Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli
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
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
IV: 1g, 2g, 10g vials
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
100-150mg/kg/day divided q8-12h
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
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.
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.