Cefamandole (PDF Version)

Antibiotic Class:

Second-Generation Cephalosporin (true 2nd generation cephalosporin)

Antimicrobial Spectrum:

Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp. Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, E. coli

Mechanism of Action:

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: 139 mcg/L; Protein binding: 70%; Half-life: 0.8 hours; Table 10

Adverse Effects:

Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia

Hematologic: Neutropenia, Leukopenia, Thrombocytopenia

GI: Diarrhea, C. difficile disease

Renal: Interstitial nephritis

Table 14


IV/IM: Powder for reconstitution: 1g, 2g, 10g

Dosing in adults:

Bone/joint infection: 500mg-1g IV/IM q4-8h

Skin and/or subcutaneous tissue infection: 500mg IV/IM q6h

Peritonitis: 500mg-1g IV/IM q4-8h

Uncomplicated UTI: 500mg IV/IM q8h

Dosing in pediatrics:

50-150mg/kg/day IV q4-8h

Table 12

Disease state based dosing:

Renal failure: CrCl > 80mL/min Standard dose

                        CrCl 50-80mL/min 1.5g q4h OR 2g q6h

                        CrCl 25-50mL/min 1.5g q6h OR 2g q8h

                        CrCl 10-25mL/min 1g q6h OR 1.25g q8h

                        CrCl 2-10mL/min 1g q12h

                        Table 13

Hepatic failure: No dosing changes recommended at this time.


Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment

Drug Interactions:

Heparin - increased risk of bleeding

Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine

Warfarin – increased risk of bleeding


Category B: No evidence of risk in humans but studies inadequate.

Monitoring Requirements:

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.

Brand names/Manufacturer:

Mandol̉/Eli Lilly