Цефалоспориновый антибиотик III поколения для парентерального введения. Действует бактерицидно, нарушая синтез клеточной стенки микроорганизмов. Обладает широким спектром действия.
Активен в отношении грамположительных микроорганизмов: Staphylococcus aureus и Staphylococcus epidermidis (штаммы, продуцирующие и не продуцирующие пенициллиназу), Streptococcus pneumoniae, Streptococcus pyogenes (бета-гемолитический штамм группы A), Streptococcus agalactiae (бета-гемолитический штамм группы В), Enterococcus faecalis, другие штаммы бета-гемолитических Streptococcus spp.; грамотрицательных микроорганизмов: Escherichia coli, Klebsiella spp. (включая Klebsiella pneumoniae), Enterobacter spp., Citrobacter spp., Haemophilus influenzae (штаммы, продуцирующие и не продуцирующие β-лактамазы), Proteus mirabilis, Proteus vulgaris, Morganella morganii, Providencia spp. (в т.ч. Providencia rettgeri), Serratia spp. (в т.ч. Serratia marcescens), Salmonella spp., Shigella spp., Pseudomonas spp. (в т.ч. Pseudomonas aeruginosa), некоторые штаммы Acinetobacter spp., Neisseria gonorrhoeae (штаммы, продуцирующие и не продуцирующие β-лактамазы), Neisseria meningitidis, Bordetella pertussis, Yersinia enterocolitica; анаэробных микроорганизмов: грамположительные и грамотрицательные кокки (включая Peptococcus spp., Peptostreptococcus spp., Veillonella spp.), грамположительные споро- и неспорообразующие анаэробы (Clostridium spp., Eubacterium spp., Lactobacillus spp.) и грамотрицательные (включая Fusobacterium spp., Bacteroides spp. /в т.ч. Bacteroides fragilis/, Prevotella spp.).
Фармакокинетика
Всасывание
Тmax после в/м введения - 1-2 ч, после в/в - в конце инфузии, Cmax после в/м введения препарата в дозе 1 г составляет 65-75 мкг/мл, в дозе 2 г - 97 мкг/мл; после однократного в/в введения в дозах 1 г, 2 г, 3 г и 4 г Cmax составляет 153 мкг/мл, 252 мкг/мл, 340 мкг/мл, 506 мкг/мл соответственно. Cmax в моче после в/м и в/в введения в дозе 2 г - 1000 мкг/мл и более 2200 мкг/мл соответственно.
Распределение
Связывание с белками плазмы - 82-93%. Достигает терапевтических концентраций в перитонеальной, асцитической жидкости и спиномозговой жидкости (при менингите), моче, желчи, стенке желчного пузыря, легких, мокроте, небных миндалинах и слизистой оболочке синусов, предсердиях, почках, мочеточниках, предстательной железе, яичках, матке, фаллопиевых трубах, костях, крови пуповины и амниотической жидкости. Vd - 0.14-2 л/кг.
Выведение
Т1/2 - 1.6-2.4 ч, независимо от способа введения, 2.8-4.2 ч - при гемодиализе, 2.2 ч - у новорожденных и детей от 2 мес до 11 лет. Выводится с желчью - 70-80%, почками - 20-30% в неизмененном виде.
Фармакокинетика в особых клинических случаях
У пациентов с нарушенной функцией печени и обструкцией желчевыводящих путей Т1/2 составляет 3-7 ч, выведение с мочой - 90% и более. Даже при тяжелых поражениях печени в желчи достигаются терапевтические концентрации, а Т1/2 удлиняется только в 2-4 раза.
У пациентов с почечно-печеночной недостаточностью цефоперазон может кумулировать.
Показания к применению
Инфекции верхних и нижних отделов дыхательных путей;
инфекционно-воспалительные заболевания органов малого таза (эндометрит, гонорея и другие инфекции половых путей).
Способ применения и дозы
Препарат вводят в/м и в/в (струйно или капельно).
Взрослым препарат назначают в суточной дозе 2-4 г, 2 раза/сут. При тяжелом течении инфекций доза может быть увеличена до 12 г/сут: по 2-4 г каждые 8 ч или по 3-6 г каждые 12 ч. Лечение может быть начато до получения результатов исследования чувствительности микроорганизмов.
