In this medical article, you can get acquainted with the drug Zinnat. The instructions for use will explain in which cases you can take injections or tablets, what the medicine helps with, what are the indications for use, contraindications and side effects. The annotation presents the form of release of the drug and its composition.

In the article, doctors and consumers can only leave real reviews about Zinnat, from which you can find out if the medicine helped in the treatment of tonsillitis, pyelonephritis, bronchitis and other infections in adults and children, for which it is also prescribed. The instructions list the analogues of Zinnat, the prices of the drug in pharmacies, as well as its use during pregnancy.

Antibiotic of the second generation of cephalosporin drugs is Zinnat. Instructions for use prescribes taking 125 mg and 250 mg tablets, granules for the preparation of an antibiotic suspension for the treatment of bacterial infections.

Release form and composition

The drug is produced in the following dosage forms:

1. Zinnat tablets have an oval shape, white color and a smooth biconvex surface. They are sheathed. The main active ingredient of the drug is cefuroxime, its content in one tablet can be 125 and 250 mg. It also contains auxiliary components

Tablets are packaged in a blister of 5 and 10 pieces. A cardboard pack contains 1 or 2 blisters and instructions for using the drug.

2. Granules for the preparation of a suspension for oral administration (sometimes erroneously called syrup). Color is white or almost white. After dilution, a white or light yellow suspension is formed, which has a fruity aroma. Granules are contained in dark glass bottles, 125 mg / 5 ml. The bottle is closed with a plastic cap equipped with an anti-tamper device. A measuring spoon is also included in the cardboard box.

The granules from which the Zinnat suspension is prepared contain axetil as an active substance in cefuroxime, as well as additional ingredients: stearic acid, sucrose, aspartame, acesulfame potassium, povidone K30, xanthan gum, flavor.

pharmachologic effect

The active substance of Zinnat cefuroxime is highly resistant to bacterial lactamases, and is most effective against a wide range of pathogens, including amoxicillin-resistant and ampicillin-resistant strains.

The bactericidal effect of cefuroxime is due to the suppression of the synthesis of bacterial cell walls as a result of binding to target proteins. After oral administration, the antibiotic Zinnat is slowly absorbed from the digestive tract, rapidly hydrolyzing in the mucous membrane of the small intestine and blood with the release of cefuroxime.

The active substance penetrates the placenta, the BBB and is excreted along with breast milk. The maximum concentration of cefuroxime in plasma is observed 2-4 hours after ingestion. The substance does not undergo metabolic processes and is excreted unchanged by the urinary system.

Indications for use

What helps Zinnat? Zinnat tablets and suspension are indicated for use against a wide range of Gram-positive and Gram-negative bacteria. It is used to treat diseases of an infectious and inflammatory nature, provoked by bacteria that are sensitive to cefuroxime:

• peritonitis;
• sepsis;
• Lyme disease in its early stage, prevention of the development of the later stages of this disease in patients over 12 years of age;
• infectious diseases of the lower respiratory tract (bronchitis, pneumonia, exacerbation of the chronic form of bronchitis);
• infectious diseases of the urinary tract (pyelonephritis, cystitis, urethritis, etc.);
• gonorrhea;
• infectious diseases of soft tissues and skin (furunculosis, pyoderma, etc.);
• infectious diseases of the ENT organs and upper respiratory tract (sinusitis, otitis media, pharyngitis, etc.);
• meningitis.

Instructions for use

Zinnat for adults is prescribed in a single dose of an average of 250 mg, the frequency of administration is 2 times a day.

• In severe infections of the lower respiratory tract appoint 500 mg 2 times a day; for infections of mild and moderate severity - 250 mg 2 times a day.
• For urinary tract infections, 125 mg 2 times a day are prescribed, for pyelonephritis - 250 mg 2 times a day.
• In the treatment of uncomplicated gonorrhea, 1 g is prescribed once.
• In Lyme disease, adults and children over 12 years of age - 500 mg 2 times a day for 20 days.

Children under the age of 12 years can be prescribed the drug in the form of a suspension. The average dose for children with most infections is 1 tablet (125 mg) 2 times a day.

• For severe infections or otitis media in children aged 2 years and older, the average dose is 1 tablet (250 mg) or 2 tablets (125 mg) 2 times a day.
• In infectious diseases of mild and moderate severity, a single dose is set at the rate of 10 mg / kg of body weight.
• With otitis media and severe infections, a single dose is set at the rate of 15 mg / kg.

Multiplicity of reception - 2 times a day. The maximum daily dose is 500 mg. The duration of the drug is on average 7 days (5-10 days). The drug is recommended to be taken after meals.

Contraindications

According to the instructions, Zinnat is not prescribed for:

• hypersensitivity to cephalosporins;
• pregnancy;
• bleeding and diseases of the digestive tract;
• breastfeeding;
• allergic reactions to penicillins.

Side effects

The development of side effects after the start of taking Zinnat tablets is usually not pronounced, they have a reversible development and disappear after the drug is discontinued. Undesirable reactions can develop from various organs and systems:

• Liver and biliary tract - a reversible increase in the level of hepatic transaminases in the blood, indicating damage to hepatocytes (liver cells), rarely - hepatitis (inflammation of the liver) and cholestatic jaundice.
• Allergic reactions - a rash on the skin, itching, urticaria (a specific rash that resembles a nettle burn). Quincke's angioedema (significant swelling in the face and genitals), as well as a severe systemic allergic reaction in the form of anaphylactic shock (a pronounced decrease in blood pressure with the development of multiple organ failure) may develop less frequently.
• Digestive system - abdominal pain, nausea and occasional vomiting.
• Skin and subcutaneous tissue - erythema multiforme (the appearance of rashes on the skin in the form of red spots of various shapes and sizes), Stevens-Johnson syndrome and toxic epidermal necrolysis (severe skin damage with the death of its cells).
• Nervous system - headache and dizziness.
• Blood and red bone marrow - eosinophilia (an increase in the number of eosinophils in the blood - immune cells responsible for allergic reactions), less often thrombocytopenia (a decrease in the number of platelets) and leukopenia (a decrease in the number of leukocytes) may develop.

