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January 31, 2017

Can intravenous intramuscular antibiotics be administered?

The friend told me how to use her appointed intramuscular antibiotic cefazolin. As the intramuscular injection of cefazolin even with lidocaine painful enough, the girl herself injected this antibiotic intravenously. In addition, with Lidocaine, the statement they do not read. Familiar spread 1 g of cefazolin in 5 ml of 1% lidocaine and 5-10 seconds for them themselves intravenously. Subsequent sensations caused by side effects of the rapid administration of 2 drugs regain her any desire to continue treatment intravenously. On some side effects, I will discuss later. Familiar back intramuscular administration.

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We analyze whether antibiotics are administered intravenously, intramuscularly, which is ordered, and what you need to breed antibiotic powder from the vial.

Also in 1976, it was proposed to divide all antibiotics in the two groups. The effect of the first group of antibiotics depends on the duration of their presence in the eruption, the second group – the maximum concentration reached in the fireplace.

To understand better, you need to learn the concept of IPC – the minimum inhibitory concentration (the lowest concentration of the antibiotic in mg / L or pg / ml, which is fully visible in the laboratory inhibiting the growth of bacteria).

Antibiotics have a 2 effect on the sensitive bacteria:

  • Bacteriostatic (Greek statics – fixed) – the termination of the growth and the multiplication of bacteria;
  • Bactericide (Latin cidere – kill) – kill bacteria with subsequent decay.

There are antibiotics that have only bacteriostatic effect. Other antibiotics at low doses give bacteriostatic effects and higher bactericidal effects.

When administered intravenously, the blood instantly produces a very high concentration of the drug, which drops rapidly because the medicine goes into the tissue of the liver and / or kidney destroyed and excreted.

In intramuscular antibiotic slowly absorbed into the bloodstream from the muscle tissue and have a longer effect, the peak concentration being less than with intravenous administration.

If the drug is preserved within a slow absorption and slow elimination of the drug and the peak concentration is low.

Antibiotics, which depends on the time

The procedure (where) and frequency (as often a day) of antibiotics in this group have the objective of keeping the maximum duration of the antibiotic content in the blood and the place of infection in concentrations above the minimum (above the IPC). The main parameter – the time at which the antibiotic concentration in the blood above the IPC.

Thus, the first group of antibiotics, for which it is important to time (duration). Antibiotics are often prescribed this group intramuscularly as intravenous administration leads to large fluctuations in blood levels and an insufficient effect. In intensive care units, to maintain stable blood levels of the drug when administered via an intravenous catheter using special dispensers (infusion pumps, infusion pumps, ciliates, syringe pumps) that the drug can drive for several hours.

Antibiotics that are more important than the time (the first 4 groups are beta-lactam antibiotics)

1. Penicillins: benzylpenicillin, ampicillin, amoxicillin, oxacillin, carbenicillin, ticarcillin, azlocillin and others.

The sodium salt of penicillin in the vial is diluted for injection purposes or 0.25-0.5% solution of novocaine with saline solution (0.9% sodium chloride), water. The intramuscular injection 4-6 times a day, allows an intravenous (only dilution water for injection or saline solution).

Procain salt of penicillin (penicillin G procaine) is diluted with water for injection or saline solution. It may not be administered intravenously, it is administered by intramuscular injection.

The extended form of penicillin, or bitsillin (benzathinpenicillin G), is required only by intramuscular injection, since they are poorly soluble, slowly absorbed and long-term support concentration of penicillin in the blood required.

2. Cephalosporins: Cefazolin, Cephalexin, Cefepim, Cefixime, Ceftazidim, Cefotaxim, Cefpirom, Ceftazidim, Ceftriaxon, Cefuroxim and others.

3. Carbapenemes: Meropenem, Ertapenem, doripenem.

4. Monobactame: aztreonam.

5. Macrolides: erythromycin, roxithromycin, clarithromycin, oleandomycin esters, spiramycin, midecamycin.

Note: Azithromycin (brand name – Sumamed), belonging to the group of macrolides, belongs to the second group of antibiotics. Its effect is dependent on the concentration reached a maximum. The reason is that azithromycin accumulates intracellularly and is very effective against intracellular pathogens. The concentration of azithromycin in tissues and cells is 10-50 times higher than in the blood plasma, and the source of the infection – from 24-34% higher than in healthy tissues. Azithromycin is taken once a day. It should not be administered intramuscularly or intravenously, can be slow only orally or intravenously.

6. Lincosamides: Lincomycin, Clindamycin.

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Antibiotics, which depends on the concentration

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

Antibiotics are the second group:

  1. Aminoglycosides: gentamicin, amikacin, kanamycin, netilmicin, streptomycin, tobramycin, framycetin, neomycin. Aminoglycosides are not absorbed into the intestine, so only taken into the intestinal sanitation (due to the high toxicity of neomycin only within assigned). Traditionally daily aminoglycosides administered intramuscularly 2-3 times, but studies have shown that the intravenous administration of a daily dose of 1 time the whole day is not only effective, but also less expensive and produces fewer side effects (an aminoglycoside can affect the function of the kidneys and the inner ear Shown). The only exception for intravenous administration of 1 time per day is a bacterial endocarditis (inflammation of the inner lining of the heart valves with a primary lesion), in which the conventional intramuscular injection mode is recommended. In elderly patients and in case of injury to renal function should also be cautious in such cases, it is recommended to administer the daily dose of aminoglycoside intramuscular parts, as well as determine the level of the drug in the blood before administration.
  2. Fluoroquinolones: Ofloxacin, ciprofloxacin, norfloxacin, lomefloxacin, levofloxacin, sparfloxacin, grepafloksatsin, moxifloxacin, gemifloxacin, gatifloxacin. Animal experiments have shown the high antibacterial efficacy of daily doses of intravenous administration, but high concentrations of fluoroquinolones can be shown to cause side effects in the nervous system so that the daily dose of fluoroquinolone is administered intravenously, usually within 60-90 minutes.
  3. Tetracycline: tetracycline, oxytetracycline, doxycycline, minocycline, tigecycline.
  4. Azithromycin (an exception to the macrolide).
  5. Vancomycin

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