Second-Generation Cephalosporin (3rd generation cephamycin)
Methicillin-susceptible Staphylococcus aureus (MSSA), Coagulase negative Staphylococci, penicillin-susceptible Streptococcus pneumoniae, Streptococci spp. (less activity compared to 1st generation and 2nd generation cephalosporins), Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae
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)
IM bioavailability: 92%; Total protein binding: 52%; Volume of distribution: 0.18-0.44 L/kg; Half-life: 5.4-7.6 hours
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
IV: 1g, 2g
Serious gram-negative infections: 1 to 2 g q8h
Gram-negative bacillary meningitis: 1 to 2 g q8h
IV/IM: 2 to 4 g/day in divided doses q8h or q12h for 5 to 10 days, or up to 14 days
Severe, life-threatening infections: 6 to 12 g/day IV in divided doses q8h or q12h
25-200mg/kg/day divided q6-12h
Renal failure: CrCl > 80mL/min: standard dosing
CrCl 50-80mL/min 0.5-1g q8h
CrCl 25-50mL/min 0.25-1g q12h
CrCl 2-25mL/min 0.25-0.5g q8h
Hepatic failure: No dosing changes recommended at this time.
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis renal impairment, coagulation abnormalities
Heparin: increased risk of bleeding
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
Warfarin: increased risk of bleeding
Category C. Risk established, but benefits may outweigh risk.
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.
Moxam Ò/Eli Lilly