Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli
Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.
Cephalosporins exhibit time-dependent killing (T > MIC)
Dose of 400mg: Cmax: 3.6 mcg/L; Half-life: 3.1 hours; Tmax: 3.7hours; Table 11
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
PO: 400mg tablets
Adult dosing: 400 mg PO once a day or divided twice a day
Gonorrhea: 400 mg PO as one-time dose
Renal failure: CrCl > 60 mL/min: standard dosing
CrCl 21-60 mL/min: 75% of usual dose q24h
CrCl < 20 mL/min: Half of usual dose q24h
Hepatic failure: No dosing changes recommended at this time.
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis,
Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count
Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.