A vial of<unk> , manufactured and sold in Russia<unk>  and other third-generation antibiotics are used to treat organisms that tend to be resistant to many other antibiotics. Due to emergent resistance,<unk>  should not be used for the treatment of Enterobacter infections. Before using<unk> , it is important to determine the susceptibility of the bacteria. If sepsis is being considered, empiric therapy may be initiated prior to susceptibility testing. Medical uses include: * lower respiratory tract infections * acute bacterial otitis media * skin and skin structure infections * urinary tract infections * uncomplicated gonorrhea * pelvic inflammatory disease * bacterial sepsis * intra-abdominal infections * meningitis * surgical prophylaxis * Lyme disease<unk>  is also a choice drug for treatment of bacterial meningitis caused by pneumococci, meningococci, Haemophilus influenzae, and "susceptible enteric Gram-negative rods, but not Listeria monocytogenes." In combination with doxycycline or azithromycin,<unk>  used to be recommended by the United States Centers for Disease Control and Prevention (CDC) for the treatment of uncomplicated gonorrhea. Due to increased risk of developing azithromycin resistant strains and the high efficacy of higher doses of<unk>  the guidance has been updated to mono-antibiotic therapy with a higher dose of<unk> . Spectrum of activity Like other third-generation cephalosporins,<unk>  is active against Citrobacter spp., Serratia marcescens, and beta-lactamase-producing strains of Haemophilus and Neisseria. However, unlike ceftazidime and cefoperazone,<unk>  does not have useful activity against Pseudomonas aeruginosa. It is generally not active against Enterobacter species, and its use should be avoided in the treatment of Enterobacter infections, even if the isolate appears susceptible, because of the emergence of resistance. Some organisms, such as Citrobacter, Providencia, and Serratia, have the ability to become resistant through the development of cephalosporinases (enzymes that hydrolyze cephalosporins and render them inactive). Available forms<unk>  is available for administration via the intramuscular or the intravenous routes. Diluents containing calcium should not be used to reconstitute<unk> , and it must not be administered in intravenous lines containing other calcium-containing solutions, as a<unk> -calcium precipitate could form. Specific populations Pregnancy<unk>  is pregnancy category B. It has not been observed to cause birth defects in animal studies, but a lack of well-controlled studies done in pregnant women exists. Breastfeeding Low concentrations of<unk>  are excreted in breast milk that are "not expected to cause adverse effects in breastfed infants." The manufacturer recommends that caution be exercised when administering<unk>  to women who breastfeed. Newborns Hyperbilirubinemic neonates are contraindicated for the use of<unk> . It can compete with bilirubin and displace it from binding to albumin, increasing the risk of bilirubin encephalopathy. Elderly According to the package insert, clinical studies did not show differences in efficacy and safety of<unk>  in geriatrics compared to younger patients but "greater sensitivity of some older individuals cannot be ruled out."
Ceftriaxone
Meropenem
Levofloxacin
Cefotaxime
Azithromycin
Cefepime
Vancomycin
Ampicillin