In the event of side effects, the drug is stopped.

Children, during pregnancy and lactation

Zinnat is used with caution in the 1st trimester of pregnancy and during lactation. In experimental studies, the embryotoxic and teratogenic effects of the drug have not been established.

Zinnat belongs to the second generation of cephalosporin antibiotics. It acts on a wide range of bacterial infections due to cefuroxime, which is part of it. The medicine not only prevents the growth of dangerous bacteria, but also destroys them. Consider the indications and instructions for the use of the drug in pediatrics.

Forms of release and composition of the antibiotic

Cefuroxime - the main component of the drug - is resistant to a number of beta-lactamase, has a positive effect in the treatment of ailments caused by both gram-positive and gram-negative infectious agents. Produced under several trademarks: Kimatsef, Ceftin, Aksetin, etc. Zinnat is produced in the UK.

Slightly elongated, convex on both sides, Zinnat tablets are white or slightly yellowish in color. They produce 2 types of tablets: 125 mg and 250 mg of cefuroxime. The oral form of the drug is resistant to enzymes produced by microorganisms that provide resistance to antibiotics.

The active ingredient is supplemented with auxiliary elements: microcrystalline cellulose, hydrogenated (modified) vegetable oil, primellose (sodium croscarmellose) and sodium lauryl sulfate. The composition of the surface layer of the tablets in both versions includes hypromellose, propylene glycol, white dye opasprey and preservative E216. Tablets are packaged in blisters of 10 pieces, sold in cardboard boxes.

The suspension is obtained from the granular form of the drug, which differs in excipients from tablets. The granules as additional elements include: octadecanoic acid, sucrose, sweeteners E950, E951, povidone K30, xanthan gum, flavoring.

Granules are small particles of white color with a diameter of up to 3 mm, having an irregular shape. When diluted with water, a yellowish suspension with a fruity taste is formed. The suspension is available in glass bottles with a plastic cap, equipped with a child-proof device. The bottle is placed in a cardboard case, it is accompanied by a measuring spoon with a capacity of 5 ml and a measuring cup.

What diseases is Zinnat prescribed for?

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Zinnat for children is chosen for inflammatory diseases caused by infectious agents sensitive to cefuroxime. These include:

• bacterial lesions of the ear, throat and nose, tonsillitis, diseases of the larynx, trachea, paranasal sinuses;
• inflammation of the bronchi of an infectious nature;
• pneumonia;
• infectious lesions of the skin and soft tissues - furunculosis, pyoderma;
• urinary tract infections - cystitis, pyelonephritis, gonorrhea;
• peritonitis - inflammation of the abdominal wall, blood poisoning, meningitis;
• the initial stage of tick-borne borreliosis (Lyme disease).

Due to the ability of cefuroxime to resist bacterial beta-lactamases, Zinnat is effective in the treatment of ailments caused by ampicillin-resistant or amoxicillin-resistant infectious agents. The susceptibility of pathogens to cefuroxime varies by region and varies over time. When choosing an antibiotic, local data must be taken into account.

Zinnat is an antibiotic, so its use is possible only on the recommendation of a doctor.

Method of application and dosage of the drug

The recommended period of therapy is from 5 to 10 days. The medicine is taken after a meal with a sufficient amount of liquid. Zinnat is prescribed to adult patients in the form of tablets of 250 mg twice a day. The maximum dose for serious diseases is 500 mg 2 times a day.

For urinary tract infections, the drug can be prescribed in an amount of 125 mg twice a day, for the treatment of gonorrhea, the drug should be taken 1 time per day in an amount of 1 g. The course of treatment for tick-borne borreliosis lasts 20 days, the drug is prescribed in an amount of 500 mg twice a day.

Use of tablets for children

Tablets can be given to children over 3 years of age. The maximum daily dose for them is 500 mg. Usually taken twice a day in the amount of 125 mg after meals. In the treatment of severe diseases, including inflammation of the middle ear, a single dose may be 250 mg, with a total daily dose of 500 mg.

Zinnat tablets are not suitable for children who have difficulty swallowing. Since it is not recommended to break and grind the tablets, the drug is prescribed for babies in the form of a suspension. The exact dosage for various diseases and the recommended form are given in the instructions for use.

Suspension preparation and dosage according to age

The antibacterial suspension has a specific taste, so sometimes after taking it, the child may experience nausea.

To dilute the suspension, it is necessary to add water to the open vial, the amount of which is measured using a measuring cup (up to the indicated mark). Shake the bottle beforehand to dissolve the powder. After dilution with water, the bottle should be tightly closed and shaken several times, then wait at least 3 minutes for the drug to completely combine with water.

The suspension is given to the child in an amount determined by weight, age, degree of organ damage or violation of their functions. Appointment of Zinnat to children from 3 months to 12 years is produced in the doses indicated below.

Table 1. Dosage of the antibiotic Zinnat in suspension:

In case of severe infections, as well as inflammation of the middle ear, the dose of the drug is increased by 1.5 times. The amount is determined at the rate of 15 mg per kilogram of the child's weight.

Table 2. Dosage for severe diseases:

In case of serious ailments with a severe course, the antibiotic is administered intramuscularly. For injections, the drug Zinacef is used, containing cefuroxime in the form of a sodium salt. In the future, there is a transition to oral administration.

Contraindications

An effective antibiotic has a number of contraindications. These include:

• age less than 3 months;
• children under 3 years of age are prescribed with caution;
• allergic reactions to antibiotics;
• negative response of the immune system to penicillin preparations;
• hereditary disorder of amino acid metabolism - phenylketonuria;
• peptic ulcer of the stomach or duodenum, especially in case of bleeding;
• syndrome of impaired renal function, accompanied by a disorder of water, electrolyte and other types of metabolism - renal failure;
• chronic inflammation of the mucous membrane of the large intestine - ulcerative colitis (we recommend reading:);
• pregnancy and breastfeeding;
• bleeding of various etiologies.

