Инванз Лиофилизат, флакон, 1 шт, 15 мл, 1 г, для раствора для инъекций

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Инванз эффективен против большинства штаммов следующих микроорганизмов in vitro и при вызываемых ими инфекциях. Активен в отношении аэробных и факультативных анаэробных грамположительных микроорганизмов: Staphylococcus aureus (включая штаммы, продуцирующие пенициллиназу; метициллин-резистентные стафилококки устойчивы), Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes. Многие штаммы Enterococcus faecalis и большинство штаммов Enterococcus faecium устойчивы. Активен в отношении аэробных и факультативных анаэробных грамотрицательных микроорганизмов: Escherichia coli, Haemophilus influenzae (включая штаммы, продуцирующие β-лактамазу), Klebsiella pneumoniae, Moraxella catarrhalis, Proteus mirabilis. Активен в отношении анаэробных микроорганизмов: Bacteroides fragilis и других Bacteroides spp., микроорганизмов рода Clostridium (кроме Clostridium difficile), микроорганизмов рода Eubacterium, микроорганизмов рода Peptostreptococcus, Porphyromonas asaccharolytica, микроорганизмов рода Prevotella. Данные о величинах минимальных подавляющих концентраций (МПК), приведенные ниже, получены в исследованиях in vitro, однако их клиническая значимость неизвестна. Инванз при МПК ≤1 мкг/мл активен против большинства (≥90%) штаммов микроорганизмов рода Streptococcus, включая Streptococcus pneumoniae; при МПК ≥0.5 мкг/мл - против большинства (≥90%) штаммов микроорганизмов рода Haemophilus; при концентрации ≤2 мкг/мл - против большинства (≥90%) штаммов других аэробных и факультативных анаэробных микроорганизмов; при концентрации ≤4 мкг/мл - против большинства (≥90%) штаммов анаэробных микроорганизмов из приведенного ниже списка. Однако безопасность и эффективность препарата Инванз при лечении инфекций, вызванных данными микроорганизмами, в клинической практике не была подтверждена в качественных и хорошо контролируемых клинических исследованиях. Активен в отношении аэробных и факультативных анаэробных грамположительных микроорганизмов: микроорганизмы рода Staphylococcus, коагулазонегативные, чувствительные к метициллину (метициллин-резистентные стафилококки устойчивы), Streptococcus pneumoniae (пенициллин-резистентные), Streptococcus viridans. Многие штаммы Enterococcus faecalis и большинство штаммов Enterococcus faecium устойчивы. Активен также в отношении аэробных и факультативных анаэробных грамотрицательных микроорганизмов: Citrobacter freundii, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli (продуцирующая β-лактамазы расширенного спектра действия), Haemophilus parainfluenzae, Klebsiella oxytoca, Klebsiella pneumoniae (продуцирующие β-лактамазы расширенного спектра действия), Morganella morgani, Proteus vulgaris, Serratia marcescens. Многие штаммы перечисленных выше микроорганизмов, обладающих мультирезистентностью к другим антибиотикам, например, пенициллинам, цефалоспоринам (в т.ч. III поколения) и аминогликозидам, чувствительны к препарату Инванз. Активен в отношении анаэробных микроорганизмов рода Fusobacterium. Определяемые значения МПК должны быть интерпретированы в соответствии с критериями, указанными в таблице 1."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Лечение тяжелых и средней степени тяжести инфекционно-воспалительных заболеваний, вызванных чувствительными штаммами микроорганизмов (в т.ч. Для стартовой эмпирической антибактериальной терапии до определения возбудителей): Интраабдоминальные инфекции. Инфекции кожи и подкожной клетчатки, включая инфекции нижних конечностей при сахарном диабете (диабетическая стопа). Внебольничная пневмония. Инфекции мочевыделительной системы (в т.ч. Пиелонефрит). Острые инфекции органов малого таза (в т.ч. Послеродовый эндомиометрит, септический аборт и послеоперационные гинекологические инфекции). Бактериальная септицемия."