Names and pronunciation
(sef-a-lex′in) Keflex, Panixine
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Individual generic drug information
Extracted information for cephalexin only.
(sef-a-lex′in) Keflex, Panixine
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Func. class.: Antiinfective
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Chem. class.: Cephalosporin (first generation)
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ACTION: Inhibits bacterial cell wall synthesis; renders cell wall osmotically unstable, leads to cell death; lysis medi- ated by cell wall autolytic enzymes
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USES: cefadroxil: gram-negative bacilli: Escherichia coli, Proteus mira- bilis, Klebsiella (UTI only); gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococ- cus aureus; upper, lower respiratory tract; urinary tract, skin infections; otitis media; tonsillitis; UTIs ceFAZolin: gram-negative bacilli: Hae- mophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella pneu- moniae; gram-positive organisms: Staphylococcus aureus/epidermidis; upper, lower respiratory tract; urinary tract, skin infections; bone, joint, biliary, genital infections; endocarditis, surgical prophylaxis, septicemia; Streptococcus sp. cephalexin: gram-negative bacilli: Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae; gram-positive organ- isms: Streptococcus pneumoniae, Streptococcus pyogenes, Streptococ- cus agalactiae, Staphylococcus aureus; upper, lower respiratory tract; urinary tract, skin, bone infections; otitis media
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Extracted information for cephalexin only.
CONTRAINDICATIONS: Hyper- sensitivity to cephalosporins, infants <1 mo Precautions: Pregnancy, breastfeeding, hypersensitivity to penicillins, renal disease
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SIDE EFFECTS CNS: Headache, dizziness, weakness, paresthesia, fever, chills, confusion, fatigue, hallucinations, seizures (with high doses) GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, Clostridium difficile- associated diarrhea (CDAD) GU: Vaginitis, pruritus, candidiasis HEMA: Thrombocytopenia, anemia, neu- tropenia, eosinophilia, hemolytic anemia INTEG: Rash, urticaria, dermatitis, injec- tion site reactions SYST: Anaphylaxis, serum sickness, super- infection, Stevens-Johnson syndrome
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INTERACTIONS Increase: toxicity—aminoglycosides, loop diuretics, probenecid Drug/Lab Test Increase: AST, ALT, alkaline phosphatase, LDH, BUN, creatinine, bilirubin False positive: urinary protein, direct Coombs’ test, urine glucose Interference: cross-matching
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Extracted information for cephalexin only.
DOSAGE AND ROUTES cefadroxil UTI • Adult: PO 1-2 g/day or divided q12hr; loading dose of 1 g initially • Child: PO 30 mg/kg/day in divided doses bid, max 2 g/day Catheter-related bloodstream infections • Adult: IV 2 g q8h Renal dose • Adult: PO CCr 25-50 mL/min, 1 g, then 500 mg q12hr; CCr 10-24 mL/min, 1 g, then 500 mg q24hr; CCr <10 mL/min, 1 g, then 500 mg q36hr
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Available forms: Capsules 500 mg; tab- lets 1 g; oral suspension 250, 500 mg/5 mL ceFAZolin Surgical prophylaxis • Adult: IM/IV <120 kg 1-2 g; >120 kg 3 g 30-60 min before surgery, then 0.5-1 g q6-8hr × 24 hr. Cefazolin surgical pro- phylaxis dosing can be 1-2 gm if patient is <120 kg, recommended 3 gm if pa- tient is 120 kg or more. Life-threatening infections • Adult: IM/IV 1-2 g q6-8hr; max 12 g/ day • Child >1 mo: IM/IV 75-100 mg/kg/ day in 3-4 divided doses; max 6 g/day Mild/moderate infections • Adult: IM/IV 250 mg-1 g q8hr, max 12 g/day • Child >1 mo: IM/IV 50 mg/kg in 3-4 equal doses, max 6 g/day, or 2 g as a single dose Renal dose • Adult: IM/IV after loading dose, CCr 35-54 mL/min, dose q8hr; CCr 10-34 mL/ min, 50% of dose q12hr; CCr <10 mL/min, 50% of dose q18-24hr • Child: IM/IV CCr >70 mL/min, no dos- age adjustment; CCr 40-70 mL/min after loading dose, reduce dose to 7.5-30 mg/ kg q12hr; CCr 20-39 mL/min, give 3.125- 12.5 mg/kg after loading dose q12hr; CCr 5-19 mL/min, 2.5-10 mg/kg after loading dose q24hr Available forms: Powder for injection 500 mg, 1, 10, 20 g/vial; premixed infu- sion 500 mg, 1 g/50 mL, 500 mg/50 mL vial cephalexin Moderate infections • Adult: PO 250-500 mg q6hr, max 4 g/day • Child: PO 25-100 mg/kg/day in 4 equal doses, max 4 g/day Moderate skin infections • Adult: PO 500 mg q12hr Severe infections • Adult: PO 500 mg-1 g q6hr, max 4 g • Child: PO 50-100 mg/kg/day in 4 equal doses, max 4 g/day Renal dose • Adult: PO CCr 10-40 mL/min, 250-500 mg then 250-500 mg q8-12hr; CCr <10 mL/ min, 250-500 mg, then 250 mg q12-24hr Available forms: Capsules 250, 500, 750 mg; tablets 250, 500 mg; oral suspension 125, 250 mg/5 mL
