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.

 

Pharmacodynamics:

Cephalosporins exhibit time-dependent killing (T > MIC)

 

Pharmacokinetics:

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

 

Dosage:

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.

 

Contraindications/Warnings/Precautions:

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

 

Pregnancy:

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:  MandolÒ/Eli Lilly