Drug interactions- summary

+Aminoglycosides-
concomitant administration may increase risk of nephrotoxicity

+ Heparin/warfarin-
concurrent use may cause marked hypothrombinemia and/or prolonged bleeding time.

Meningitis
Respiratory tract infections
Skin and soft tissue infections
Urinary tract infections
Septicaemia
 

Hypersensitivity reactions- rash, skin reactions, fever, eosinophillia, urticaria, and pruritus

Hematological- slight decrease in hemoglobulin concentration and hemotocrit value.

GI-effects- diarrhea, or loose stools,nausea, and vomiting.

Hepatic effects- mild,transcient elevations of serum SGOT ,SGPT, and alkaline phosphatase
concentrations

Renal effects- transcient elevations, in BUN, and serum creatinine concentrations.

Hypersensitivity, known allergy to penicillins

Special precautions-

Pregnancy, lactation

Indications-

Meningitis
Respiratory tract infections
Skin and soft tissue infections
Urinary tract infections
Septicaemia

Dosage-

Adults- ratio of sulbactum to cefoperazone is 1: 1
Doses are expressed in terms of cefoperazone

1-2g daily every 12 hours

Severe infections- up to 4g daily in equally divided doses every 12 hours
Max 4g daily of sulbactum.

Child- ratio of sulbactum to cefoperazone is 1: 1
Doses are expressed in terms of cefoperazone 

Recommended  doses- 20-40mg /kg /day. given in equally divided doses
upto 160mg/kg/day given in 2-4 equally divided doses may be used.

Max dose of sulbactum - 80mg/kg/day

Pharmacology-
Cefoperazone a bacterial antibiotic,inhibits bacterial cel wall snthesis of activity dividing cells by binding to one more penicillin binding proteins (PBPs). The affinity patternm of cefoperazone for the PBPs for differrent bacterial species affects the drugs antimicrobial spectrum of activity.

Sulbactum is beta-lactamase inhibitor and acts primarily by irreversible inactivation of beta-lactamases. IOt increases the spetrum of activity of cefoperazone and delays emergence of antibiotic resistence. Its binding to penicillin-binding proteins imparts weak intrinsic antibacteraial activity.

Rationale for the Combination-
In vitro the combination of cefopeazone and subcatum show a marked synergy against bacterial species in which betatactamase is a major mechanism of resistence. By restoring or expanding the activity of well-established beta-lactum antibiotics,sublactum offers a new approach to the management of bacteraial infections, the minimum toxicity of sulbactum -cefoprerazone makes the combination appealing for the treatment of gram-negative
non-pseudodomal and anaerobic infections.

Use contraindicated- Observe caution