При неосложненном гонококковом уретрите - в/м в дозе 500 мг однократно.
Для профилактики послеоперационных осложнений - в/в, по 1 г или 2 г за 30-60 мин до начала операции, с повтором каждые 12 ч (в большинстве случаев в течение не более 24 ч). При операциях с повышенным риском инфицирования (например, операциях в колоректальной области), или если возникшее инфицирование может нанести особенно большой вред (например, при операциях на открытом сердце или протезировании суставов), профилактическое применение препарата может продолжаться в течение 72 ч после завершения операции.
Пациентам с почечно-печеночной недостаточностью назначают не более 2 г/сут. Пациентам со скоростью клубочковой фильтрации ниже 18 мл/мин, или содержанием сывороточного креатинина более 3.5 мг/мл - не более 4 г/сут.
При изолированной печеночной недостаточности не требуется снижения дозы, если пациент не получает максимальной дозы, т.к. компенсаторно возрастает почечная экскреция препарата до 90 % и более.
У детей суточные дозы составляют 50-200 мг/кг массы тела в 2 приема (каждые 12 ч) или больше, если необходимо. Новорожденным (менее 8 дней) препарат назначают каждые 12 ч.
Препарат в дозах до 300 мг/кг/сут применяется без осложнений у детей раннего возраста и детей с тяжелыми инфекциями, включая бактериальный менингит.
Правила приготовления и введения препарата
Для приготовления растворов для в/м введения могут использоваться следующие растворители: стерильная вода для инъекций, 0.9% раствор натрия хлорида, 0.5% раствор лидокаина гидрохлорида, которые добавляют к 1 г цефоперазона в объеме 3 мл. При в/м введении препарат вводится глубоко в ягодичную мышцу. Свежеприготовленные растворы цефоперазона хранят не более 24 ч при температуре от 5° до 25°С.
При струйной в/в инъекции максимальная разовая доза цефоперазона для взрослых составляет 2 г, для детей 50 мг/кг массы тела, при этом продолжительность введения должна быть не менее 3-5 мин. Раствор для в/в введения готовят ex tempore. В качестве растворителей могут использоваться 5% раствор декстрозы (глюкозы), 0.9% раствор натрия хлорида, раствор Рингера лактата, стерильная вода для инъекций.
Для капельного в/в введения 1 г цефоперазона растворяют в 5 мл стерильной воды для инъекций, полученный раствор добавляют к инфузионному раствору до концентрации 20-100 мг/мл. Продолжительность введения в зависимости от объема раствора может составлять от 10 до 30 мин и более.
Побочное действие
Со стороны пищеварительной системы: тошнота, рвота, диарея, псевдомембранозный колит, повышение активности печеночных трансаминаз и ЩФ.
Со стороны свертывающей системы: кровотечения (дефицит витамина К), гипопротромбинемия, увеличение протромбинового времени.
Со стороны системы кроветворения: анемия, нейтропения.
Местные реакции: при в/в введении - флебит; при в/м введении - болезненность в месте введения.
Взаимодействие с другими лекарственными средствами
При одновременном применении с этанолом возможно развитие дисульфирамоподобных реакций.
Непрямые антикоагулянты, гепарин, тромболитики при одновременном применении с Цефоперусом увеличивают риск возникновения гипопротромбинемии, кровотечения.
Аминогликозиды и "петлевые" диуретики при одновременном применении с Цефоперусом повышают нефротоксичность, особенно у лиц с почечной недостаточностью.
Препараты, снижающие канальцевую секрецию, повышают концентрацию препарата Цефоперус® в крови и замедляют его выведение.
Фармацевтическое взаимодействие
Фармацевтически несовместим с аминогликозидами (при необходимости проведения комбинированной терапии цефоперазоном и аминогликозидом назначают в виде последовательного дробного в/в введения препаратов, с использованием 2 отдельных в/в катетеров).
Особые указания
Цефоперус® может применяться при комбинированной терапии в сочетании с другими антибиотиками.
Больным с повышенной чувствительностью к пенициллину препарат необходимо назначать с большой осторожностью.
В случаях обтурации желчных протоков, тяжелого заболевания печени или сопутствующего нарушения функции почек, может появиться необходимость в изменении режима дозирования.
