Is it possible to dilute antibiotics with saline solution?

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How to store diluted Ceftriaxone?

The antibiotic is available in powder, which must be diluted with 0.9% sodium chloride or anesthetic before administration. A person who is not familiar with medical concepts and the characteristics of drugs is often interested in how long diluted Ceftriaxone can be stored and whether it is possible to prepare a solution in advance.

Table of contents:

Let's consider why the drug is produced in the form of a powder substance and what happens to the solution during long-term storage.

Features of the drug

The powder contains the active substance in an inactive form and before answering whether diluted Ceftriaxone can be stored or not, it is worth familiarizing yourself with what happens in the body after taking the medicine:

  • depending on the method of administration (after an hour with intravenous, and after 3 – with intramuscular), the maximum concentration of the drug in the circulatory system is noted;
  • With the bloodstream, Ceftriaxone enters the tissues, where it begins the “work” of destroying bacterial microflora;
  • after a day, the number of active metabolites decreases and repeated administration of the drug is necessary to maintain the effect.

The instructions for use indicate that Ceftriaxone is excreted from the body in the urine and partially in the bile. The time it takes for the drug to be completely eliminated from the body is affected by the condition of the liver and kidneys. If these organs are diseased, the elimination period increases - this must be taken into account when planning to start treatment with another drug or when planning to drink alcohol.

Can it be stored diluted?

The rule of mixing powder with saline or anesthetic is based on the characteristics of Ceftriaxone and other cephalosparin and penicillin antibiotics.

After dilution of the drug, the following occurs:

  • When interacting with the solution, the active components in the powder transform into an active form;
  • Maximum activity lasts for about an hour, and then the active substances in the solution begin to disintegrate into inactive elements.

At room temperature, after only 6 hours of storing the diluted powder, the effectiveness of the solution is reduced by almost half.

Sometimes patients who are given an injection at home by familiar doctors ask: will the medicine remain effective if diluted Ceftriaxone is stored in the refrigerator when injecting 2 times a day.

Indeed, lowering the temperature slows down the disintegration of the active substances, but injections are given at intervals of 12 hours and if stored for a long time, Ceftriaxone will still reduce its effectiveness. If the doctor has prescribed injections twice a day, then it is better to purchase Ceftriaxone in bottles of 0.5 g rather than 1 g - the overpayment will be insignificant, and the medication diluted before use will increase the effectiveness of the therapy.

When can the drug be stored for a long time?

Ceftriaxone in solution is prescribed not only for injection, it is also used to treat mucous membranes and skin in the following cases:

  • irrigation of the oropharynx for ENT infections and gum diseases caused by bacterial microflora;
  • treatment of skin or wounds when suppuration appears.

In these cases, it is impossible to use up the prepared solution immediately, so it is allowed to store Ceftriaxone in diluted form for 24 hours. A slight destruction of the active substances of the drug will not affect the effectiveness of the drug.

The shelf life of Ceftriaxone in diluted form for injection should not exceed 6 hours at room temperature and 12 in the refrigerator. The solution prepared for treating the skin or mucous membranes can be stored for a day and a change in color (becomes yellow-orange) does not indicate that the medicine has lost its effectiveness. But it should be remembered that Ceftriaxone has a maximum therapeutic effect within an hour, and then, during storage, the activity of the active substances decreases: it is recommended not to store the prepared solution for a long time, but to prepare it before use.

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IMPORTANT. The information on the site is provided for informational purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Source: http://pillsman.org/25798-skolko-hranitsya-razvedennyy-ceftriakson.html

Is it possible to dilute ceftriaxone with saline solution?

In the section Diseases, Medicines, the question is whether ceftriaxone can be diluted with saline solution. The best answer given by the author is Possible. If you inject intramuscularly, then 3 ml, if intravenously, 5-8 ml. But it will hurt when administered intramuscularly. solution.

It is undesirable if you mean intramuscular injections. It is better to perform such injections with lidocaine solution. Lidocaine, as a more progressive second-generation analgesic, is recommended for use with cephalosporin antibiotics. The optimal dosage is 1% 3.5 ml. The use of Lidocaine is rarely complicated by allergic reactions (3 times less likely than Novocaine), and Lidocaine also has a powerful analgesic effect (4 times more effective than Novocaine). Lidocaine belongs to the second generation of analgesic drugs, therefore it is safer than its predecessors - representatives of the first generation of ether analgesics, such as Novocaine. The drug has long proven itself in the clinical practice of many doctors, so its effectiveness and good tolerability are confirmed by time. Like any drug, lidocaine has a list of contraindications. To avoid side effects of the drug, consult your doctor before use. All the best!

Personally, I use a 1% lidocaine solution to dilute cephalosporins, as my doctor advised me. He said that Lidocaine is a newer drug and is safer to use. People are more likely to be allergic to novocaine, and it doesn’t relieve pain that well. And with Lidocaine, after five minutes nothing hurts, and you can forget that you gave the injection :)). In addition, the instructions for Lidocaine say that it has indications for use with cephalosporin antibiotics, but I didn’t read this in the instructions for Novocaine. Do not be ill!

Hello! Dilute the antibiotic with a 1% lidocaine solution in 3.5 ml. Lidocaine will provide an optimal balance between high-quality dilution of the antibiotic, a powerful analgesic effect and safety of drug administration. The antibiotic should not be diluted with Novocaine, since according to its instructions, Novocaine is not used as a solvent for cephalosporin antibiotics; it is usually used in anesthesiological practice for infiltration and conduction anesthesia, nerve blockade and in the treatment of pain syndromes of various origins. Novocaine does not provide an effective analgesic effect (the drug is 4 times weaker than Lidocaine in this regard) and has a short duration of action. Therefore, the use of Lidocaine is completely justified and justified. Consult your healthcare practitioner before use.

It's possible, but it hurts. If there is a risk of allergies, there is nothing else left for you.

It’s better to use lidocaine, saline solution, it’s very painful, but how much. the same amount as lidocaine or 5 ml per 0.5 ceftriaxone is enough.

