses can be given

Contraindication: Patients with a history of hypersensitivity to Ciprofloxacin or to other quiolones.

Adverse reaction: Adverse effects include nausea  and other gastrointestinal disturbances, headache, dizziness and skin rashes. Crystalluria has occurred with high doses.

Storage Condition: Store below 30 degree C. Protect from light and moisture. Keep away from children’s reach.

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