RISTOMYCINUM (synonym: Ristocetin, Spontin) — the antibiotic formed by Streptomyces gardneri (a synonym of Nocarclia fructiferi var. ristomycini).
P. it is allocated in 1963, treats group of high-molecular antibiotics of complex structure. Pier. weight (weight) of 2352.
The expressed antimicrobic action of R. is shown concerning gram-positive cocci (stafilokokk, streptococci, enterococci, pneumococci). The majority of strains of the stafilokokk steady against a benziliyenitsillin, tetracyclines, streptomycin, Kanamycinum, macroleads, levomycetinum keep sensitivity to a ristomitsnn. The river does not affect gram-negative bacteria and pathogenic fungi. The mechanism of antibacterial action of R. is connected with suppression of the last stages of biosynthesis of a cell wall of the activator.
At intake of R. it is not soaked up. After single intravenous administration of R. in doses 10 000, 15 000, 20 000 PIECES/kg drug in therapeutic concentration is found in blood during 6 hours and longer. The river quickly gets into fabrics and it is found in the high concentration (exceeding his levels in blood) in kidneys, lungs, a spleen, in smaller quantities — in a liver, a myocardium, tissue of a brain. In exudate of pleural and peritoneal cavities of R. contains in the concentration making 25 — 50% of the level of an antibiotic in blood. The river does not get normal through a blood-brain barrier, at an inflammation of a meninx it is found in cerebrospinal liquid in therapeutic concentration. R. preferential is removed by kidneys (to 80% of the entered dose during 36 — 60 hours), the main part of drug is allocated during the first 3 hours after introduction. With bile P. it is allocated in insignificant quantities (0,1 — 0,2% of the entered dose).
Rubles apply at treatment heavy inf. the diseases caused by the stafilokokka and enterococci steady against other antibiotics: sepsis, endocarditis, pneumonia and abscesses of lungs, osteomyelitis, arthritis, staphylococcal meningitis, coloenteritis, etc. Enter R. only intravenously. At hit under skin or in a muscle solution of an antibiotic renders irritant action.
Due to the narrow action spectrum and weight of the side reactions observed in the course of R.'s treatment, and also a possibility only of intravenous administration of R. apply restrictedly (at allocation of multiple resistant strains of bacteria and lack of effect at treatment by other less toxic drugs).
The daily dose of an antibiotic for adults makes 1 000 000 — 1 500 000 PIECES, for children — 20 000 — 30 000 PIECES! kg. The daily dose is entered in two steps at an interval of the 12th hour. The first dose of R. at adults limit 250 000 E D, at children of 10 000 PIECES/kg. At disturbance of secretory function of kidneys the single dose of R. is reduced to 250 000 PIECES, the interval between introductions is increased to 48 hours and more (depending on a condition of secretory function of kidneys).
Solution of Ristomycinum is prepared before introduction, dissolving, e.g., 250 000 PIECES of an antibiotic in 125 ml of isotonic solution of sodium chloride or 5% of solution of glucose. For prevention of local irritant action at the end of introduction, without taking out a needle from a vein, enter in addition 10 — 20 ml of isotonic solution of sodium chloride. Duration of treatment is from 5 — 7 days up to 20 — 30 days and more depending on a condition of the patient and portability of drug.
At long intravenous administration of R. phlebitis and a periphlebitis are possible, at hit of an antibiotic under skin painful infiltrates can develop. The river sometimes causes leukopenias, neutropenias (up to an agranulocytosis), toxic thrombocytopenia. At the usual scheme of use of Ristomycinum for 5 — 12% of patients anemia develops. Are described from - and nephrotoxic reactions at R. Vozmozhno's treatment development of allergic reactions (rash, fever, etc.), in the first days of treatment the fever, temperature increase, nausea can be observed.
Rubles produce sulfate in the form of sterile powder in bottles on 100 000, 250 000 and 500 000 Units
See also Antibiotics .
Bibliography: Navashin S. M. and Fomina I. P. Rational antibiotn-koterapiya, page 153, M., 1982.
I. P. Fomina.