Source: http://2oa.ru/mozhno-li-razvodit-tseftriakson-fizrastvorom/

Ceftriaxone: how to dilute lidocaine and water for injection

The drug Ceftriaxone is a broad-spectrum antibiotic that belongs to the type of cephalosporic drugs. This medicine is intended to fight infectious diseases in the body.

The purpose of the drug is to destroy pathogenic microorganisms. The medicine Ceftriaxone is very painful both intramuscularly and intravenously. To solve this problem, it was decided to dilute Ceftriaxone powder with anesthetics, which significantly reduce pain.

For what diseases is Ceftriaxone used?

Ceftriaxone: what does it help with? Diseases in the body of a child and an adult are caused by microorganisms: viruses, bacteria, fungi. Bacteria that cause infections are quite sensitive to the antibiotic Ceftriaxone. This remedy is used for the following diseases:

  • otitis of ENT organs;
  • inflammation of the nasopharynx (sinusitis, sinusitis);
  • infectious sore throat, pharyngitis, tonsillitis;
  • acute respiratory infections (bronchitis, tracheitis);
  • infectious pneumonia;
  • diseases pyelonephritis;
  • prostatitis in the male body;
  • bacterial cystitis;
  • acute and latent form of urethritis;
  • endometritis disease;
  • gynecological diseases;
  • gonorrhea, syphilis, chancroid;
  • diseases of the stomach and intestines;
  • diseases caused by E. coli;
  • salmonellosis;
  • purulent meningitis;
  • purulent sepsis;
  • purulent skin diseases.

The therapeutic effect of using this drug shows a positive result - already from the second or third day of taking the medicine, positive dynamics are observed.

Why dilute Ceftriaxone?

A large mass of various antibacterial drugs used for injection are produced in bottles with lyophilized powder. Before use, this powder must be dissolved in saline or anesthetics (lidocaine, novocaine).

Ceftriaxone is available only in powder form; this product is not available in the form of ready-made solutions or suspensions.

But when using this type of antibiotic, it is necessary to understand exactly how the patient reacts to this solution, what exactly should be used to dilute the medicine in powder: water, saline or lidocaine. It is necessary to make sure that the patient does not have an allergy to anesthetics, which could cause harm to the sick person’s body.

It is very important to know where exactly the injection should be given; solutions of Ceftriaxone with lidocaine cannot be used if the injection must be given intravenously.

Dilution of Ceftriaxone with Lidocaine

How to dilute Ceftriaxone with Lidocaine? Ceftriaxone diluted with lidocaine can cause an allergic reaction in the body. To avoid this, before giving the injection, you need to conduct a reaction test that can show how a person reacts to the substances. It is necessary to make two small scratches on the skin on the inside of the arm and apply a little Ceftriaxone and Lidocaine to them, each drug in a separate scratch. If the skin at the site of scratching turns red after 5–10 minutes, then you should not take the drug. If the skin in these places remains unchanged, then there is no allergy to the drugs. How to dilute Ceftriaxone with lidocaine and water for injection?

  • Ceftriaxone cannot be mixed with any antibacterial drugs - this can lead to an allergic reaction;
  • for the preparation of an antibiotic solution Ceftriaxone - Novocaine is not used instead of the medicine Lidocaine is not worth it: the anesthetic reduces the therapeutic effect of the antibiotic and can lead the patient to a state of anaphylactic shock;
  • Ceftriaxone diluted in anesthetic - do not store for more than 6 hours;
  • for intravenous use of an antibiotic drug, it is prohibited to dilute Ceftriaxone with Lidocaine;
  • make the injection into the buttock and administer the drug quite slowly.

In order to prepare a suspension for injections of the drug Ceftriaxone using the substance Lidocaine, it is necessary to carry out the following manipulations:

  • on the antibiotic bottle, you need to bend the aluminum cap and wipe it with cotton wool and alcohol;
  • 3.5 ml of 1% lidocaine solution is introduced into a vial of 1.0 g of Ceftriaxone;
  • insert the syringe with a needle into the cap and squeeze out lidocaine;
  • It is necessary to shake the bottle with the drug until Ceftriaxone is completely dissolved in the anesthetic.

If the pharmacy does not currently have Lidocaine 1%, then Lidocaine 2% can also be used, and you also need to purchase a specialized liquid for making injections (saline solution) along with this anesthetic:

  • Mix 2 ml of Lidocaine 2% solution with 2 ml of water for making injections, shake the syringe so that the liquid mixes together as much as possible;
  • after this, the same manipulations are performed as with the use of Lidocaine 1%.

Dilution of the antibiotic Ceftriaxone for intravenous use

In order to dilute Ceftriaxone for intravenous injections, a sodium chloride solution is used. The intravenous procedure should be carried out very carefully and the antibiotic should be administered as slowly as possible.

If a single dosage, according to the treatment regimen prescribed by the doctor, exceeds 1 g of Ceftriaxone, then there is a need to administer the medicine by dropper instead of an intravenous injection. The procedure using a dropper should last at least 30 minutes and use 100 ml of liquid sodium chloride to prepare a drop solution.

The prepared solution for intravenous use in the form of a dropper or injection must be used immediately after preparation. Freshly prepared medicine gives much faster positive results in treatment.

Use of Ceftriaxone during pregnancy and breastfeeding

Ceftriaxone instructions for use do not recommend the use of Ceftriaxone during pregnancy and when breastfeeding a small child.

The drug Ceftriaxone during pregnancy is prescribed in an extreme situation, if the benefits of taking the medication will be much higher than the threat of side pathologies for the developing fetus.

When taking this drug, special doctoral control over the condition of the expectant mother’s body and the condition of the intrauterine fetus is required.

If there is an urgent need to take an antibiotic during lactation, then you need to stop breastfeeding.

Use of the drug Ceftriaxone for a child’s body

For newly born children, children who are breastfed and children under 12 years of age, according to the instructions for use, use the following treatment regimen:

  • for children under 14 days of age from birth, mg of antibiotic per kilogram of baby’s weight. Increasing the dose per day to more than 50 mg is strictly prohibited;
  • for infants from one month after birth until the child reaches 12 years of age, mg of antibiotic per kilogram of baby’s weight. If it is necessary to exceed the daily dose of the drug, in this case the drip method of administering the drug is used.

For children over 12 years of age, the drug is prescribed as for adults.