Side effects of the drug and overdose

With proper use of the product and following the instructions, the child may still experience allergic reactions to Zinnat. A characteristic symptom of drug rejection will be urticaria, accompanied by severe itching. There may be drug fever. Further use is prevented by the onset of diarrhea, icteric phenomena, vomiting and nausea.

A reaction to an antibiotic can be a change in the composition of the blood. A decrease in the number of neutrophils, platelets or leukocytes, an increase in the number of eosinophils require a revision of the treatment regimen.

Anaphylactic shock, which is expressed in the appearance of severe pain, swelling, difficulty breathing, a sharp drop in blood pressure, requires not only the abolition of the antibiotic, but also the immediate call of an ambulance. Paleness of the integument, blue lips and fingers, loss of consciousness indicate a threat to the patient's life.

Which is better - Zinnat or Suprax?

With any disease, the choice of the drug remains with the doctor. However, parents should control the appointment of a specialist, taking into account the allergic reactions of the child known to them:

• Zinnat is a highly effective drug. It can be used in some cases from the age of 4 months. However, its disadvantage is a large number of contraindications and side effects.
• Suprax is an effective third-generation drug (more details in the article:). However, its use is possible from 7 months of age. It is usually used in cases where weaker antibiotics have not given the desired result.

Which drug is better, Zinnat or Suprax, depends on the age and condition of the child. It is not worth trying to prescribe antibiotics to the baby on your own, it can be dangerous. In some cases, to avoid a negative reaction to Zinnat, you can replace it with other drugs.

What else can replace Zinnat?

If necessary, Zinnat can be replaced with another antibiotic with a similar composition. Cefuroxime is available under different brand names: Akcetin, Aksosef, Kefstar, Xorim, Mikreks and many others.

In some cases, it is required to replace the antibiotic with another one that has a similar effect, but contains a different active substance. Suprax can be used to treat similar diseases. However, there are other drugs:

1. - an antibiotic, the active substance in which is Azithromycin. Indications for use are the same as for Zinnat, but it can also be used to treat peptic ulcer. The drug is prescribed for children over 3 years old for a single daily intake in the amount of 10 mg per kilogram of body weight.
2. - an antibiotic related to macrolides. The active substance is clarithromycin. According to the testimony, he intersects with Zinnat. Children under 12 years of age are prescribed the drug at the rate of 7.5 mg per kilogram of body weight per day. In severe cases, the dose is doubled. Reception is made 2 times a day.
3. Augmentin - contains 2 active substances: amoxicillin and clavulanic acid (see also:). It is prescribed for babies from 4 months of age. It is not resistant to beta-lactamases, therefore it is used to combat microorganisms that do not produce these enzymes.

Any drug has contraindications and side effects. If it is necessary to replace Zinnat with another antibiotic, the choice should be entrusted to a specialist.

Registration number: P N008779-101209

Trade name of the drug: Zinnat

International nonproprietary name (INN): cefuroxime.

chemical name: (1RS)-1-[(acetyl)oxy]ethyl-(6R,7R)-3-[(carbamoyloxy)-methyl]-7-[[(Z)-2-(furan-2-yl)-2 -(methoxyimino)acetyl]amino]-8-oxo-5-thia-1-azabicyclo-oct-2-en-2-carboxylate

Dosage form: granules for oral suspension 125mg/5ml.

Compound:
Active substance: cefuroxime axetil 150mg (equivalent to 125mg cefuroxime)
Excipients(in 5 ml): stearic acid, sucrose (3.062 g), flavor Tutti Frutti 51.880/AP 05:50, acesulfame potassium, aspartame, povidone KZO, xanthan gum.

Description: granules in the form of grains of irregular shape, of various sizes, but not more than 3 mm, white or almost white.
When diluted, a suspension is formed from white to light yellow in color with a characteristic fruity odor.

Pharmacological group: antibiotic cephalosporin
ATX code J01DC02

Pharmacodynamics
Cefuroxime acetyl is the precursor of cefuroxime, which belongs to the second generation cephalosporin antibiotics. Cefuroxime is active against a wide range of pathogens, including ß-lactamase producing strains.
Cefuroxime is resistant to the action of bacterial ß-lactamases, therefore it is effective against ampicillin-resistant or amoxicillin-resistant strains.
The bactericidal action of cefuroxime is associated with the suppression of the synthesis of the bacterial cell wall as a result of binding to the main target proteins.
Cefuroxime is usually active in vitro against the following microorganisms:
Aerobes Gram-negative:
haemophilus influenzae(including ampicillin-resistant strains); Haemophilus parainfluenzae, Moraxella (Branhamella) catarrhalis, Neisseria gonorrhoeae(including strains producing and not producing penicillinase); Escherichia coli, Klebsiella spp., Proteus mirabilis, Providencia spp., Proteus rettgeri.
Aerobes Gram-positive:
Staphylococcus aureus Staphylococcus epidermidis(including strains producing penicillinase, but excluding strains resistant to methicillin); Streptococcus pyogenes(and other beta-hemolytic streptococci); Streptococcus pneumoniae, Group B streptococci ( Streptococcus agalactiae).
Anaerobes:
Gram-positive and Gram-negative cocci (including species of the genera Peptococcus and Ptptostreptococcus); Gram-positive rods (including species of the genus Clostridium)-, Gram-negative rods (including Bacteroides and Fusobacterium species), Propionibacterium spp.
Other microorganisms:
Borrelia burgdorferi
The following microorganisms are insensitive to cefuroxime:
Clostridium difficile, Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Listeria monocytogenes, methicillin-resistant strains Staphylococcus aureus and Staphylococcus epidermidis, Legionella spp.
Some strains of the following genera are insensitive to cefuroxime:
Enterococcus (Streptococcus) faecalis, Morganella morganii, Proteus vulgaris, Enterobacter spp., Citrobacter spp., Serratia spp., Bacteroides fragilis.

