세포탁심

항생제 - 3세대 세팔로스포린Critically Important

세포탁심은 그람 양성균 및 그람 음성균 모두에 대해 광범위한 항균 활성을 갖는 **3세대 주사용 세팔로스포린** 항생제입니다. 주요 임상적 특징은 다음과 같습니다: * **확장된 그람 음성균 커버리지**: 장내세균과(예: 클레브시엘라, 대장균, 살모넬라, 프로테우스)에 매우 효과적입니다. * **혐기성 균 활성**: 박테로이데스 프라질리스 및 클로스트리디움 종을 포함한 많은 혐기성 균에 효과적입니다. * **중추신경계(CNS) 침투**: 1세대 및 대부분의 2세대 세팔로스포린과 달리, 뇌수막에 염증이 있을 때 **뇌척수액(CSF)**에서 치료 농도에 도달하므로 세균성 뇌수막염 및 척수 감염에 유용한 옵션입니다. * **투여**: 경구로 거의 흡수되지 않으므로 반드시 비경구(IV, IM, SC)로 투여해야 합니다. 부작용을 최소화하기 위해 정맥 주사는 천천히(3-5분 이상) 투여해야 합니다. > **임상 팁**: 많은 그람 음성 호기성 균에 대해 우수한 활성을 보이지만, 녹농균(Pseudomonas aeruginosa)에 대한 효능은 변동성이 크며 임상적으로 실망스러운 경우가 많습니다. 디스크 확산법 감수성 검사 시 30마이크로그램 세포탁심 디스크를 사용해야 합니다.

작용 기전: Cefotaxime is a **time-dependent, bactericidal** antibiotic. * **Mechanism**: It binds to specific **penicillin-binding proteins (PBPs)** located inside the bacterial cell wall → inhibits the third and final stage of bacterial cell wall peptidoglycan synthesis → leads to cell lysis and death mediated by bacterial cell wall autolytic enzymes (autolysins). * **Metabolism**: It is partially metabolized in the liver to **desacetylcefotaxime**, an active metabolite that works synergistically with the parent compound to enhance antibacterial activity.

동물 종별 용량

Dogs

Soft tissue infections · 22 mg/kg IV, IM or SC q8h for 7 days or less or 50 mg/kg IV or IM q12h for 7 days or less · IV, IM, SC · q8h or q12h · 7 days or less
Orthopedic infections · 20-40 mg/kg IV, IM or SC q6-8h for 7 days or less · IV, IM, SC · q6-8h · 7 days or less
Severe bacteremia · 20-80 mg/kg IV q6h or 10-50 mg/kg IV q4-6h for as long as necessary · IV · q4-6h · As long as necessary
Susceptible infections · 25-50 mg/kg IV, IM or SC q8h · IV, IM, SC · q8h
Sepsis · 20-80 mg/kg IV, IM q8h · IV, IM · q8h
CNS infections (spinal cord) · 25 mg-50 mg/kg IV, IM q8h · IV, IM · q8h
Acute sepsis or serious susceptible infections · 40-50 mg/kg · IV/IM/SC · q8h · Until clinical resolution · Standard recommended dose.
Susceptible infections · 10-20 mg/kg · IV/IM/SC · q12h · Until clinical resolution · Lower dose suggested by some authors to have good clinical efficacy.

Birds

Susceptible infections (most birds) · 50-100 mg/kg IM three times a day · IM · TID · May be used with aminoglycosides, but nephrotoxicity may occur. Reconstituted vial good for 13 weeks if frozen.
Bacterial infections, bacterial hepatitis · 75-100 mg/kg IM or IV q4-8h · IM, IV · q4-8h

투여 경로

IVIMSCRegional perfusionNebulization

금기

Patients with a documented history of hypersensitivity to cephalosporins

이상반응

Pain at the IM injection site
Thrombophlebitis (after IV administration)
Hypersensitivity reactions (rashes, fever, eosinophilia, anaphylaxis)
Antibiotic-associated diarrhea (alteration of gut flora)
Sterile abscesses or local tissue reactions
Rarely: Nephrotoxicity, neurotoxicity (at high doses), neutropenia, agranulocytosis, thrombocytopenia, hepatitis

약물 상호작용

Aminoglycosides / Nephrotoxic drugs (e.g., amphotericin B) · Potential for additive nephrotoxicity. In vitro studies show synergistic antibacterial activity, but they must NOT be mixed in the same syringe or fluid bag.
Probenecid · Competitively blocks the renal tubular secretion of cefotaxime, significantly increasing its serum levels and prolonging its elimination half-life.
Oxytetracycline · Bacteriostatic agents may antagonize the bactericidal activity of cephalosporins. · moderate
Erythromycin · Bacteriostatic agents may antagonize the bactericidal activity of cephalosporins. · moderate
Aminoglycosides · Synergistic antibacterial effect, but do not mix in the same syringe due to chemical incompatibility. · minor
Amphotericin B · Increased risk of nephrotoxicity. · major
Furosemide · Loop diuretics may increase the risk of nephrotoxicity when used with cephalosporins. · major

모니터링

Clinical efficacy (resolution of infection signs)
Renal function parameters (BUN, creatinine, urinalysis) in compromised patients or those on concurrent nephrotoxic drugs

과용량

Acute cephalosporin overdoses are unlikely to cause significant life-threatening problems. However, massive overdoses may exacerbate adverse effects, potentially leading to **neurotoxicity** (seizures, encephalopathy), **nephrotoxicity**, or severe gastrointestinal upset. Treatment should consist of standard supportive care and monitoring.

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