Second-Generation Cephalosporin (2nd generation cephamycin)
Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli Bacteroides spp.
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: 64 mcg/L; Protein binding: 73%; Half-life: 0.7 hours
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
I.V.: Vials for reconstitution 1g, 2g
Susceptible infections: 1-2g I.V. q6-8h. Doses may be given by painful intramuscular injection
80-160mg/kg/day divided in q4-q6h intervals
See Table 12
Renal failure: CrCl > 50mL/min: Standard dose
CrCl 30-50mL/min: 1-2g q8-12
CrCl 10-29mL/min: 1-2g q12-24h
CrCl < 10mL/min: q24-48h
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
Aminoglycosides - loss of aminoglycoside efficacy
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, signs and symptoms of infection (eg fever), WBC
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.
Mefoxin Ò/Merck, Cefoxitin Ò/ESI Lederle