Third-Generation Cephalosporin
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: 17 mcg/L; Tmax: 2.0 hour; Half-life: 2.3 hours; Table 10
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
PO: 400mg tablets
Powder for Suspension: 90mg/5mL, 180mg/5mL
Tonsillitis: 400 mg PO q24h x 10 days
Otitis media: 400 mg PO q24h x 10 days
Pharyngitis: 400 mg PO q24h x 10 days
Acute exacerbation of chronic bronchitis: 400mg PO q24h x 10 days
9mg/kg/day q24h
Renal failure: CrCl > 50 mL/min: Standard dosing
CrCl 30-49 mL/min: 200mg q24h OR 4.5mg/kg q24h
CrCl 5-29 mL/min: 100mg q24h OR 2.25mg/kg q24h
Hepatic failure: No dosing changes recommended at this time.
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment
Cimetidine: an increased risk of ceftibuten adverse effects
Famotidine: an increased risk of ceftibuten adverse effects
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
Nizatidine: an increased risk of ceftibuten adverse effects
Ranitidine: an increased risk of ceftibuten adverse effects
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.
Cedax Ò/Schering