With aminoglycosides- concomitant administration may increase risk of nephrotoxicity With heparin/warfarin- concurrent use may cause marked hypothrombinemia and/or prolonged bleeding time.

Respiratory tract infections

Intra-abdominal infections

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

Respiratory tract infections

Intra-abdominal infections

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. I

Ot 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.