Contraindications to the use of this medication

According to the instructions for use, like any medicine, Ceftriaxone has a contraindication for various diseases of the body:

  • intolerance to components;
  • allergic reaction to substances in the product;
  • allergic intolerance to cephalosporins;
  • increased level of bilirubin in the blood;
  • myocardial infarction and heart failure;
  • epilepsy;
  • nervous excitability;
  • patients undergoing hemodialysis;
  • chronic and acute liver diseases;
  • cirrhosis of the liver;
  • diseases of the kidneys and adrenal glands;
  • alcoholism;
  • carrying a child (use in the first trimester is especially dangerous);
  • breastfeeding;

Complications from taking Ceftriaxone

Complications after taking Ceftriaxone usually develop with an overdose or improper use.

The action of the drug is aimed at suppressing microbes and, together with harmful infections, beneficial microbes in the microflora of the stomach and intestines can die and against the background of this indicator, dysbiosis develops in the body with pronounced symptoms:

  • abdominal pain;
  • frequent and loose stools;
  • nausea and possibly vomiting.

If you have abdominal pain, this is the first sign of dysbiosis. Taking probiotics during this period is mandatory.

The consequences of dysbacteriosis can be fungal infections, and with disturbed microflora, these infections tend to multiply quite quickly.

Symptoms of fungal infection in the body:

  • thrush in children of breastfeeding age;
  • vaginitis or thrush in girls, which causes pain when urinating;
  • itching of the genitals with redness of the vulva;

Before taking this drug, you must consult with your doctor.

Side effects from using Ceftriaxone

After using the antibiotic Ceftriaxone, a number of side effects occur:

  • constant nausea, vomiting after eating;
  • painful diarrhea, constipation;
  • acute form of dysbacteriosis;
  • stomatitis with severe pain;
  • overexcitement;
  • anxiety;
  • insomnia;
  • sharp pain in the head;
  • severe morning dizziness;
  • acute conjunctivitis;
  • anaphylactic shock and possible coma;
  • itching in the genitals;
  • candidomycosis of the vaginal mucosa.

Before you start taking this medication, you should definitely consult with your doctor.

An allergic reaction to the drug manifests itself in angioedema, skin rash, and anaphylactic shock. Dyspeptic indicators are disturbances in appetite, severe nausea, belching, vomiting after taking or while eating.

Only compliance with all the instructions of the treating doctor will guarantee the positive effect of the antibiotic Ceftriaxone on the body.

Source: http://wmedik.ru/zabolevaniya/urologiya/ceftriakson-kak-razvodit-lidokainom-i-vodoj-dlya-inekcij.html

How to properly dilute the antibiotic Ceftriaxone? What solvents to use (novocaine, lidocaine, water for injection) to reduce pain and what quantity is needed to obtain a dosage of 1000 mg, 500 mg and 250 mg for adults and children

In the article we will talk about diluting the antibiotic Ceftriaxone with a solution of Lidocaine 1% and 2% or water for injection for adults and children to obtain the initial dosage of the finished drug solution of 1000 mg, 500 mg or 250 mg. We will also look at what is better to use for diluting the antibiotic - Lidocaine, Novocaine or Water for injection and what is better for relieving pain during the injection of the prepared Ceftriaxone solution.

These questions are the most common, so now there will be a link to this article so as not to be repeated. Everything will be with examples of use.

In all instructions for Ceftriaxone (including drugs under a different name, but with the same composition), 1% Lidocaine is recommended as a solvent.

1% Lidocaine is already contained as a solvent in packages of such drugs as Rosin, Rocephin and others (the active ingredient is Ceftriaxone).

Advantages of Ceftriaxone with solvent in packaging:
  • no need to buy a solvent separately (figure out which one);
  • the required dose of solvent is already measured in the ampoule of the solvent, which helps to avoid mistakes when drawing the required amount into the syringe (no need to figure out exactly how much solvent to take);
  • the ampoule with the solvent contains a ready-made solution of 1% lidocaine - there is no need to dilute 2% lidocaine to 1% (it can be difficult to find exactly 1% in pharmacies, you have to dilute it additionally with water for injection).

Disadvantages of Ceftriaxone with a solvent in the package:

  • An antibiotic together with a solvent is more expensive (choose what is more important to you - convenience or cost).

How to dilute and inject Ceftriaxone

For intramuscular injection, 500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine (or for 1000 mg (1 g) of the drug - 3.5 ml of Lidocaine solution (usually 4 ml is used, since this amounts to 2 ampoules of Lidocaine 2 ml each)). It is not recommended to inject more than 1 g of solution into one gluteal muscle.

The dosage of 250 mg (0.25 g) is diluted in the same way as 500 mg (250 mg ampoules did not exist at the time of writing this instruction). That is, 500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine, and then draw half of the finished solution into two different syringes.

So let's summarize:

1. We obtain 250 mg (0.25 g) of the finished solution as follows:

500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine and the resulting solution should be drawn into two different syringes (half of the finished solution each).

2. We obtain 500 mg (0.5 g) of the finished solution as follows:

500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine and draw the resulting solution into 1 syringe.

3. We obtain 1000 mg (1 g) of the finished solution as follows:

1000 mg (1 g) of the drug should be dissolved in 4 ml (2 ampoules) of a 1% solution of Lidocaine and draw the resulting solution into 1 syringe.

How to dilute Ceftriaxone with 2% lidocaine solution

Below is a plate with dilution schemes for the antibiotic Ceftriaxone with a 2% solution of Lidocaine (a 2% solution is found in pharmacies more often than a 1% solution; the dilution method we have already discussed above):

Abbreviations in the table: CEF - Ceftriaxone, R-l - solvent, V injection - water for injection. Below are examples and explanations.

The child was prescribed a course of Ceftriaxone injections twice a day, 500 mg (0.5 g) for 5 days. How many vials of ceftriaxone, ampoules with solvent and syringes will be needed for the entire course of treatment?

If you bought Ceftriaxone 500 mg (0.5 g) (the most convenient option) and Lidocaine 2% at the pharmacy, you will need:

  • 10 vials of ceftriaxone;
  • 10 ampoules of lidocaine 2%;
  • 10 ampoules of water for injection;
  • 20 syringes of 2 ml (2 syringes for each injection - add the solvent with one, draw and inject with the second).