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Установленная повышенная чувствительность к компонентам препарата или к другим антибиотикам той же группы. Повышенная чувствительность к другим бета-лактамным антибиотикам. При использовании в качестве растворителя лидокаина гидрохлорида в/м введение препарата противопоказано пациентам с установленной повышенной чувствительностью к амидным анестетикам местного действия, пациентам с тяжелой артериальной гипотензией или с нарушением внутрисердечной проводимости."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Достаточного клинического опыта применения препарата Инванз при беременности нет. Препарат следует применять только в тех случаях, когда предполагаемая польза терапии для матери превосходит потенциальный риск для плода. С осторожностью следует применять препарат в период лактации (грудного вскармливания), т.к. эртапенем выделяется с грудным молоком."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Средняя суточная доза препарата для взрослых и подростков в возрасте 13 лет и старше составляет 1 г, кратность введения - 1 раз/сут. Детям в возрасте от 3 мес до 12 лет Инванз назначают в дозе 15 мг/кг 2 раза в сут (но не более 1 г/сут). Препарат вводят путем в/в инфузии или в/м инъекции. При в/в введении длительность инфузии должна составлять 30 мин. В/м введение может быть альтернативой в/в инфузии. Обычная продолжительность терапии составляет от 3 до 14 дней в зависимости от тяжести заболевания и вида микроорганизмов. При наличии клинических показаний допустим переход на последующую адекватную пероральную антибактериальную терапию. Препарат можно применять для лечения инфекций у взрослых пациентов с почечной недостаточностью. У пациентов с ККбольше30 мл/мин/1.73 м2 коррекции режима дозирования не требуется. У пациентов с выраженными нарушениями функции почек (КК≤30 мл/мин/1.73 м2), включая пациентов, находящихся на гемодиализе, рекомендуемая доза составляет 500 мг/сут. Нет данных о применении препарата у детей с почечной недостаточностью. Взрослым пациентам, находящимся на гемодиализе и получившим препарат в дозе 500 мг/сут в ближайшие 6 ч перед сеансом гемодиализа, следует дополнительно ввести 150 мг препарата после сеанса. Если препарат вводят более чем за 6 ч до гемодиализа, введения дополнительной дозы не требуется. В настоящее время нет достаточных данных по рекомендации пациентам, находящимся на перитонеальном диализе или гемофильтрации. Нет данных о применении препарата у детей, находящихся на гемодиализе."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нежелательные явления (возможно, вероятно или определенно связанные с применением препарата), были отмечены примерно у 20% пациентов, принимавших эртапенем. В связи с нежелательными явлениями эртапенем отменяли у 1.3% пациентов. Наиболее частые нежелательные явления, связанные с парентеральным введением препарата, включали диарею (4.8%), местные осложнения после в/в введения (4.5%) и тошноту (2.8%). Со стороны иммунной системы редкие - аллергические реакции. частота неизвестна - анафилаксия, включая анафилактоидные реакции. Инфекционные и паразитарные заболевания нечастые - кандидоз слизистой оболочки полости рта, кандидоз, грибковая инфекция, псевдомембранозный колит, вагинит. редкие - пневмония, дерматомикоз, послеоперационная раневая инфекция, инфекции мочевыделительной системы. Со стороны системы кроветворения редкие - нейтропения, тромбоцитопения. Со стороны обмена веществ редкие - гипогликемия. Со стороны ЦНС частые - головная боль. нечастые - бессонница, спутанность сознания, головокружение, сонливость, извращение вкуса, судорожный припадок. редкие - ажитация, тревожность, депрессия, тремор, обморок. частота неизвестна - измененное психическое состояние (включая агрессивность, делирий, дезориентацию, изменение психического статуса), галлюцинации, дискинезия, миоклония, нарушение походки. Со стороны органа зрения редкие - нарушения со стороны склер. Со стороны сердечно-сосудистой системы частые - синусовая брадикардия, постинфузионные венозные осложнения (флебит, тромбофлебит). нечастые - снижение АД. редкие - аритмия, тахикардия, кровотечение, повышение АД. Со стороны дыхательной системы нечастые - диспноэ, неприятные ощущения в горле. редкие - заложенность носа, носовое кровотечение, хрипы, затрудненное дыхание. Со стороны пищеварительной системы частые - диарея, тошнота, рвота. нечастые - запор, отрыжка кислым содержимым, ощущение сухости во рту, диспепсия, боль в животе. редкие - дисфагия, недержание кала, тазовый перитонит, холецистит, желтуха, поражение печени. Дерматологические реакции редкие - сыпь, зуд. нечастые - эритема, крапивница. редкие - дерматит, шелушение кожи. частота неизвестна - лекарственная сыпь с эозинофилией и системными симптомами (DRESS-синдром). Со стороны костно-мышечной системы редкие - мышечные спазмы, боль в плече. частота неизвестна - мышечная слабость. Со стороны мочевыделительной системы редкие - почечная недостаточность, острая почечная недостаточность. Со стороны половых органов генитальное кровотечение. Со стороны организма в целом и местные реакции нечастые - экстравазация, слабость, утомляемость, лихорадка, боль в груди, анорексия. редкие - уплотнение в месте введения, недомогание. Со стороны лабораторных показателей частые - повышение активности АЛТ (4.6%), ACT (4.6%), ЩФ (3.8%), увеличение числа тромбоцитов (3%). нечастые - повышение концентрации прямого и непрямого билирубина, креатинина, мочевины и глюкозы, уменьшение количества лейкоцитов, тромбоцитов, сегментоядерных нейтрофилов, снижение гемоглобина и гематокрита, увеличение количества эозинофилов, АЧТВ и протромбинового времени, увеличение количества сегментоядерных нейтрофилов и лейкоцитов, увеличение количества бактерий, лейкоцитов, эритроцитов и эпителиальных клеток в моче, кандидурия, положительная реакция на токсин Clostridium difficile. редкие - снижение концентрации бикарбонатов, креатинина, уменьшение содержания калия, повышение активности ЛДГ, увеличение содержания фосфора и калия, уменьшение количества лимфоцитов, увеличение количества палочкоядерных нейтрофилов, моноцитов, миелоцитов, атипичных лимфоцитов, повышение концентрации уробилиногена."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Специальной информации по передозировке препарата нет. В клинических исследованиях случайное введение препарата взрослым в дозе до 3 г/сут не приводило к клинически значимым нежелательным явлениям. В клинических исследованиях у детей однократное в/в введение препарата в дозе от 40 мг/кг до 2 г максимально не вызывало токсических реакций. Лечение: препарат следует отменить и проводить общую поддерживающую терапию (до полного выведения эртапенема из организма). Препарат можно удалить из организма путем гемодиализа, но информации о применении гемодиализа для лечения передозировки не имеется."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Длительное применение препарата Инванз, как и других антибиотиков, может привести к избыточному росту нечувствительных микроорганизмов. При развитии суперинфекции следует принять соответствующие меры. При применении почти всех антибактериальных препаратов, включая эртапенем, возможно развитие псевдомембранозного колита (главной причиной которого является токсин, вырабатываемый Clostridium difficile). Выраженность колита может варьировать от легкого до опасного для жизни. Следует учитывать возможность развития такого осложнения при возникновении выраженной диареи у пациентов, получавших антибактериальную терапию. При в/м введении следует соблюдать осторожность, чтобы избежать случайного введения препарата в кровеносный сосуд. В клинических исследованиях эффективность и безопасность препарата Инванз у пациентов пожилого возраста (≥65 лет) были сопоставимы с таковыми у более молодых пациентов (≤65 лет). Использование в педиатрии: Применение препарата у детей в возрасте до 3 мес не рекомендуется."