Intravenous injection antimicrobials

Substances that have been used as preservatives for disperse systems include chlorocresol, chlorobutanol, benzoates, phenylmercuric nitrate, parabens, and others [76,77]. The use of cationic antimicrobial agents such as quaternary ammonium compounds (e.g., benzalkonium chloride) is contraindicated in many cases because they may be inactivated by other formulation components and/or they may alter the charge of the dispersed phase. Clay suspensions and gels should be adequately preserved with nonionic antimicrobial preservatives. The use of preservatives is generally limited to products that are not intended for parenteral use. Intravenous injectable... 

Vitamin K is an essential cofactor for the synthesis of prothrombin and other blood-clotting factors. Vitamin K deficiency occurs due to liver disease, longterm antimicrobial therapy, and malabsorption. Vitamin K deficiency can lead to hemorrhages in newborns and development of hypoprothrombobinemia. Rapid intravenous injection of emulsified vitamin K produces flushing, breathlessness, hypotension, and may lead to death. 

Intraosseous administration is a feasible alternative to intravenous injection of some antimicrobial agents (sodium ampicillin or amoxicillin, cefotaxime, gentamicin or amikacin sulfate) in neonatal foals (less than 7 days of age). This particularly applies in the treatment of septicemia in neonatal foals that are in a state of septic shock or dehydration or both. The plasma concentration profiles for amikacin administered intraosseously and intravenously to neonatal foals are similar (Fig. 4). ... 

Cephapirin Sodium, Sterile, USP. Cephapirin (Cefa-dyl) is a scmisynthctic 7-ACA derivative released in the United States in 1974. It closely resembles ccphalothin in chemical and phannacokinetic properties. Like cephalothin, cephapirin is unstable in acid and must be administered par-enterally in the form of an aqueous solution of the. sodium salt. It is moderately protein bound (45 to 50%) in plasma and cleared rapidly by the kidneys. Cephapirin and cephalothin arc very similar in antimicrobial spectrum and potency. Conflicting reports concerning the relative tK-currence of pain at the site of injection and thrombophlebitis after intravenous injection of cephapirin and cephalothin are dirTicuIt to as.sess on the basis of available clinical data. 

The variability associated with drug absorption from the gastrointestinal tract can be overcome by using a parenteral preparation (dosage form). It should preferably be administered either by intravenous infusion or slow intravenous injection to avoid circulatory overload. Intraosseous administration is a useful alternative to intravenous injection of some antimicrobial agents (e.g. sodium ampicillin or amoxycillin, cefotaxime, ceftriaxone, gentamicin or amikacin sulphate) in neonatal foals (Fig. 7.1) (Golenz et al, 1994) and puppies (Lavy et al, 1995). This particularly applies when the neonate is in a state of septic shock and/or dehydration. Total plasma protein concentration is an inaccurate index of hydration status unless monitored (repeatedly measured) and interpreted in conjunction with packed cell volume (PCV). 

Leopold and Scheie (16,17) first introduced intravitreal antimicrobial therapy for treatment of endophthalmitis shortly after the development of antibiotics, but intraocular antibiotics did not gain favor for treatment of endophthalmitis for several decades. Up until the 1970s intravenous antimicrobials, frequent topical drops, and subconjunctival injections were the favored routes of antimicrobial delivery. Intravenous antimicrobial treatment was demonstrated to be effective in some cases of Staphylococcus epidermidis endophthalmitis, but effectiveness of intravenous therapy has not been demonstrated in randomized clinical trials (18). 

Streptomycin is used for the treatment of certain unusual infections usually in combination with other antimicrobial agents. Because it is less active than other members of the class against aerobic gram-negative rods, it has fallen into disuse. Streptomycin may be administered by deep intramuscular injection or intravenously. The dose of streptomycin is 15 mg/kg/day for patients with creatinine clearances above 80 mL/min. It typically is administered as a 1000-mg single daily dose or 500 mg twice daily. The daily dose should be reduced in proportion to creatinine clearance for creatinine clearances >30 mL/min (Table 45-1). 

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