Pharmacokinetics
After oral administration, cefuroxime axetil is absorbed from the gastrointestinal tract and is rapidly hydrolyzed in the small intestinal mucosa and in the blood, releasing cefuroxime into the systemic circulation. Cefuroxime crosses the BBB, crosses the placenta and passes into breast milk. Optimal absorption provided that the drug is taken during or immediately after a meal. The maximum serum concentrations after ingestion with food are determined after 2.4 hours. Food accelerates the absorption of cefuroxime axetil suspension.
When the suspension is taken orally, the rate of absorption of cefuroxime axetil is lower than when taking tablets, as a result of which the maximum concentrations decrease, the time to reach them increases and systemic bioavailability decreases (by 4-17%).
The half-life is from 1 to 1.5 hours. Depending on the methods of determination used, the degree of protein binding of cefuroxime ranges from 33 to 50%.
Cefuroxime is not metabolized and is excreted by glomerular filtration and tubular secretion. Serum levels of cefuroxime decrease with dialysis.

INDICATIONS FOR USE
The drug is indicated for the treatment of diseases caused by bacteria sensitive to cefuroxime.

• Infections of the upper respiratory tract, ear, throat, and nose, such as otitis media, sinusitis, tonsillitis, and pharyngitis.
• Lower respiratory tract infections such as pneumonia, acute bronchitis and exacerbation of chronic bronchitis.
• Infections of the genitourinary system, such as pyelonephritis, cystitis and urethritis. Gonorrhea, acute uncomplicated gonococcal urethritis and cervicitis.
• Infections of the skin and soft tissues, such as furunculosis, pyoderma and impetigo.
• Treatment of early stages of Lyme disease and subsequent prevention of late manifestations of Lyme disease in adults and children over 12 years of age.

CONTRAINDICATIONS
Hypersensitivity to cephalosporin antibiotics, penicillins and carbapenems.
Caution should be used in renal failure, diseases of the gastrointestinal tract (including history and ulcerative colitis), pregnancy, lactation and in children under 3 months.

METHOD OF APPLICATION AND DOSES
The standard course of therapy is about 7 days (5 to 10 days).
For optimal absorption, Zinnat suspension should be taken with meals.
Adults :

For most infections	- 250 mg twice a day
For urinary tract infections	- 125 mg twice a day
With pyelonephritis	- 250 mg twice a day
For mild to moderate lower respiratory tract infections, such as bronchitis	- 250 mg twice a day
For more severe lower respiratory tract infections or suspected pneumonia	- 500 mg twice a day
For uncomplicated gonorrhea	- once 1 g
For Lyme disease in adults and children over 12 years of age	- 500 mg twice a day for 20 days.

Children :
There are no clinical trial data on the use of Zinnat in children under 3 months of age.
If a fixed dose is preferred, 125 mg twice daily is recommended for most infections. Children 2 years of age and older with otitis media or more severe infections are given 250 mg twice daily; the maximum daily dose is 500 mg.
In the treatment of infants and children, it may be necessary to calculate the dose depending on body weight and age. For most infections, the dose for infants and children aged 3 months to 12 years is 10 mg/kg twice daily, not to exceed 250 mg per day. For otitis media and more severe infections, the recommended dose is 15 mg/kg twice a day, but not more than 500 mg per day.
The following tables show the doses according to the age and weight of the child for dosing Zinnat 125 mg/5 ml suspension with the 5 ml measuring spoons supplied in the package.
Dose based on 10 mg / kg body weight, prescribed for most infections:

Age	Body weight (kg)(approximately)
3 months-6 months	4-6	40-60	1/2
6 months-2 years	6-12	60-120	1/2-1
2 years-12 years	12->20	125	1

Dose at the rate of 15 mg / kg of body weight, prescribed for otitis media and severe infections:

Age	Body weight (kg)(approximately)	Single dose (mg) when taken 2 times a day	Number of measuring spoons (5 ml) per dose
3 months-6 months	4-6	60-90	1/2
6 months-2 years	6-12	90-180	1 - 1 1/2
2 years-12 years	12->20	180-250	1 1/2 - 2

Cefuroxime is also available as a sodium salt (Zinacef) for parenteral administration. This allows switching from parenteral administration of cefuroxime to oral administration in the presence of clinical indications.
Suspension preparation:
Shake the vial vigorously several times (within 1 min). Pour 20 ml of water into a measuring cup (up to the mark). Pour the measured amount of water into the bottle and close the bottle cap. Invert the vial and shake vigorously for 1.5 minutes to completely mix the drug. Turn the vial upside down and shake vigorously.

SIDE EFFECT
By frequency, side effects are divided into the following categories: very common > 1/10; frequent > 1/100 and<1/10; нечастые >1/1000 and<1/100; редкие >1/10 000 and<1/1000; очень редкие <1/10 000.
Side effects of cefuroxime axetil treatment are usually mild and resolve over time.
infections: often - excessive growth of fungi of the genus Candida.
From the blood and lymphatic system: often - eosinophilia; infrequently, a positive Coombs reaction, thrombocytopenia, leukopenia (sometimes pronounced); very rarely, hemolytic anemia.
From the side of the immune system: hypersensitivity reactions including: infrequently - skin rash, rarely - urticaria, itching. Very rarely drug fever, serum sickness and anaphylaxis.
From the CNS: often - headache, dizziness.
From the gastrointestinal tract: often - diarrhea, nausea, stomach ache. Infrequently - vomiting. Rarely, pseudomembranous colitis.
From the side of the liver and bile ducts : often - a temporary increase in the level of liver enzymes AJIT, ACT, LDH. Very rare - jaundice (mainly cholestatic), hepatitis.
From the skin and subcutaneous fat : very rarely - erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.