If you bought Ceftriaxone 1000 mg (1.0 g) at the pharmacy (you didn’t find Ceftriaxone 0.5 g) and Lidocaine 2%, you will need:

  • 5 vials of Ceftriaxone;
  • 5 ampoules Lidocaine 2%
  • 5 ampoules of water for injection
  • 5 syringes of 5 ml and 10 syringes of 2 ml (3 syringes for preparing 2 injections - add the solvent with one, draw the required volume with the second and third, inject the second immediately, put the third in the refrigerator and inject after 12 hours).

The method is acceptable provided that the solution is prepared for 2 injections at once and the syringe with the solution is stored in the refrigerator (freshly prepared ceftriaxone solutions are physically and chemically stable for 6 hours at room temperature and for 24 hours when stored in the refrigerator at a temperature of 2° to 8°C ).

Disadvantages of this method: injection of an antibiotic after storage in the refrigerator may be more painful; during storage, the solution may change color, which indicates its instability.

The same dosage of Ceftriaxone 1000 mg and Lidocaine 2%, although the regimen is more expensive, but less painful and safer:

  • 10 vials of ceftriaxone;
  • 10 ampoules of lidocaine 2%;
  • 10 ampoules of water for injection;
  • 10 syringes of 5 ml and 10 syringes of 2 ml (2 syringes for each injection - one (5 ml) we add the solvent, the second (2 ml) we draw and inject). Half of the resulting solution is drawn into the syringe, the rest is thrown away.

Disadvantage: treatment is more expensive, but freshly prepared solutions are more effective and less painful.

Now popular questions and answers to them.

Why use Lidocaine, Novocaine for diluting Ceftriaxone and why can’t you use water for injection?

To dilute Ceftriaxone to the required concentrations, you can also use water for injection, there are no restrictions, but you need to understand that intramuscular injections of the antibiotic are very painful and if this is done in water (this is what they usually do in hospitals), then it will hurt as much as when injected drug, and for some time after. So it is preferable to use an anesthetic solution as a means for dilution, and use water for injection only as an auxiliary solution when diluting Lidocaine 2%.

There is also a point that it is not possible to use Lidocaine and Novocaine due to the development of allergic reactions to these solutions. Then the option of using water for injection for dilution remains the only possible one. Here you will have to endure pain, since there is a real chance of dying from anaphylactic shock, Quincke's edema, or getting a severe allergic reaction (the same urticaria).

Also, Lidocaine cannot be used for intravenous administration of an antibiotic, only STRICTLY intramuscularly. For intravenous use, the antibiotic must be diluted in water for injection.

What is better to use Novocaine or Lidocaine to dilute the antibiotic?

Novocaine should not be used to dilute Ceftriaxone. This is due to the fact that Novocain reduces the activity of the antibiotic and, in addition, increases the risk of the patient developing a fatal complication - anaphylactic shock.

In addition, according to the observations of the patients themselves, the following can be noted:

  • pain during the administration of Ceftriaxone is better relieved by Lidocaine than Novocaine;
  • pain during administration may intensify after the administration of not freshly prepared solutions of Ceftriaxone with Novocaine (according to the instructions for the drug, the prepared solution of Ceftriaxone is stable for 6 hours - some patients practice preparing several doses of the Ceftriaxone + Novocaine solution at once to save antibiotic and solvent (for example, solutions of 250 mg of Ceftriaxone from powder 500 mg), otherwise the remainder would have to be thrown away, and for the next injection use a solution or powder from new ampoules).

Is it possible to mix different antibiotics in one syringe, including Ceftriaxone?

Under no circumstances should ceftriaxone solution be mixed with solutions of other antibiotics, because it may crystallize or increase the patient's risk of developing allergic reactions.

How to reduce pain when administering Ceftriaxone?

It is logical from the above - you need to dilute the drug with Lidocaine. In addition, the skill of administering the finished drug also plays an important role (you need to administer it slowly, then there will be little pain).

Can I prescribe an antibiotic myself without consulting a doctor?

If you are guided by the main principle of medicine - Do no harm, then the answer is obvious - NO!

Antibiotics are medications that cannot be dosed or prescribed yourself, without consulting a specialist. Since choosing an antibiotic based on the advice of friends or on the Internet, we thereby narrow the field of activity for doctors who can treat the consequences or complications of your disease. That is, the antibiotic did not work (it was injected or diluted incorrectly, it was taken incorrectly), but it was good, and since the bacteria are already accustomed to it as a result of the incorrect treatment regimen, you will have to prescribe a more expensive backup antibiotic, which, after incorrect previous treatment, will also help unknown whether. So the situation is clear - you need to go to the doctor for a prescription and appointment.

Also, allergy sufferers (ideally, again, all patients who are taking this drug for the first time) are also advised to prescribe scratch tests to determine an allergic reaction to prescribed antibiotics.

Also, ideally, it is necessary to inoculate biological fluids and human tissues and determine the sensitivity of the inoculated bacteria to antibiotics so that the prescription of a particular drug is justified.

I would like to believe that after the appearance of this article in the Directory, there will be fewer questions on the methods and dilution schemes for the antibiotic Ceftriaxone, since I have analyzed the main points and schemes here, all that remains is to read carefully.

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Can an intramuscular antibiotic be administered intravenously?

A friend told me how she used the antibiotic cefazolin . Since intramuscular administration of cefazolin, even together with lidocaine , is quite painful, the girl decided to inject herself with this antibiotic intravenously. And also together with lidocaine, the instructions for which she did not read. A friend diluted 1 g of cefazolin in 5 ml of 1% lidocaine and injected it intravenously in 5-10 seconds. The subsequent sensations caused by the side effects of the rapid administration of 2 drugs discouraged her from continuing any further IV treatment. I will tell you about the adverse reactions that arose a little later. The friend returned to intramuscular injection.

We will analyze whether antibiotics that were prescribed intramuscularly can be administered intravenously, and how to dilute the antibiotic powder from the bottle.