Длительное применение может привести к развитию устойчивости возбудителя.
В период применения препарата может иметь место ложноположительная реакция на глюкозу в моче с раствором Бенедикта или Фелинга.
Во время лечения следует воздерживаться от приема этанола, т.к. возможно развитие дисульфирамоподобных реакций (гиперемия кожи лица, спазм в животе и в области желудка, тошнота, рвота, головная боль, снижение АД, тахикардия, одышка).
У пациентов, придерживающихся неполноценной диеты или имеющих нарушение всасывания пищи (например, при муковисцидозе), а также пациентов, находящихся в течение продолжительного времени на парентеральном питании, может возникнуть дефицит витамина К. Таким больным должен осуществляться контроль протромбинового времени, при необходимости им показано назначение экзогенного витамина К.
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форме натриевой соли)"}}]},{"id":7,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"Цефалоспориновый антибиотик III поколения для парентерального введения. Действует бактерицидно, нарушая синтез клеточной стенки микроорганизмов. Обладает широким спектром действия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАктивен в отношении грамположительных микроорганизмов:\u003c/i\u003e Staphylococcus aureus и Staphylococcus epidermidis (штаммы, продуцирующие и не продуцирующие пенициллиназу), Streptococcus pneumoniae, Streptococcus pyogenes (бета-гемолитический штамм группы A), Streptococcus agalactiae (бета-гемолитический штамм группы В), Enterococcus faecalis, другие штаммы бета-гемолитических Streptococcus spp.; \u003ci\u003eграмотрицательных микроорганизмов:\u003c/i\u003e Escherichia coli, Klebsiella spp. (включая Klebsiella pneumoniae), Enterobacter spp., Citrobacter spp., Haemophilus influenzae (штаммы, продуцирующие и не продуцирующие β-лактамазы), Proteus mirabilis, Proteus vulgaris, Morganella morganii, Providencia spp. (в т.ч. Providencia rettgeri), Serratia spp. (в т.ч. Serratia marcescens), Salmonella spp., Shigella spp., Pseudomonas spp. (в т.ч. Pseudomonas aeruginosa), некоторые штаммы Acinetobacter spp., Neisseria gonorrhoeae (штаммы, продуцирующие и не продуцирующие β-лактамазы), Neisseria meningitidis, Bordetella pertussis, Yersinia enterocolitica; \u003ci\u003eанаэробных микроорганизмов: \u003c/i\u003eграмположительные и грамотрицательные кокки (включая Peptococcus spp., Peptostreptococcus spp., Veillonella spp.), грамположительные споро- и неспорообразующие анаэробы (Clostridium spp., Eubacterium spp., Lactobacillus spp.) и грамотрицательные (включая Fusobacterium spp., Bacteroides spp. /в т.ч. Bacteroides fragilis/, Prevotella spp.)."}},{"type":"header","data":{"text":"Фармакокинетика","level":4}},{"type":"paragraph","data":{"text":"\u003ci\u003eВсасывание\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Т\u003csub\u003emax\u003c/sub\u003e после в/м введения - 1-2 ч, после в/в - в конце инфузии, C\u003csub\u003emax\u003c/sub\u003e после в/м введения препарата в дозе 1 г составляет 65-75 мкг/мл, в дозе 2 г - 97 мкг/мл; после однократного в/в введения в дозах 1 г, 2 г, 3 г и 4 г C\u003csub\u003emax\u003c/sub\u003e составляет 153 мкг/мл, 252 мкг/мл, 340 мкг/мл, 506 мкг/мл соответственно. C\u003csub\u003emax\u003c/sub\u003e в моче после в/м и в/в введения в дозе 2 г - 1000 мкг/мл и более 2200 мкг/мл соответственно."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРаспределение\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Связывание с белками плазмы - 82-93%. Достигает терапевтических концентраций в перитонеальной, асцитической жидкости и спиномозговой жидкости (при менингите), моче, желчи, стенке желчного пузыря, легких, мокроте, небных миндалинах и слизистой оболочке синусов, предсердиях, почках, мочеточниках, предстательной железе, яичках, матке, фаллопиевых трубах, костях, крови пуповины и амниотической жидкости. V\u003csub\u003ed\u003c/sub\u003e - 0.14-2 л/кг."