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: 102 mcg/L; Half-life: 1.1 hours; Volume of distribution: 14L; Table 11
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
IV: Powder for reconstitution: 500mg, 1g, 2g, 10g, 20g
Intravenous Solution: 1g/50mL, 2 g/50mL
Meningitis: 1-2 g IV/IM q8h
Bone and/or joint infection: 1-2g IV/IM q8h
Gonococcal urethritis: 0.5g IM x 1 dose
Lower respiratory tract infection: 1-2 g IV/IM q8h
Bacterial peritonitis: 1-2g q8-12h
100-150mg/kd/day divided q4-6h
Renal failure: CrCl > 50mL/min: Standard dosing
CrCl 10-50mL: 1-2g q8-12h
CrCl < 10mL/min 1-2g q24h
Hepatic failure: No dosing changes recommended at this time.
CVVH (Continuous venovenous hemofiltration): 1-2g IV q12h
CVVHD (Continuous venovenous hemodialysis): 2g IV q12h
CVVHDF (Continuous venovenous hemodiafiltration) 2g IV q12h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
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.
Brand names/Manufacturer: Cefotaxime Ò/American Pharmaceuticals; Claforan Ò/Aventis