Back in 1976, it was proposed to divide all antibiotics into 2 groups. The effect of antibiotics of the first group depends on the duration of their presence in the lesion, the second group - on the maximum achieved concentration in the lesion.

Antibiotics have 2 effects on sensitive bacteria:

  • bacteriostatic (Greek statike - motionless ) - cessation of growth and reproduction of bacteria;
  • bactericidal (lat. cidere - kill ) - killing bacteria with subsequent decay.

There are antibiotics that provide only a bacteriostatic effect. Other antibiotics have a bacteriostatic effect in low doses, and a bactericidal effect in higher doses.

Now consider a figure showing the dependence of the concentration of a drug in the blood on the method of its administration.

Intraperitoneal administration is used mainly in animals

  • When administered intravenously, a very high concentration of the drug is immediately created in the blood, which quickly drops because the drug goes into the tissues, is destroyed and excreted by the liver and/or kidneys.
  • When administered intramuscularly, the antibiotic is absorbed more slowly into the blood from muscle tissue and acts longer, while the peak concentration is lower than when administered intravenously.
  • When the drug is taken orally, the active substance is slowly absorbed and excreted slowly, and the peak concentration is low.

Antibiotics whose effect depends on time

The method (where) and frequency (how many times per day) of administration of antibiotics of this group are aimed at maintaining the antibiotic content in the blood and at the site of infection for as long as possible in concentrations above the minimum (above the MIC). The main parameter is the time during which the concentration of the antibiotic in the blood is above the MIC.

So, the first group includes antibiotics for which time ( duration of action ) is important. Antibiotics in this group are often prescribed intramuscularly, since intravenous administration leads to large fluctuations in blood levels and insufficient effect. In intensive care units, in order to maintain a stable concentration of the drug in the blood when administered through an intravenous catheter, special dispensers are used ( infusion pumps, infusion pumps, infusers, syringe pumps ), which allow the medication to be administered for several hours.

Antibiotics for which time is more important (the first 4 groups belong to beta-lactam antibiotics):

  1. PENICILLINS: benzylpenicillin, ampicillin, amoxicillin, oxacillin, carbenicillin, ticarcillin, azlocillin , etc.

The sodium salt of benzylpenicillin in the bottle is diluted with saline solution (0.9% sodium chloride solution), water for injection or 0.25-0.5% novocaine solution. It is administered intramuscularly 4-6 times a day, intravenous administration is allowed (only when diluted in water for injection or saline).

Novocaine salt of benzylpenicillin ( procaine benzylpenicillin ) is diluted with water for injection or saline solution. It cannot be administered intravenously; it is administered intramuscularly.

Extended forms of penicillin, or bicillins ( benzathine benzylpenicillin ), are administered only intramuscularly, since they are sparingly soluble, are slowly absorbed and maintain the desired concentration of penicillin in the blood for a long time.

  • CEPHALOSPORINS: cefazolin, cephalexin, cefepime, cefixime, cefoperazone, cefotaxime, cefpirome, ceftazidime, ceftriaxone, cefuroxime , etc.
  • CARBAPENEMS: meropenem, ertapenem, doripenem .
  • MONOBACTAMS: aztreonam .
  • MACROLIDES: erythromycin, roxithromycin, clarithromycin, oleandomycin, spiramycin, midecamycin.

    Please note: azithromycin (trade name - sumamed ), belonging to the macrolide group, belongs to the second group of antibiotics. Its effect depends on the maximum concentration achieved. The reason is that azithromycin accumulates inside cells and is very effective against intracellular pathogens. The concentration of azithromycin in tissues and cells is several times higher than in blood plasma, and at the site of infection it is 24-34% higher than in healthy tissues. Azithromycin is taken once a day. It cannot be administered intramuscularly or intravenously in a stream; it can only be administered orally or intravenously slowly.

  • LINCOSAMIDES: lincomycin, clindamycin.

    • Antibiotics whose effect depends on concentration

    The second group of antibiotics gives maximum effect when the maximum concentration is reached. Typically, they can be administered intravenously.

    Antibiotics of the second group:

    1. AMINOGLICOSIDES: gentamicin, amikacin, kanamycin, netilmicin, streptomycin, tobramycin, framycetin, neomycin .

    Aminoglycosides are not absorbed in the intestine, so they are taken orally only for intestinal sanitation (due to high toxicity, neomycin is prescribed only orally). Traditionally, aminoglycosides are prescribed intramuscularly 2-3 times a day, but studies have shown that intravenous administration of the entire daily dose once a day is not only as effective, but also cheaper and has fewer side effects (aminoglycosides can impair the function of the kidneys and inner ear ). The only exception to intravenous administration once a day is bacterial endocarditis ( inflammation of the inner lining of the heart with predominant damage to the valves ), in which the traditional intramuscular administration regimen is recommended. In elderly patients and in cases of impaired renal function, caution is also required; in such cases, it is recommended to administer the daily dose of aminoglycoside intramuscularly in parts, and also determine the level of the drug in the blood before administration.

  • FLUOROQUINOLONES: ofloxacin, ciprofloxacin, norfloxacin, lomefloxacin, levofloxacin, sparfloxacin, grepafloxacin, moxifloxacin, gemifloxacin, gatifloxacin.

    Experiments on animals have proven the high antibacterial effectiveness of daily doses administered intravenously, however, high concentrations of fluoroquinolones can cause adverse reactions from the nervous system, so the daily dose of fluoroquinolone is administered intravenously, usually within minutes.

  • TETRACYCLINES: tetracycline, oxytetracycline, doxycycline, minocycline, tigecycline.

    AZITHROMYCIN (exclusion from the group of macrolides ).

    Solvents for antibiotic injections

    The most well-known 5 solvents for the preparation of injection dosage forms (dissolving the dry contents of bottles):

    • water for injections,
    • isotonic (0.9%) sodium chloride solution,
    • glucose solution (usually 5%),
    • novocaine solution,
    • lidocaine solution.

    All injection solvents must be purchased at a pharmacy, be sterile and opened immediately before use (ampoules, vials).