}},{"type":"paragraph","data":{"text":"\u003ci\u003eВыведение\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Т\u003csub\u003e1/2\u003c/sub\u003e - 1.6-2.4 ч, независимо от способа введения, 2.8-4.2 ч - при гемодиализе, 2.2 ч - у новорожденных и детей от 2 мес до 11 лет. Выводится с желчью - 70-80%, почками - 20-30% в неизмененном виде."}},{"type":"paragraph","data":{"text":"\u003ci\u003eФармакокинетика в особых клинических случаях\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"У пациентов с нарушенной функцией печени и обструкцией желчевыводящих путей Т\u003csub\u003e1/2\u003c/sub\u003e составляет 3-7 ч, выведение с мочой - 90% и более. Даже при тяжелых поражениях печени в желчи достигаются терапевтические концентрации, а Т\u003csub\u003e1/2\u003c/sub\u003e удлиняется только в 2-4 раза."}},{"type":"paragraph","data":{"text":"У пациентов с почечно-печеночной недостаточностью цефоперазон может кумулировать."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"list","data":{"style":"ordered","items":["Инфекции верхних и нижних отделов дыхательных путей;","инфекции мочевыводящих путей;","абдоминальные инфекции (перитонит, холецистит, холангит);","сепсис;","менингит;","инфекции кожи и мягких тканей;","инфекции костей и суставов;","инфекционно-воспалительные заболевания органов малого таза (эндометрит, гонорея и другие инфекции половых путей)."]}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Препарат вводят в/м и в/в (струйно или капельно)."}},{"type":"paragraph","data":{"text":"\u003cb\u003eВзрослым\u003c/b\u003e препарат назначают в суточной дозе 2-4 г, 2 раза/сут. При \u003ci\u003eтяжелом течении инфекций\u003c/i\u003e доза может быть увеличена до 12 г/сут: по 2-4 г каждые 8 ч или по 3-6 г каждые 12 ч. Лечение может быть начато до получения результатов исследования чувствительности микроорганизмов."}},{"type":"paragraph","data":{"text":"При \u003ci\u003eнеосложненном гонококковом уретрите\u003c/i\u003e - в/м в дозе 500 мг однократно."}},{"type":"paragraph","data":{"text":"Для \u003ci\u003eпрофилактики послеоперационных осложнений\u003c/i\u003e - в/в, по 1 г или 2 г за 30-60 мин до начала операции, с повтором каждые 12 ч (в большинстве случаев в течение не более 24 ч). При\u003ci\u003e операциях с повышенным риском инфицирования\u003c/i\u003e (например, операциях в колоректальной области), или если возникшее инфицирование может нанести особенно большой вред (например, при операциях на открытом сердце или протезировании суставов), профилактическое применение препарата может продолжаться в течение 72 ч после завершения операции."}},{"type":"paragraph","data":{"text":"\u003cb\u003eПациентам с почечно-печеночной недостаточностью\u003c/b\u003e назначают не более 2 г/сут. \u003cb\u003eПациентам со скоростью клубочковой фильтрации ниже 18 мл/мин, или содержанием сывороточного креатинина более 3.5 мг/мл\u003c/b\u003e - не более 4 г/сут."}},{"type":"paragraph","data":{"text":"При \u003cb\u003eизолированной печеночной недостаточности\u003c/b\u003e не требуется снижения дозы, если пациент не получает максимальной дозы, т.к. компенсаторно возрастает почечная экскреция препарата до 90 % и более."}},{"type":"paragraph","data":{"text":"У \u003cb\u003eдетей\u003c/b\u003e суточные дозы составляют 50-200 мг/кг массы тела в 2 приема (каждые 12 ч) или больше, если необходимо. \u003cb\u003eНоворожденным (менее 8 дней)\u003c/b\u003e препарат назначают каждые 12 ч."}},{"type":"paragraph","data":{"text":"Препарат в дозах до 300 мг/кг/сут применяется без осложнений у \u003cb\u003eдетей раннего возраста и детей \u003c/b\u003eс т\u003ci\u003eяжелыми инфекциями, включая бактериальный менингит\u003c/i\u003e."