OVERDOSE
An overdose of cephalosporins can cause an increase in the excitability of the central nervous system with the development of seizures. Serum levels of cefuroxime can be lowered by hemodialysis and peritoneal dialysis.

SPECIAL INSTRUCTIONS
Caution should be exercised when prescribing the drug to patients with allergic a history of reactions to beta-lactam antibiotics. As with other antibiotics, cefuroxime axetil may cause overgrowth fungi of the genus Candida. Long-term use may cause growth of other resistant microorganisms ( Enterococci and Clostridium difficile), which may require discontinuation of treatment. Pseudomembranous colitis has been observed with broad-spectrum antibiotics, so perform differential diagnosis of pseudomembranous colitis in patients with severe diarrhea during or after antibiotic treatment.
Consideration should be given to the content of sucrose in the suspension Zinnat in the treatment of patients with diabetes mellitus. In the treatment of Lyme disease with Zinnat, the Jarisch-Gersheimer reaction is sometimes noted, which is due to the bactericidal activity of the drug against the causative agent of the spirochete disease. Borrelia burgdorferi. Patients should be informed that these symptoms are a typical consequence of the use of antibiotics in this disease, which resolves spontaneously.
Since Zinnat suspension contains aspartame, which is a source of phenylalanine, it should be administered with caution to patients with phenylketonuria.

INTERACTION WITH OTHER DRUGS AND OTHER FORMS OF INTERACTION
Drugs that reduce the acidity of gastric juice may cause a decrease in the bioavailability of the suspension Zinnat.
Like many antibacterial drugs, Zinnat can affect the intestinal microflora, which leads to reduced estrogen reabsorption and, accordingly, to a decrease in the effectiveness of combined oral contraceptives.
Simultaneous reception with "loop" diuretics slows down tubular secretion, reduces renal clearance, increases plasma concentration and increases the half-life of cefuroxime. Simultaneous administration of cefuroxime and probenecid results in a 50% increase in the area under the pharmacokinetic curve.
When taken simultaneously with aminoglycosides and diuretics, the risk of nephrotoxic effects increases.
In patients receiving cefuroxime axetil, the potassium ferricyanide test may give a false negative result. For such patients, it is recommended to use methods using glucose oxidase or hexokinase to determine blood glucose.
Cefuroxime does not affect the results of determining the level of creatinine by the alkaline-picrate method.

USE IN PREGNANCY AND LACTATION
There is no experimental evidence of the embryopathic and teratogenic effects of cefuroxime axetil, but, as with other drugs, it should be carefully administered in the first months of pregnancy.
Cefuroxime is excreted in breast milk, so care must be taken when prescribing it to nursing women.

EFFECT ON ABILITY TO DRIVE AND/OR OTHER MECHANISMS
No messages.

RELEASE FORM
Granules for suspension for oral administration 125 mg / 5 ml in dark glass bottles, sealed with a membrane and closed with a plastic screw cap with a device against opening the bottle by children. 1 bottle together with a measuring cup, a measuring spoon and instructions for use in a cardboard box.

BEST BEFORE DATE
2 years.
Do not take the drug after the expiry date which is stated on the package.

STORAGE CONDITIONS
At a temperature not higher than 30°C. Keep out of the reach of children.
The prepared suspension is stored in a refrigerator at a temperature of 2 to 8°C for no more than 10 days.

TERMS AND CONDITIONS OF DISCOUNT FROM PHARMACIES
On prescription.

MANUFACTURER
Glaxo Operations UK Limited (UK)
Legal address:
Glaxo Operations UK Limited, Harmire Road, Barnard Castle, Durham, DL12 8DT, United Kingdom /
Glaxo Operations UK Limited, UK, DL12 8DT, Durham, Barnard Castle, Harmire Road.

Address in Moscow:
Russia 121614, Moscow, st. Krylatskaya, 17, building 3, floor 5 Business Park "Krylatsky Hills"

Available in the form of granules for suspension. The drug belongs to the group of II generation Cephalosporins and, as a rule, is well tolerated, side effects from the gastrointestinal tract are rare. The effectiveness of the active component against many pathogenic microorganisms is monitored, therefore the drug is often prescribed for colds provoked by the activity of pathogenic microbes.

The drug is prescribed to children over the age of 3 years. Studies regarding the use of the composition in the neonatal period have not been conducted. It is important to remember that the finished suspension can be used within 10 days after preparation, after this time it should be disposed of with household waste. It is important to remember that, despite the safety of cephalosporins, a clear dosage regimen should be followed. You can use the remedy only as prescribed by the doctor, strictly observing the recommended doses.

Dosage form

The substance for the preparation of the suspension is a granular mixture that must be mixed with water before use. In finished form, the mixture is stored for no more than 10 days, the dry composition retains its properties for 2 years. This explains the need to combine the drug with the liquid immediately before taking. The granules for the preparation of the medicinal composition are white and irregular in shape.

Attention! The drug is available in the form of tablets. In a similar dosage form, the drug is prescribed for children over the age of 3 years.

The combination of substances that are a drug - do not harm the baby's immune system.

The composition of the drug includes:

• axetil cefuroxime;
• sucrose;
• stearic acid;
• aspartame;
• xanthan gum;
• acesulfame potassium;
• flavors.

Suspension is the preferred form for children, as the solution tastes good due to safe flavors.

The optimal dose of the medicinal composition is determined by the attending physician, taking into account the age and health of the baby. Before using an antibacterial agent, you should pass a test for the susceptibility of pathogenic microorganisms to the active ingredient, this will reduce the duration of the course of therapy. Based on the results of the study, the specialist will be able to choose the optimal dose of the component.

