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 1g: Cmax: 123-151mcg/L; Half-life: 8 hours; Volume of distribution: 10.7L; Table 11
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
IV: 1g, 2g, 250mg, 500mg
Meningitis: 2g IV q24h
Intraabdominal infections: 1-2g IV q12-24h
Pelvic inflammatory disease: 1-2g IV q12-24h
Bone and/or joint infection: 1-2g IV q12-24h
Gonorrhea: 250mg IM x 1 dose
50-100mg/kg divided q12-24h
Renal failure: No dosing changes recommended at this time.
Hepatic failure: No dosing changes recommended at this time.
CVVH (Continuous venovenous hemofiltration): 2g IV q12-24h
CVVHD (Continuous venovenous hemodialysis): 2g IV q12-24h
CVVHDF (Continuous venovenous hemodiafiltration) 2g IV q12-24h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Contraindications: Hyperbilirubinemic neonates; increased risk for bilirubin encephalopathy (kernicterus)
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis,
Cyclosporine: an increased risk of cyclosporine toxicity (renal dysfunction, cholestasis, paresthesias)
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
FDA: Ceftriaxone Must Not Be Co-administered with Calcium
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.