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Антибиотик из группы карбапенемов, представляет собой 1-β-метил-карбапенем, бета-лактамный антибиотик длительного действия для парентерального введения, обладающий активностью против широкого спектра грамположительных и грамотрицательных аэробных и анаэробных бактерий. Бактерицидная активность эртапенема обусловлена ингибированием синтеза клеточной стенки и опосредована его связыванием с пенициллин-связывающими белками (ПСБ). У Escherichia coli он проявляет сильное сродство к ПСБ 1a, 1b, 2, 3, 4 и 5, причем предпочтительно - к ПСБ 2 и 3. Эртапенем обладает значительной устойчивостью к действию β-лактамаз большинства классов (включая пенициллиназы, цефалоспориназы и β-лактамазы расширенного спектра, но не металло-β-лактамазы). Инванз эффективен против большинства штаммов следующих микроорганизмов in vitro и при вызываемых ими инфекциях. Активен в отношении аэробных и факультативных анаэробных грамположительных микроорганизмов: Staphylococcus aureus (включая штаммы, продуцирующие пенициллиназу; метициллин-резистентные стафилококки устойчивы), Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes. Многие штаммы Enterococcus faecalis и большинство штаммов Enterococcus faecium устойчивы. Активен в отношении аэробных и факультативных анаэробных грамотрицательных микроорганизмов: Escherichia coli, Haemophilus influenzae (включая штаммы, продуцирующие β-лактамазу), Klebsiella pneumoniae, Moraxella catarrhalis, Proteus mirabilis. Активен в отношении анаэробных микроорганизмов: Bacteroides fragilis и других Bacteroides spp., микроорганизмов рода Clostridium (кроме Clostridium difficile), микроорганизмов рода Eubacterium, микроорганизмов рода Peptostreptococcus, Porphyromonas asaccharolytica, микроорганизмов рода Prevotella. Данные о величинах минимальных подавляющих концентраций (МПК), приведенные ниже, получены в исследованиях in vitro, однако их клиническая значимость неизвестна. Инванз при МПК ≤1 мкг/мл активен против большинства (≥90%) штаммов микроорганизмов рода Streptococcus, включая Streptococcus pneumoniae; при МПК ≥0.5 мкг/мл - против большинства (≥90%) штаммов микроорганизмов рода Haemophilus; при концентрации ≤2 мкг/мл - против большинства (≥90%) штаммов других аэробных и факультативных анаэробных микроорганизмов; при концентрации ≤4 мкг/мл - против большинства (≥90%) штаммов анаэробных микроорганизмов из приведенного ниже списка. Однако безопасность и эффективность препарата Инванз при лечении инфекций, вызванных данными микроорганизмами, в клинической практике не была подтверждена в качественных и хорошо контролируемых клинических исследованиях. Активен в отношении аэробных и факультативных анаэробных грамположительных микроорганизмов: микроорганизмы рода Staphylococcus, коагулазонегативные, чувствительные к метициллину (метициллин-резистентные стафилококки устойчивы), Streptococcus pneumoniae (пенициллин-резистентные), Streptococcus viridans. Многие штаммы Enterococcus faecalis и большинство штаммов Enterococcus faecium устойчивы. Активен также в отношении аэробных и факультативных анаэробных грамотрицательных микроорганизмов: Citrobacter freundii, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli (продуцирующая β-лактамазы расширенного спектра действия), Haemophilus parainfluenzae, Klebsiella oxytoca, Klebsiella pneumoniae (продуцирующие β-лактамазы расширенного спектра действия), Morganella morgani, Proteus vulgaris, Serratia marcescens. Многие штаммы перечисленных выше микроорганизмов, обладающих мультирезистентностью к другим антибиотикам, например, пенициллинам, цефалоспоринам (в т.ч. III поколения) и аминогликозидам, чувствительны к препарату Инванз. Активен в отношении анаэробных микроорганизмов рода Fusobacterium. 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