    WATER FOR INJECTION - sterile specially prepared water with low salt content. However, the introduction of large volumes of water for injection can disrupt the ion-salt balance in the body, so for volumetric infusions (infusions) saline or Ringer's solution (contains sodium, potassium and calcium chlorides) is used.
    Standards for the content of microbes in water for injection in the USA and Europe are a thousand times stricter than in Russia

    How to obtain water for injections

    Source: same

    ISOTONIC (0.9%) SODIUM CHLORIDE SOLUTION ( saline, saline ) has an osmotic salt pressure equal to the osmotic pressure of blood plasma. The introduction of saline does not cause additional movement of fluid in or out of the blood vessels. However, saline solution contains sodium chloride (table salt), which may be undesirable for dissolving single antibiotics.

    It is safest to dilute any antibiotic in water for injection. It is also usually possible to use an isotonic sodium chloride solution (read the instructions for the antibiotic). For intravenous administration, antibiotics must be diluted in water for injection or saline (no anesthetics for intravenous administration).

    Sometimes a 5% GLUCOSE SOLUTION is used to dissolve drugs. Is it possible to dilute an antibiotic with a solution of 5% glucose? In many cases it is possible, but not in all, so always refer to the instructions for the drug. Glucose solution is destroyed when stored in a glass container with residual alkali, so hydrochloric acid (HCl) is added to it for stability. Glucose itself, being a strong oxidizing agent, can also enter into chemical reactions. Therefore, a number of drugs are prohibited from being dissolved in glucose, starting with ascorbic acid and cardiac glycosides and ending with the antibiotics benzylpenicillin, lincomycin, streptomycin .

    Intramuscular administration of cefazolin is very painful, so it is usually diluted with a local anesthetic (an anesthetic that blocks pain receptors). Previously, a solution of NOVOCAINE (procaine) was widely used in medicine. Is it possible to dilute antibiotics in a solution of novocaine? Not all. Novocaine injection solutions are also stabilized with hydrochloric acid, so some antibiotics can be destroyed in an acidic environment: ampicillin (can only be diluted in water for injection), amphotericin B (only in water for injection). A solution of streptomycin in novocaine can be stored for no more than 6 hours. As for benzylpenicillin , its decomposition in an acidic environment does not occur immediately, but gradually: after 30 minutes - 1.5%, after 24 hours - 40%. Hence the conclusion: benzylpenicillin can be dissolved in novocaine, but only before use. Unused benzylpenicillin solution cannot be stored. You may ask: how is the novocaine salt of benzylpenicillin (procaine benzylpenicillin) made? In this case, novocaine is not stabilized by hydrochloric acid, and before administration the drug is diluted with water for injection.

    Novocaine has now lost its former role and has been replaced by LIDOCAINE since the mid-1990s. Lidocaine is 2 times better than novocaine in terms of strength and duration of pain relief, and also works well in inflamed tissues. Lidocaine is less likely to cause allergies and is considered less toxic.

    According to the instructions for cefazolin , for intramuscular administration it can be diluted with lidocaine . Lidocaine is not only a local anesthetic, but also an antiarrhythmic drug (treatment of ventricular arrhythmias). Lidocaine causes many unwanted reactions, especially when administered quickly or in high doses.

    From the nervous system and sensory organs: depression or stimulation of the central nervous system, nervousness, euphoria, flashing “floaters” before the eyes, photophobia, drowsiness, headache, dizziness, tinnitus, diplopia, impaired consciousness, depression or cessation of breathing, muscle twitching, tremor, disorientation, convulsions (the risk of their development increases against the background of hypercapnia and acidosis).

    From the cardiovascular system and blood (hematopoiesis, hemostasis): sinus bradycardia, cardiac conduction disturbances, transverse heart block, decreased or increased blood pressure, collapse.

    From the gastrointestinal tract: nausea, vomiting.

    Allergic reactions: generalized exfoliative dermatitis, anaphylactic shock, angioedema, contact dermatitis (hyperemia at the site of application, skin rash, urticaria, itching), short-term burning sensation in the area of ​​action of the aerosol or at the site of application of the plate.

    Other: sensation of heat, cold or numbness of the extremities, malignant hyperthermia, suppression of the immune system.

    A friend told me that she diluted 1 g of cefazolin in 5 ml of 1% lidocaine and injected it intravenously in 5-10 seconds. Not even half a minute had passed before she “ turned inside out ” (severe vomiting occurred). Fortunately, after a few minutes the condition returned to normal, but the vomiting greatly frightened the friend. Nausea and vomiting can be side effects not only of lidocaine, but also of cefazolin, and in our case, the side effects of the 2 drugs and their rapid administration probably overlapped. This dose of lidocaine should not be administered intravenously in less than 1 minute. Although it could have been worse - for example, convulsions.

    When administered intravenously, the instructions for cefazolin recommend administration within 3-5 minutes. If you ignore the instructions, you can seriously harm yourself.

    • ex tempore (Latin “ from time ”) - as needed, immediately, without storage;
    • parenteral (from the Greek para - about , enteron - intestines ) - the introduction of medicine into the body, bypassing the gastrointestinal tract. Parenteral administration includes injections (intravenously, intramuscularly, subcutaneously, etc.), as well as inhalations, intranasal, intraosseous, subconjunctival administration, etc.;
    • bolus administration (lat. bolus - lump, piece ) - parenteral administration of the drug in a short time (usually no more than 3-5 minutes) in contrast to a longer infusion (dropper). The concepts of “ intravenous bolus ” and “ intravenous bolus ” are practically the same.

    The main thing from the article

    1. Antibiotics are divided into 2 groups. For the first group, time is important (long-term maintenance of the desired concentration in the blood), this includes all beta-dactam antibiotics ( penicillins, cephalosporins, carbapenems, monobactams ), macrolides (with the exception of azithromycin) and lincosamides .

    For the second group, the peak concentration of the antibiotic in the lesion is more important; these include aminoglycosides, fluoroquinolones, tetracyclines, azithromycin and vancomycin .

