Second-Generation Cephalosporin (true 2nd generation cephalosporin)
Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp. Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, 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 500mg: Cmax: 7 mcg/L; Tmax: 3 hours; Half-life: 1.2 hours; Table 10
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
PO: 125mg, 250mg, 500mg tablet
Powder for Suspension: 125mg/5mL, 250mg/5mL
IV: Injection Powder for Solution: 1.5g, 7.5g, 75g, 225g, 750g
Intravenous Solution: 1.5g/50mL, 750mg/50mL
Acute exacerbation of chronic bronchitis: 250mg to 500mg PO q12h x 10 days
Uncomplicated UTI: 125mg - 250mg PO q12h x 7-10 days
Gonorrhea: 1g PO x 1 dose
Lower respiratory tract infection: 750mg - 1.5g IV/IM q8h
Bone/joint infection: 1.5 g IV/IM q8h
PO: 30mg/kg/day divided q12h
IV/IM: 50-100mg/kg/day divided q6 to q8h
Renal failure (IV dosing): CrCl > 20mL/min: Standard dosing
CrCl 10-20mL/min: 0.75g q12h
CrCl < 10mL/min: 0.75g q12h
Hepatic failure: No dosing changes recommended at this time.
Contraindications: Hypersensitivity to cephalosporins
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment
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.
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