Indications for use

According to the information described in the instructions for use of the medicinal product, the drug can be used in the following cases:

• infection of the upper or lower respiratory tract;
• chronic;
• infectious lesions of the lungs and bronchus;
• lung abscess;
• bacterial nature;
• infection of the chest after surgery;
• sinusitis;
• tonsillitis;
• average ;
• infectious diseases of the pelvic organs;
• infectious lesions of the urogenital area;
• pathology of bones and joints;
• soft tissue diseases.

The effectiveness of the drug in the treatment of all infectious pathologies, the provocateurs of which are bacteria sensitive to the active substance of the antibiotic, has been proven.

Dosing regimen of the drug

Regardless of the original form of release, white granules intended for oral administration are used for the preparation of formulations. The medicinal composition, like all drugs of the antibiotic group, is recommended to be taken immediately after eating.

Attention! It is important to consider that 10 ml of suspension is equivalent to 250 mg of the active ingredient. The drug in such doses is used to treat diseases in children over the age of 12 years.

The duration of the course of therapy is determined by the doctor individually for each patient. As a rule, there is a need to use the composition for 5-10 days, in severe cases it is recommended to take the drug for 20 days.

The dosage regimen of the medicinal composition is as follows:

• children over the age of 12 years in the presence of infectious lesions of the upper respiratory tract, the drug is prescribed at a dosage of 25 mg 2 times a day;
• with or other aggravated lesions, the drug is used in increased doses, children over the age of 12 are prescribed a remedy of 500 mg 2 times a day;
• with lesions of the genitourinary system, it is recommended to take 125 mg 3 times a day;
• with infectious lesions of the genital tract (gonorrhea), it is recommended to take 1 g of the drug per day, a similar dose is equivalent to 20 ml of suspension.

For children under the age of 12 years, the drug is prescribed at a dosage of 125 mg per day. For young children, the dose is calculated individually depending on the weight of the baby: 10 mg of the active component of the composition should be per 1 kg of body weight.

In case of severe infectious lesions, the drug can be used at the rate of 15 mg per 1 kg of the child's body weight.

Attention! If it is not possible to take a suspension and tablets for a child, the drug is prescribed in the form of injections. This is a necessity when the absorption of the components of the drug through the gastrointestinal tract is not possible.

The transition to taking medication in the form of a suspension is possible after a significant and sustainable improvement in the well-being of the baby.

How to take the composition in the form of a suspension

The drug is equipped with a special measuring spoon, which is engraved with 2.5 and 5 ml. Giving a remedy, therefore, is not always convenient for children, therefore it is better to replace the measuring device with a syringe without a needle.

The drug is recommended to be taken after or during meals. It is important to note that the medicinal composition has a pronounced sweet taste with a predominant taste of drugs. Not all children take the composition with pleasure and parents should be prepared for this. If the child flatly refuses to take the drug in this form, you should consult a doctor with a request to replace the suspension with tablets.

Attention! The normalized volume of the suspension is allowed to be added to the child in juice or tea, but even in this form, children are reluctant to take the medicine.

Suspension preparation rules

To prepare the solution, the granules are poured with purified or boiled water. Pharmacological factories specially complete the preparation with a measuring flask designed for 37 ml of liquid. It is this volume of water that is required to dilute the composition.

It should be noted that the bottle cap is equipped with special protection. To open the vial, it should be clamped and turned clockwise. After that, remove the protective film from the neck of the vial and add water. In order to obtain a homogeneous mixture, the bottle should be thoroughly shaken for 2-3 minutes. After complete dissolution of the granules, the product is ready for use. The composition should be stored in the refrigerator for 10 days, the bottle should be shaken before use.

in order to remember the date of preparation of the solution, it should be written with a pen on the bottle. The drug is forbidden to use after 10 days, this can cause a deterioration in the patient's condition, especially the child. If the doctor has prescribed the patient an appointment within 20 days, you should purchase 2 bottles at once.

Side effects of Zinnat

Instructions for use of the drug indicates the possible manifestations of side effects from various body systems.

Gastrointestinal disorders are often observed:

• nausea;
• stool disorders;
• flatulence;
• spasms;
• pain in the epigastrium;
• and other ulcers in the oral cavity (in children).

From the genitourinary system:

• vaginosis;
• itching of the genitals;

Allergic reactions:

• skin rash accompanied by itching;
• fever;
• angioedema;
• exudative erythema;
• bronchospasm;
• anaphylactic shock.

Organs of the hematopoietic system:

• hemolytic anemia;
• leukopenia;
• hypoprothrombinemia;
• eosinophilia.

From the side of the central nervous system:

• headache;
• hearing impairment;
• confusion;
• drowsiness;
• convulsions.

When using the drug in injectable forms, local reactions are observed at the injection site.

It is worth remembering that taking the drug can provoke the manifestation of vaginal candidiasis in women. This is due to the increased growth of fungal microflora on the first day of taking the composition.

Contraindications for use

The tool is prohibited to receive in the following cases:

• if the patient is hypersensitive to penicillins;
• allergic reaction to cephalosporins;
• bleeding and pathology of the gastrointestinal tract;
• period of pregnancy and lactation.

Interaction with other components

Zinnat is a suspension for children and a bactericidal agent that reduces the acidity of gastric juice and reduces the bioavailability of cefuroxime. The drug is not recommended to be taken before meals in order to avoid excessive aggressiveness of the composition. Taking before meals may cause unwanted side effects.

Many antibiotics have a negative effect on the intestinal microflora, and is no exception. The drug tends to reduce the effectiveness of combined oral contraceptives, so women who are protected from unwanted pregnancies should therefore consider other methods of protection.

Additional Information

The shelf life of granules for the preparation of a solution in individual packaging is 3 years. The finished suspension should be stored in the refrigerator for no more than 10 days. After this period, the remains of the composition should be disposed of together with household waste. The drug is dispensed from a network of pharmacies in the Russian Federation without a prescription, but it should be remembered that self-administration of the drug is unacceptable. It is important to evaluate the present risk of expressing undesirable effects.