  • It is strictly forbidden to administer intravenously long-acting antibiotics, which are allowed to be administered only intramuscularly (for example, bicillin-1, bicillin-3, bicillin-5 ). If bicillin is administered intravenously, a serious complication is likely - embolism ( blockage with insoluble particles ) of the vessels of the lungs and brain, which can lead to organ infarction and death. Intra-arterial administration of bicillin will clog small arteries and lead to gangrene (death) of a limb or other part of the body. It is recommended that immediately before administering bicillin intramuscularly, pull the syringe plunger towards you to make sure that no blood enters the syringe (that the needle does not accidentally enter the vessel).
  • For intravenous administration, the antibiotic is diluted in water for injection. You can use saline solution or 5% glucose solution for dissolution only if this is allowed by the instructions for the antibiotic. lidocaine can be used to dilute the antibiotic for intramuscular administration , if this is permitted in the instructions for the drug.
  • You cannot administer an antibiotic in the same syringe with any other drugs, unless specifically permitted by the instructions. For example, mutual inactivation of drugs is possible—loss of activity (for example, penicillins and cephalosporins inactivate aminoglycosides when mixed, but when administered separately into the body they enhance each other’s effects). It is not advisable to self-administer antibiotics and other drugs.
  • Only freshly prepared antibiotic solutions should be administered. Soluble antibiotics may degrade or react with the solvent and therefore should not usually be stored.
  • The final decision regarding the antibiotic regimen is made by the attending physician, taking into account the diagnosis, concomitant diseases and risk factors.
  • Be sure to read the instructions for your medications. If it is written that the drug must be administered intravenously over 3-5 minutes or the rate of administration is indicated, it must be understood that faster administration may be fraught with complications.

    • My comments regarding the treatment of a friend

    • She was prescribed cefazolin to treat a cough with purulent sputum. Antibiotics must be prescribed in case of pneumonia (pneumonia), and bronchitis is not an indication for the mandatory prescription of an antibiotic.
    • Antibiotics are often prescribed irrationally: without indications, inappropriately, or with the wrong dosage regimen. In this case, cefazolin intramuscularly 2 times a day can be replaced with cephalexin orally 3 times a day. Cefazolin and cephalexin are 1st generation cephalosporins, have an almost identical spectrum of action and cost approximately the same.
    • It was possible to add to the treatment the anti-inflammatory immunomodulator Galavit, which is effective against purulent infections, enhances the effect of antibiotics (but can be used without them) and does not produce side effects. And to kindle mucus and reduce inflammation, I usually recommend the complex herbal preparation Bronchipret .

    Regarding cough prevention

    • Do not smoke - smoking disrupts the protective function of the ciliated epithelium of the respiratory tract. Over the years, the cough becomes chronic (“ smoker’s cough ”).
    • To prevent purulent complications of respiratory infections (including in smokers), I recommend using bacterial lysates: Ismigen (Respibron), Bronchomunal and others. I wrote a detailed article on this topic earlier. Bacterial lysates will not be able to protect against the occurrence of acute respiratory infections/ARVI, but will significantly reduce the severity of the disease and the risk of complications.

    When writing this article, the material was used: The influence of the pharmacodynamics of various classes of antibacterial drugs on their dosage regimens (Strachunsky L. S., Mukonin A. A. Smolensk State Medical Academy. ANTIBIOTICS AND CHEMOTHERAPY, 2000 - N4, pp. 40-44).

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    Instructions for use of Ceftriaxone, how to dilute for injections

    How to dilute Ceftriaxone with Lidocaine and water for injection? It is an antibacterial drug and helps resist infection. Since injections of a medicinal substance are perceived by the body as quite painful, it is necessary to use an anesthetic. You should adhere to the established proportions and avoid long-term storage of the finished solution.

    Purpose and features of use of the drug

    Thanks to the constant development of medicine, more and more new drugs are being produced that can cope with pathological disorders much more effectively. Among the new generation of drugs there are many antibiotics that have a wide spectrum of action and eliminate infectious diseases in the shortest possible period. One of these antibiotics is Ceftriaxone, which has pronounced bactericidal properties.

    The instructions for use of this medicine say: when the antibiotic is administered intramuscularly, there is quite severe painful discomfort. To reduce discomfort, the medicinal substance is recommended to be diluted with an anesthetic.

    Ceftriaxone is a white crystalline powder that is sometimes yellowish in color.

    The substance for intravenous or intramuscular administration is prescribed to patients with:

    • damage to the respiratory system of infectious etiology;
    • skin inflammations;
    • diseases of the urinary system;
    • venereal pathologies;
    • gynecological problems;
    • peritonitis.

    As practice shows, thanks to injections, positive changes in the patient’s condition are noted already on the second or third day.

    It is also necessary to dilute the drug before use because it is produced in powder form, like many other medications with antibacterial properties. The antibiotic has no other forms of release. The instructions for use indicate that for dilution you should use saline solution of sodium chloride or anesthetic drugs - Lidocaine, Novocaine.

    It is important to remember that each patient will react differently to the antibiotic and the means in which it should be dissolved. Injections should be done only after a special test has been carried out, which will show whether the prepared solution is suitable for the patient or not.

    What is best for diluting the drug?

    It is necessary to consider in more detail the question of what means and why doctors recommend diluting the antibiotic.

    As already mentioned, you can dissolve the medicinal substance:

    • distilled water;
    • sodium chloride;
    • Lidocaine;
    • Novocaine.

    Ceftriaxone is diluted only with water for intravenous administration. There is no need for anesthetics in this case. They will be needed only when the patient is prescribed intramuscular injections, because this method of administration is accompanied by severe pain discomfort.

    Before injecting Ceftriaxone, it is better to ask a specialist which solvent is the best for treatment. Don't forget about the many nuances that may arise.

    For example, if an antibiotic is prescribed for intramuscular (IM) administration to a child, dilution of the anesthetic with water or sodium chloride is indicated. The ratio of the drug and distilled liquid or saline solution is 1:1.

    To obtain the desired concentration of the drug, dilution with water for injection is provided. But with intramuscular injections, the patient will have to endure pain both during the procedure and after it. It is better to take water to dilute 2% Lidocaine, since, according to the instructions, the Lidocaine used should be 1% concentration.

    Water for injection will be the only option for those patients who have an allergic reaction to anesthetics.

    Correct dosages

    How to dilute Ceftriaxone before the upcoming injection? In some patients, administration of an antibiotic that is dissolved in lidocaine may cause an unwanted immune response.

