Cefoperazone  (PDF Version)

Antibiotic Class:

Third-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, Enterobacteriaceae, 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: 153mcg/L; Half-life: 2.1 hours; Volume of distribution: 11L; Table 11 

Adverse Effects:

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

Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia

GI: Diarrhea, C. difficile disease

Renal: Interstitial nephritis

Table 14  


IV: 1g, 2g, 10g vials 

Dosing in adults:

Skin and/or subcutaneous tissue infections: 2-4g/day divided IV q12h

Pelvic inflammatory disease: 2-4g/day divided IV/IM q12h

Respiratory tract infection: 2-4 g/day divided IV/IM q12h

Endometritis: 2-4 g/day divided IV/IM q12h 

Dosing in pediatrics:

100-150mg/kg/day divided q8-12h

Table 12 

Disease state based dosing:

Renal failure:  No dosing changes recommended at this time.

Hepatic failure:  No dosing changes recommended at this time. 


Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment, dosage reduction may be necessary in patients with liver dysfunction, concomitant alcohol use (disulfiram-like reaction), patients with a poor nutritional status, malabsorption states (eg, cystic fibrosis), alcoholism, and patients on prolonged hyperalimentation regimens are at high risk for cefoperazone-induced vitamin K deficiency  

Drug Interactions:

Heparin: an increased risk of bleeding

Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine

Warfarin: an 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: 

CephobidŽ/Pfizer, SulperazoneŽ/Pfizer