Drug analogues

Analogues include the following drugs:

1. Aksetin is a complete substitute for the drug. It is available in tablets and powder, from which an injection solution is prepared. With caution, the antibiotic should be used to treat premature babies, newborns, pregnant and lactating women.
2. Cefamabol is a substitute for the clinical and pharmacological group. Its active ingredient is cefamandol, which has a bactericidal effect. The drug is produced in powder for the manufacture of a solution for injection into the muscle and into the vein. The antibiotic is contraindicated in infants under 6 months of age and during breastfeeding. During the period of gestation, it is discharged with caution.
3. refers to substitutes in the therapeutic group. On sale, the drug is in granules, from which a suspension is made that is allowed for children from birth and tablets, they cannot be used by patients under 3 years of age. The antibiotic is incompatible with breastfeeding, but it can be taken during pregnancy.

The onset of an inflammatory process of a bacterial nature in a child's body is a reason for taking antibiotics. Many parents are wary of such appointments, fearing the possible negative consequences of antibiotic therapy. Common side effects include diarrhea, intestinal dysbiosis, and other gastrointestinal problems.

However, the benefits of antibacterial drugs outweigh the likely harm to the body, and in some cases it is impossible to cure the disease without the use of antibiotics. One of the most common antibiotics for the treatment of children is Zinnat - a modern second-generation drug that is characterized by a wide spectrum of action, high efficiency against the background of low toxicity and is available in the form of a suspension.

Description of the drug Zinnat and the principle of its action

Zinnat is an antibiotic belonging to the group of conditional II generation cephalosporins. There are four generations of antibiotics in this direction, differing in the progression of the breadth of the spectrum of action. Zinnat for children is used to treat bacterial infections caused by a large group of gram-positive and gram-negative aerobic and anaerobic bacteria, including penicillin-resistant strains.

The active substance of the drug - cefuroxime axetil - is resistant to beta-lactamases secreted by bacteria. It destroys the structure of the cell wall of the microbe and promotes the release of autolytic enzymes, inhibits the reproduction of bacteria and provokes their death.

Cefuroxime is used against microorganisms and bacteria:

	Gram positive	Gram negative	Ineffective
Aerobes	Staphylococci, including penicillinase-producing strains; Staphylococcus aureus; Staphylococcus epidermis; Streptococcus pyogenes and other alpha-hemolytic streptococci; Streptococcus pneumoniae; Streptococcus agalactiae; Propionibacterium spp.; pneumococci.	haemophilus influenzae; Haemophilus parainfluenzae; Moraxella catarrhalis; Escherichia coli; Klebsiella spp (recommended reading: ).; Proteus mirabilis; Proteus inconstances; Providence spp.; Proteus rettgeri; Neisseria gonorrhoeae.	Streptococcus faecalis; Staphylococcus epidermidis; Acinetobacter calcoaceticus; Enterobacter spp.; Legionella spp.;
Anaerobes	Gram-positive anaerobes, including Peptococcus and Peptostreptococcus species; Gram-positive bacilli, including Clostridium species.	gram-negative bacilli, including Bacteroides and Fusobacterium species; haemophilus influenzae; Escherichia coli; Fusobacteriales; Neisseria gonorrhoeae; Spirochaetales; Borrelia burgdorferi.	Bacteroides fragilis; Streptococcus faecalis; Clostridium difficile; Serratia spp.; Citrobacter spp.; Proteus vulgaris; Pseudomonas.

The maximum concentration of cefuroxime in plasma is observed 2-3 hours after administration, binding to plasma proteins reaches 35-50%. Simultaneous food intake increases the adsorption of the drug in the small intestine. The half-life from the body is one and a half hours. Excreted by the kidneys unchanged.

The composition of the antibiotic, in addition to cefuroxime, includes additional substances:

• sucrose;
• sweetener acesulfame potassium;
• aspartame;
• stabilizer stearic acid;
• xanthan gum;
• enterosorbent povidone k30;
• fruit flavoring "tutti-frutti".

Release form of the antibiotic

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The drug is available in the form of tablets of 125 mg and 500 mg, as well as granules for suspension. Tablets are white, film-coated, oval-shaped, packed in blisters and in cardboard packs of 10 pcs.

Dry granules are grains of various sizes and irregular shapes of white or almost white color. Sold in dark glass bottles of 50 or 100 ml. 5 ml of the prepared solution contains 125 or 250 mg of the active substance. A dosing spoon and a measuring cup are attached to the medicine.

Indications for the use of the drug

Zinnat can be prescribed for the treatment of infectious and inflammatory diseases, the pathogens of which are sensitive to the active substance of the drug - cefuroxime. The drug is prescribed by a doctor after a mandatory examination of the child and familiarization with the medical history. Self-administration of medication and uncontrolled use are not allowed.

Dosage and administration

Zinnat is prescribed from the age of more than three months, since there are no clinical data confirming the safety of the drug for younger children. Instructions for use of the antibacterial agent Zinnat differ depending on the form of release of the drug.

The required amount of active substance is calculated based on the age of the patient. Since the simultaneous intake of food increases the absorption of the drug, it is necessary to take an antibiotic with meals. The standard course of antibiotic therapy is from 5 to 10 days as prescribed by a doctor, the treatment of Lyme disease is 20 days.

Tablets

The drug in the form of tablets is not recommended for children under 3 years of age and for patients who have difficulty swallowing. For most uncomplicated infections, including mild to moderate lower respiratory tract infections and pyelonephritis, adults and adolescents over 12 years of age are treated with cefuroxime 250 mg twice daily. For more severe infections, pulmonary pneumonia and borreliosis, tablets are prescribed at a dosage of 500 mg 2 times a day. In infectious diseases of the urinary tract, a single dose is 125 mg.