    In order not to harm the patient, you should first check how the body reacts to the Ceftriaxone solution. To do this, two small scratches are made on the inside of the forearm. One of them is treated with a small amount of antibiotic, the other with an anesthetic. You will need to wait approximately 5-10 minutes for results. If the tested area of ​​skin has retained its natural color, then the injection is allowed.

    The attached instructions for use of the antibiotic recommend dissolving Ceftriaxone with 1% Lidocaine.

    To dilute Ceftriaxone 1 g, do the following:

    • take a syringe with a capacity of 5 cubic meters and draw 3.5 ml of lidocaine solution;
    • on the bottle containing the powder, bend the aluminum cap;
    • the rubber stopper is treated with cotton wool soaked in alcohol;
    • a needle is inserted into the stopper and the solution is slowly introduced;
    • To dilute Ceftriaxone, the bottle must be shaken well.

    There should be no problems when diluting the powdered substance, since it dissolves quite easily. Doctors warn: if you dilute the medicine and cloudiness or any foreign impurities appear, you should refrain from using the solution.

    Unfortunately, it is not always possible to obtain 1% Lidocaine. Usually 2% anesthetic is sold in pharmacies. In this case, to achieve the best effect, it should be diluted with a small amount of water.

    Before diluting 1 g (1000 mg) of an antibiotic drug with 2% Lidocaine, you must:

    1. Prepare one ampoule of anesthetic and distilled water, which will be mixed in one syringe.
    2. First, you should take 2 ml of Lidocaine, and then liquid in the same amount.
    3. To obtain a solution, the contents of the syringe are shaken vigorously.
    4. Now the required concentration of the anesthetic is introduced into the bottle where the powder is located.

    As stated in the instructions, if you need to dilute Ceftriaxone in an amount of 0.5 g, you need to prepare 1 ml of Lidocaine and water.

    Adult patients are allowed to use no more than two grams of the diluted substance per day, while a maximum of 1 g of medication can be injected into one buttock.

    It is advisable to have a qualified nurse dilute and inject the medicine into a vein. The procedure should be carried out carefully and slowly. If, according to the doctor's prescription, a dose that exceeds 1 g needs to be administered, the injection is replaced with a dropper. To prepare the solution you will need sodium chloride in an amount of 100 ml. The drip is placed for at least half an hour.

    The diluted mixture should be used immediately. If you administer solutions immediately after preparation, you can get the desired results much faster.

    Dosages for children, during pregnancy and lactation

    Is it possible to use Ceftriaxone in childhood and how to do it correctly? Ceftriaxone intramuscularly can be prescribed from birth.

    Dosages of the drug are established taking into account the age category of patients:

    1. Babies up to 2 weeks of age are prescribed one mg of the drug per kilogram of weight.
    2. Starting from the first month of life and up to 12 years, it is recommended to take from 20 to 75 mg of the substance per 1 kg of body weight.

    If you need to use a diluted drug in a dose that is greater than the established norm, a dropper is used instead of an injection. Children from 12 years of age are prescribed the same dosages as adults.

    Despite the accepted standards of medication, when drawing up a treatment course, the dosage is selected on an individual basis. The specialist must take into account the clinical manifestations of the disease, its severity and the characteristics of the child’s body.

    As for pregnant and breastfeeding women, treatment with diluted Ceftriaxone is not recommended. However, the injection can also be given to pregnant women if the benefits of the medicine outweigh the possible harm to the fetus. During lactation, an injection solution is also prescribed only in extreme cases, and the baby is transferred to artificial formula.

    Contraindications and possible complications

    Ignoring them and non-compliance with dosages, especially with intravenous injections, can cause dangerous consequences in both adults and children.

    Ceftriaxone should not be administered if:

    • excessive sensitivity to the components of the solution;
    • high bilirubin levels;
    • heart failure;
    • myocardial infarction;
    • epileptic disorders;
    • nervous excitability;
    • hemodialysis course;
    • liver damage of an acute or chronic nature;
    • problems with the kidneys and adrenal glands;
    • alcohol addiction;
    • pregnancy (especially in the 1st trimester);
    • breastfeeding.

    Intramuscular administration of an antibiotic, which has previously been diluted with an analgesic agent, can result in a number of undesirable reactions:

    • constantly present nausea;
    • gagging after eating food;
    • acute manifestations of dysbacteriosis;
    • stomatitis with intense symptoms;
    • rashes;
    • angioedema;
    • excessive anxiety;
    • anxiety;
    • sleep disorders;
    • sharp pain in the head;
    • dizziness after waking up;
    • acute conjunctivitis;
    • anaphylactic shock;
    • itchy discomfort in the genitals;
    • candidiasis.

    If the patient does not adhere to the prescribed dosage or begins to use a solution that has been stored longer than prescribed, the occurrence of dysbacteriosis cannot be ruled out. The drug has the property of suppressing the activity of microbes. If the medicine is used incorrectly, beneficial microorganisms die along with pathogenic microorganisms.

    A violation is indicated by symptoms such as:

    • abdominal pain;
    • frequent diarrhea;
    • nausea and vomiting.

    Due to dysbacteriosis, the development of a fungal infection is possible.

    For antibiotic treatment to be effective, it is necessary to adhere to important conditions:

    1. You should first read the instructions, which indicate how to dilute Ceftriaxone and in what proportions.
    2. It is better to dilute the prescribed Ceftriaxone with Lidocaine. If you take Novocain, the antibacterial agent will be less effective, but serious complications, for example, anaphylactic shock, cannot be ruled out.
    3. Mixing Ceftriaxone with other antibiotic drugs is prohibited, otherwise intense allergic reactions should be expected.
    4. When diluted, the injection dose can be stored for no longer than 6 hours.
    5. Lidocaine, which is considered the best anesthetic, is used only for intramuscular injection. To administer the powder intravenously, it is diluted in saline or sterile water.
    6. The area for injection is the upper part of the gluteal muscle. The dissolved antibiotic is administered gradually so as not to provoke severe pain.
    7. If the intramuscular injection causes negative reactions, you should immediately report the incident to your doctor.

    Source: http://pochki2.ru/tsistit/lekarstva/tseftriaksont-lidokainom-vodoj.html