}},{"type":"paragraph","data":{"text":"\u003cb\u003eПравила приготовления и введения препарата\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"Для приготовления растворов для в/м введения могут использоваться следующие растворители: стерильная вода для инъекций, 0.9% раствор натрия хлорида, 0.5% раствор лидокаина гидрохлорида, которые добавляют к 1 г цефоперазона в объеме 3 мл. При в/м введении препарат вводится глубоко в ягодичную мышцу. Свежеприготовленные растворы цефоперазона хранят не более 24 ч при температуре от 5° до 25°С."}},{"type":"paragraph","data":{"text":"При струйной в/в инъекции максимальная разовая доза цефоперазона для взрослых составляет 2 г, для детей 50 мг/кг массы тела, при этом продолжительность введения должна быть не менее 3-5 мин. Раствор для в/в введения готовят ex tempore. В качестве растворителей могут использоваться 5% раствор декстрозы (глюкозы), 0.9% раствор натрия хлорида, раствор Рингера лактата, стерильная вода для инъекций."}},{"type":"paragraph","data":{"text":"Для капельного в/в введения 1 г цефоперазона растворяют в 5 мл стерильной воды для инъекций, полученный раствор добавляют к инфузионному раствору до концентрации 20-100 мг/мл. Продолжительность введения в зависимости от объема раствора может составлять от 10 до 30 мин и более."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны пищеварительной системы:\u003c/i\u003e тошнота, рвота, диарея, псевдомембранозный колит, повышение активности печеночных трансаминаз и ЩФ."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны свертывающей системы:\u003c/i\u003e кровотечения (дефицит витамина К), гипопротромбинемия, увеличение протромбинового времени."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны системы кроветворения:\u003c/i\u003e анемия, нейтропения."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛабораторные показатели:\u003c/i\u003e гиперкреатининемия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАллергические реакции: \u003c/i\u003eкрапивница, макуло-папулезная сыпь, лихорадка, эозинофилия, многоформная эритема, злокачественная экссудативная эритема (синдром Стивенса-Джонсона), положительная реакция Кумбса."}},{"type":"paragraph","data":{"text":"\u003ci\u003eМестные реакции:\u003c/i\u003e при в/в введении - флебит; при в/м введении - болезненность в месте введения."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном применении с этанолом возможно развитие дисульфирамоподобных реакций."}},{"type":"paragraph","data":{"text":"Непрямые антикоагулянты, гепарин, тромболитики при одновременном применении с Цефоперусом увеличивают риск возникновения гипопротромбинемии, кровотечения."}},{"type":"paragraph","data":{"text":"Аминогликозиды и \"петлевые\" диуретики при одновременном применении с Цефоперусом повышают нефротоксичность, особенно у лиц с почечной недостаточностью."}},{"type":"paragraph","data":{"text":"Препараты, снижающие канальцевую секрецию, повышают концентрацию препарата Цефоперус\u003csup\u003e®\u003c/sup\u003e в крови и замедляют его выведение."}},{"type":"paragraph","data":{"text":"\u003ci\u003eФармацевтическое взаимодействие\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Фармацевтически несовместим с аминогликозидами (при необходимости проведения комбинированной терапии цефоперазоном и аминогликозидом назначают в виде последовательного дробного в/в введения препаратов, с использованием 2 отдельных в/в катетеров)."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Цефоперус\u003csup\u003e®\u003c/sup\u003e может применяться при комбинированной терапии в сочетании с другими антибиотиками."}},{"type":"paragraph","data":{"text":"Больным с повышенной чувствительностью к пенициллину препарат необходимо назначать с большой осторожностью."}},{"type":"paragraph","data":{"text":"В случаях обтурации желчных протоков, тяжелого заболевания печени или сопутствующего нарушения функции почек, может появиться необходимость в изменении режима дозирования."}},{"type":"paragraph","data":{"text":"Длительное применение может привести к развитию устойчивости возбудителя."