Cefuroxime can be used for stepwise therapy of pneumonia and bronchial asthma. Treatment of pneumonia begins with parenteral administration of Zinacef (sodium salt) in an amount of 1.5 g 2 or 3 times a day for up to 5 days, then therapy is continued with Zinnat 500 mg twice a day for 7-10 days. Chronic bronchitis is treated according to the same scheme, except that the dose of Zinacef is 750 grams, and the duration of taking the tablets is reduced to 5-10 days.

Young patients who can swallow a tablet without chewing it are prescribed 1 pc. for the treatment of most infectious diseases. 125 mg twice a day, and for the treatment of inflammation of the middle ear and severe infectious pathologies - 1 pc. 250 mg or 2 pcs. 125 mg per dose. If it is impossible to use the drug in the form of tablets, it is better to use granules for the manufacture of a suspension.

Suspension

To prepare the suspension, the contents of the vial with granules must be filled with boiled or distilled water, measuring 20 ml of liquid with a glass. The closed bottle must be shaken well to mix the substance until a homogeneous mixture is obtained. Children willingly drink the finished suspension in its pure form, but single doses can be diluted with juice, milk or water.

For babies under two years old, a single dose of an antibiotic should not exceed 10 mg per 1 kg of body weight. It is allowed to give the medicine twice a day. Older children are prescribed 5 ml of suspension (125 mg) twice a day. In severe forms of illness, a pediatrician can prescribe a double dose for babies over 2 years old, but not more than 250 mg, with a maximum daily amount not exceeding 500 mg.

The amount of the drug can be calculated not only according to the age of the patient, but also depending on the weight of the child. Infectious diseases without complications are treated with a single dose of a suspension of 10 mg per 1 kg of baby weight (half a measuring spoon or 2.5 ml of syrup). The medicine should be given twice a day:

• for a baby 3-6 months old, the amount of the drug in a single dose will be approximately 2.5 ml or ½ measuring spoon,
• a child under two years old will receive from 2.5 ml to 5 ml,
• children under 12 years old - 5 ml of Zinnat sweet suspension.

Severe infections, otitis media, complicated inflammatory processes of any localization are treated according to the same scheme, but with an increase in the amount of antibiotic.

From the age of two, children can receive 15 mg/kg twice a day. A child under 6 months old can be given 0.5 scoops of the suspension, children older than six months, but younger than two years old - one and a half spoons at a time, and older than two can be prescribed one and a half to two scoops at a time, but not more than 500 mg cefuroxime per day.

Contraindications

Antibacterial suspension is forbidden to be taken in the following cases:

• individual hypersensitivity to the active substance cephalosporin, as well as to the group of beta-lactam antibiotics carbapenems and penicillins;
• with phenylketonuria;
• in the presence of diabetes;
• under three months of age.

Side effects, overdose

Side effects of Zinnat are rare and are not pronounced. Most often, negative consequences occur in cases of uncontrolled use of the drug in violation of the prescribed dosage and non-compliance with the terms of treatment. An independent start of admission without a preliminary examination of the child by a pediatrician can lead to a deterioration in the patient's health. Long-term use of the drug may contribute to an increase in the population of certain bacteria, in which case cefuroxime therapy should be discontinued.

Negative effects include:

• disorders of the gastrointestinal tract, nausea, diarrhea, less often - vomiting, in isolated cases - pseudomembranous colitis;
• candidiasis;
• dizziness, headache;
• serological changes: increased eosinophils and liver enzymes ALT, AST and LDH, leukopenia, thrombopenia, increased prothrombin time;
• allergic reactions: urticaria, pruritus, extremely rarely - anaphylactic shock, with parenteral administration, serum sickness may occur;
• rarely - jaundice;
• there are isolated reports of Stevens-Johnson syndrome, erythema multiforme, Lyell's syndrome.

To reduce the negative impact on the gastrointestinal tract, it is recommended to accompany the use of antibiotics with the intake of probiotics, such as Linex, Enterogermina, Lactobacterin, etc. Probiotics can be taken from any day of treatment with Zinnat, as well as after the completion of antibiotic therapy. The duration of the course is determined by the doctor.

Interaction with other drugs

In adult women and girls, the ability of the drug to influence the intestinal microflora can reduce the reabsorption of estrogens, which leads to a decrease in the effectiveness of oral hormonal contraceptives. Simultaneous administration of cefuroxime with probenecid prolongs the time of its maximum concentration in blood plasma. Drugs that reduce the acidity of the stomach, increase the time of intestinal absorption of the antibiotic. Joint use with loop diuretics reduces renal clearance and increases the content of cefuroxime in the blood.

Analogues and prices

Zenit has the greatest similarity with drugs of the cephalosporin group, the active substance of which is also cefuroxime axetil. These include drugs such as Cefuroxime, Aksetin, Zinacef and some others. Since these drugs have one active substance, the principle of action, indications for use and contraindications do not differ much, but the form of release and dosage of antibiotics may differ. Without a doctor's prescription, it is dangerous to replace one remedy with another. The cost of the drug Zinnat in Moscow is from 233 rubles in tablets and from 285 rubles. in granules.

Structural analogues of Zinnat:

Cephalosporins are not the only group of antibiotics that have successfully proven themselves in the fight against most known pathogenic microorganisms. There are other means of similar action, some of which, for bacterial infections, can be prescribed in childhood, for example, Suprax, Augmentin. It is important to know that the choice of medication, dosage and duration of treatment belongs to the pediatrician. The presence of a successful history of antibiotic therapy does not give rise to self-administration of a serious drug to a child.

Antibiotics that can be used in childhood, and prices:

1. Suprax. It is a granule for the preparation of a suspension, Suprax Solutab is available in the form of dispersible tablets, from 833 rubles.
2. Flemoxin Solutab. Sold in the form of lozenges, from 227 rubles.
3. Amoxicillin. Tablets, capsules, granules for suspension, from 35 rubles.
4. Augmentin. Available in the form of tablets, powders for injection and syrup, from 132 rubles.
5. Sumamed. Capsules, powder for suspension, from 209 rubles.