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Administer: cefadroxil • For prescribed time to ensure organism death, prevent superinfection • With food if needed for GI symptoms • Shake suspension, refrigerate, discard after 2 wk • Identify allergies before use • After C&S specimen is obtained ceFAZolin • Obtain C&S specimen before use • Identify allergies before use IV route • Check for irritation, extravasation often; dilute in 2 mL/500 mg or 2.5 mL/1 g sterile water for injection, inject over 3-5 min; may be further diluted with 50-100 mL of NS, D5W solution, run over 10 min-1 hr by Y-tube or 3-way stopcock • After C&S completed Y-site compatibilities: Acyclovir, alfentanil, allopurinol, alprostadil, ami- fostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipo- some, anidulafungin, ascorbic acid injection, atenolol, atracurium, atro- pine, aztreonam, benztropine, bivaliru- din, bleomycin, bumetanide, buprenor- phine, butorphanol, calcium gluconate, CARBOplatin, cefamandole, cefmetazole, cefonicid, cefoTEtan, cefOXitin, cefpi- rome, cefTAZidime, ceftizoxime, cefTRI- AXone, cefuroxime, chloramphenicol, cimetidine, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexa- methasone, dexmedetomidine, digoxin, diltiaZEM, DOCEtaxel, doxacurium, doxapram, DOXOrubicin liposomal, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, esmolol, etoposide, fenoldopam, fen- taNYL, filgrastim, fluconazole, fludara- bine, fluorouracil, folic acid (as sodium salt), foscarnet, furosemide, gallium, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubi- cin, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), irinote- can, isoproterenol, ketorolac, lidocaine, linezolid, LORazepam, LR’s injection, mannitol, mechlorethamine, melphalan, meperidine, methotrexate, methyldo- pate, methylPREDNISolone, metoclo- pramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, milrinone, morphine, moxalactam, multiple vita- mins injection, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitro- glycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palono- setron, pamidronate, pancuronium, pantoprazole, penicillin G potassium/ sodium, peritoneal dialysis solution, perphenazine, PHENobarbital, phenyl- ephrine, phytonadione, piperacillin, Plasma-Lyte M in dextrose 5%, poly- myxin B, potassium chloride, procain- amide, propofol, propranolol, raNITI- dine, remifentanil, Ringer’s injection, ritodrine, riTUXimab, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, tenoxicam, theophylline, thi- amine, thiotepa, ticarcillin, ticarcillin- clavulanate, tigecycline, tirofiban, TNA, C tolazoline, trastuzumab, trimetaphan, urokinase, vasopressin, vecuronium, verapamil, vinCRIStine, vitamin B com- plex with C, voriconazole, warfarin, zole- dronic acid cephalexin • Shake suspension, refrigerate, discard after 2 wk; use calibrated oral syringe, spoon, or measuring cup • With food if needed for GI symptoms • After C&S specimen is obtained • Identify allergies before use
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Extracted information for cephalexin only.
Assess: • Infection: characteristics of wounds, sputum, urine, stools, WBC >10,000/ mm3, earache, fever; obtain baseline and periodically during treatment; obtain C&S before treatment starts, may start treatment before results are received • Cross-sensitivity to penicillin and other cephalosporins; hypersensitivity reaction may occur • Nephrotoxicity: increased BUN, cre- atinine; urine output: if decreasing, notify prescriber • Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alkaline phosphatase, Coombs’ test monthly if patient is on long-term therapy • CDAD: bowel pattern daily; if severe diarrhea occurs, product should be dis- continued • Anaphylaxis: rash, urticaria, pruritus, chills, fever, joint pain; angioedema; may occur a few days after therapy begins; discontinue product, notify prescriber immediately, keep emergency equipment nearby • Stevens-Johnson syndrome, toxic epidermal necrolysis: painful, red rash; flulike symptoms, discontinue product, do not restart • Overgrowth of infection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
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Evaluate: • Therapeutic response: decreased symptoms of infection, negative C&S
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take all medication prescribed for length of time ordered; take missed dose as soon as remembered, unless close to next dose; do not double dose; use cali- brated device for syrup, liquid, suspen- sion • To report vaginal itching; loose, foul- smelling stools; furry tongue occurs; may indicate superinfection • To report immediately rash, flulike symptoms, blisters, stop product • Diarrhea with mucus, blood (may indi- cate CDAD) TREATMENT OF ANAPHY- LAXIS: EPINEPHrine, antihistamines; resuscitate if needed CEPHALOSPORINS— SECOND GENERATION
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Extracted information for cephalexin only.
PHARMACOKINETICS cefadroxil: Peak 1-1½ hr, duration 12-24 hr, half-life 1-2 hr, 20% bound by plasma proteins, crosses placenta, excreted in breast milk ceFAZolin IV: Onset 10 min, peak infusion’s end, duration 6-12 hr, eliminated unchanged in urine, 75%-85% protein bound IM: Peak 1-2 hr, duration 6-12 hr, half- life 1½-2 hr cephalexin: Peak 1 hr, duration 6-12 hr, half-life 30-72 min, 5%-15% bound by plasma proteins, 80%-100% eliminated unchanged in urine, crosses placenta, excreted in breast milk
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Filter the extracted dose blocks for this individual drug.
cefadroxil UTI
• Adult: PO 1-2 g/day or divided q12hr; loading dose of 1 g initially
Candidate age grouping · source page 252
cefadroxil UTI
• Child: PO 30 mg/kg/day in divided doses bid, max 2 g/day Catheter-related bloodstream infections
Candidate age grouping · source page 252
cefadroxil UTI
• Adult: IV 2 g q8h Renal dose
Candidate age grouping · source page 252
cefadroxil UTI
• Adult: PO CCr 25-50 mL/min, 1 g, then 500 mg q12hr; CCr 10-24 mL/min, 1 g, then 500 mg q24hr; CCr <10 mL/min, 1 g, then 500 mg q36hr
Candidate age grouping · source page 252