}},{"type":"paragraph","data":{"text":"В период применения препарата может иметь место ложноположительная реакция на глюкозу в моче с раствором Бенедикта или Фелинга."}},{"type":"paragraph","data":{"text":"Во время лечения следует воздерживаться от приема этанола, т.к. возможно развитие дисульфирамоподобных реакций (гиперемия кожи лица, спазм в животе и в области желудка, тошнота, рвота, головная боль, снижение АД, тахикардия, одышка)."}},{"type":"paragraph","data":{"text":"У пациентов, придерживающихся неполноценной диеты или имеющих нарушение всасывания пищи (например, при муковисцидозе), а также пациентов, находящихся в течение продолжительного времени на парентеральном питании, может возникнуть дефицит витамина К. Таким больным должен осуществляться контроль протромбинового времени, при необходимости им показано назначение экзогенного витамина К."}}]}],"source":null},"description_toggle":false,"short_description":"Цефалоспориновый антибиотик III поколения для парентерального введения. Действует бактерицидно, нарушая синтез клеточной стенки микроорганизмов. Обладает широким спектром действия.Активен в отношении грамположительных микроорганизмов:Staphylococcus aureus и Staphylococcus epidermidis (штаммы, продуцирующие и не продуцирующие пенициллиназу), Streptococcus pneumoniae, Streptococcus pyogenes (бета-гемолитический штамм группы A), Streptococcus agalactiae (бета-гемолитический штамм группы В), Enterococcus faecalis, другие штаммы бета-гемолитических Streptococcus spp.;грамотрицательных микроорганизмов:Escherichia coli, Klebsiella spp. (включая Klebsiella pneumoniae), Enterobacter spp., Citrobacter spp., Haemophilus influenzae (штаммы, продуцирующие и не продуцирующие β-лактамазы), Proteus mirabilis, Proteus vulgaris, Morganella morganii, Providencia spp. (в т.ч. Providencia rettgeri), Serratia spp. (в т.ч. Serratia marcescens), Salmonella spp., Shigella spp., Pseudomonas spp. (в т.ч. Pseudomonas aeruginosa), некоторые штаммы Acinetobacter spp., Neisseria gonorrhoeae (штаммы, продуцирующие и не продуцирующие β-лактамазы), Neisseria meningitidis, Bordetella pertussis, Yersinia enterocolitica;анаэробных микроорганизмов:грамположительные и грамотрицательные кокки (включая Peptococcus spp., Peptostreptococcus spp., Veillonella spp.), грамположительные споро- и неспорообразующие анаэробы (Clostridium spp., Eubacterium spp., Lactobacillus spp.) и грамотрицательные (включая Fusobacterium spp., Bacteroides spp. /в т.ч. Bacteroides fragilis/, Prevotella spp.).ВсасываниеТmaxпосле в/м введения - 1-2 ч, после в/в - в конце инфузии, Cmaxпосле в/м введения препарата в дозе 1 г составляет 65-75 мкг/мл, в дозе 2 г - 97 мкг/мл; после однократного в/в введения в дозах 1 г, 2 г, 3 г и 4 г Cmaxсоставляет 153 мкг/мл, 252 мкг/мл, 340 мкг/мл, 506 мкг/мл соответственно. Cmaxв моче после в/м и в/в введения в дозе 2 г - 1000 мкг/мл и более 2200 мкг/мл соответственно.РаспределениеСвязывание с белками плазмы - 82-93%. Достигает терапевтических концентраций в перитонеальной, асцитической жидкости и спиномозговой жидкости (при менингите), моче, желчи, стенке желчного пузыря, легких, мокроте, небных миндалинах и слизистой оболочке синусов, предсердиях, почках, мочеточниках, предстательной железе, яичках, матке, фаллопиевых трубах, костях, крови пуповины и амниотической жидкости. Vd- 0.14-2 л/кг.ВыведениеТ1/2- 1.6-2.4 ч, независимо от способа введения, 2.8-4.2 ч - при гемодиализе, 2.2 ч - у новорожденных и детей от 2 мес до 11 лет. Выводится с желчью - 70-80%, почками - 20-30% в неизмененном виде.Фармакокинетика в особых клинических случаяхУ пациентов с нарушенной функцией печени и обструкцией желчевыводящих путей Т1/2составляет 3-7 ч, выведение с мочой - 90% и более. Даже при тяжелых поражениях печени в желчи достигаются терапевтические концентрации, а Т1/2удлиняется только в 2-4 раза. 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