Cephalosporins

Chapter 60


Cephalosporins






INDICATIONS






The mold Cephalosporin acremonium (now Acremonium chrysogenum) was discovered in sewage in Sardinia, Italy, in 1945. In 1964, the first cephalosporin, cephalothin, was marketed. Cephalosporins now comprise a large category of antimicrobials, with a wide spectrum of activity that is superior to the penicillins (Table 60-1). The generations are loosely based on antimicrobial spectrum of activity. This chapter discusses the most common oral cephalosporins, with one exception—ceftriaxone—which can be given IM in the primary care setting. Many first-, second-, third-, and fourth-generation cephalosporins are used IM or IV for serious infections and are not discussed. The primary care provider should be familiar with one oral cephalosporin from each generation. The most widely used cephalosporins for the primary care provider consist of cephalexin (Keflex), cefprozil (Cefzil), cefuroxime (Ceftin), and ceftriaxone (Rocephin).



TABLE 60-1


Cephalosporin Indications With Dosage and Administration

























































































































Drug Bacteria Site/Disease Dosage
FIRST GENERATION
cephalexin (Keflex) GABHS, S. pneumoniae, staph, H. influenzae, E. coli, Klebsiella, Proteus URI, UTI, skin Adult: 250-500 mg q6h
Child: 25-50 mg/kg/day in divided doses
Otitis media: 75-100 mg/kg/day in 3 or 4 divided doses
cefadroxil (Duricef) GABHS, S. pneumoniae, staph, H. influenzae
E. coli, Klebsiella, Proteus		 Pharyngitis, tonsillitis
UTI, skin		 Adult: 1 g/day in single or two divided doses × 10 days
Child: 30 mg/kg/day in single or two divided doses × 10 days
Adult: 1-2 g/day in single or two divided doses (2 g/day complicated UTI)
Child: 30 mg/kg/day in single or two divided doses
SECOND GENERATION
cefuroxime (Ceftin) GABHS, staph Pharyngitis, tonsillitis Adult: 250 mg bid × 10 days
Child (3 mo-12 yr): 20 mg/kg/day (maximum, 500 mg/day) divided bid × 10 days
  GABHS, S. pneumoniae, H. influenzae, M. catarrhalis Otitis media, impetigo Child: 30 mg/kg/day (maximum, 1 g/day) divided bid × 10 days
  S. pneumoniae, H. influenzae, M. catarrhalis; strep, staph Acute exacerbation of COPD, skin, soft tissue Adult: 250-500 mg bid × 10 days
  E. coli, Klebsiella, Proteus, Morganella, Citrobacter UTI Adult: 125-250 mg bid × 7 to 10 days
  N. gonorrhoeae
B. burgdorferi		 Gonorrhea
Early Lyme disease		 Adult: 1 g single dose
Adult: 500 mg bid × 20 days
cefprozil (Cefzil) GABHS Pharyngitis, tonsillitis Adult (>13 yr): 500 mg once daily × 10 days
Child (2-12 yr): 7.5-15 mg/kg (maximum, 1 g/day) q12h × 10 days
  S. pneumoniae, H. influenzae, M. catarrhalis Otitis media Child (>6 mo-12 yr): 15 mg/kg q12h × 10 days
  Same Sinusitis Adult: 250-500 mg q12h × 10 days
Child: 7.5-15 mg/kg q12h × 10 days
  Same
Strep, staph		 Exacerbation of COPD
Skin, soft tissue		 Adult: 500 mg q12h × 10 days
Adult: 250-500 mg q12h × 10 days
Child (2-12 yr): 20 mg/kg (maximum, 1 g) q24h × 10 days
cefaclor (Ceclor) Strep, staph Mild to moderate infection
Acute exacerbation of COPD
Pharyngitis, tonsillitis		 Adult: 250-500 mg q8h
Adult: 500 mg q12h × 7 days
Adult: 375 mg (ER) q12h × 10 days
Child: 20 mg-40 kg/day (maximum, 1 g/day) in divided doses q8h
cefpodoxime (Vantin) S. pneumoniae, H. influenzae, M. catarrhalis, S. pyogenes Pneumonia, bronchitis
Pharyngitis, tonsillitis
Skin
Otitis media
Pharyngitis/tonsillitis		 Adult: 200 mg q12h × 14 days
Adult: 100 mg q12h × 5 to 10 days
Adult: 400 mg q12h × 7 to 14 days
Child (2 mo-12 yr): 10 mg/kg/day (maximum, 400 mg/day) divided q12h × 5 days
Child (2 mo-12 yr): 10 mg/kg/day (maximum, 200 mg/day) in two divided doses × 5-10 days
loracarbef (Lorabid) S. pyogenes, S. pneumoniae, H. influenzae, M. catarrhalis Pharyngitis/tonsillitis
Sinusitis
Lower respiratory tract		 Adult: 200 mg q12h × 10 days
Adult: 400 mg q12h × 10 days
Adult: 400 mg q12h × 7-14 days
  Strep, staph
Same		 Skin
UTI		 Adult: 200 mg q12h × 7 days
Adult: 200-400 mg q12h × 7 days
THIRD GENERATION
cefixime (Suprax) H. influenzae, M. catarrhalis, S. pyogenes Otitis media, pharyngitis, tonsillitis, acute exacerbations of COPD Adult: 400 mg/day as single dose or 200 mg bid × 10 days
Child (<50 kg or <12 yr): 8 mg/kg/day suspension as single daily dose or a 4 mg/kg q12h × 10 days
ceftriaxone (Rocephin) S. pneumoniae, S. aureus, H. influenzae, H. parainfluenzae, K. pneumoniae, S. marcescens, E. coli, E. aerogenes, P. mirabilis, S. pyogenes Lower respiratory, skin and skin structure, UTI Adult: 1-2 g once daily × 4-14 days IM
Child: 50-75 mg/kg/day in divided doses q12h IM × 10-14 days
  N. gonorrhoeae Gonorrhea Single IM dose of 250 mg
cefdinir (Omnicef) Same Pharyngitis, tonsillitis, sinusitis Adult: 300 mg q12h or 600 mg once daily × 10 days
Child (6 mo-12 yr): 7 mg/kg q12h or 14 mg/kg once daily × 10 days (maximum, 600 mg/day)
    Acute exacerbation of COPD
Pneumonia, skin, soft tissue
Otitis media		 Adult: 300 mg q12h or 600 mg once daily × 10 days
Adult: 300 mg q12h × 10 days
Child (6 mo-12 yr): 7 mg/kg q12h × 10 days (maximum, 600 mg/day)
Child (6 mo-12 yr): 7 mg/kg q12h or 14 mg/kg once daily × 10 days (maximum, 600 mg/day)
cefditoren (Spectracef) S. pyogenes, S. aureus
H. influenzae, H. parainfluenzae,
S. pneumoniae, M. catarrhalis		 Pharyngitis, tonsillitis, skin, soft tissue
Acute exacerbation of COPD, pneumonia		 Adult: 200 mg bid × 10 days
Adult: 400 mg bid × 10 days; pneumonia: 14 days
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Jul 22, 2016 | Posted by in PHARMACY | Comments Off on Cephalosporins

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