Cephalexin: Difference between revisions
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==General== | ==General== | ||
*Type: 1st generation cephalosporin | *Type: 1st generation [[cephalosporin]] | ||
*Dosage forms | *Dosage forms | ||
**Tabs: 250mg, 500mg, 750mg | **Tabs: 250mg, 500mg, 750mg | ||
**Liquid: 125mg/5mL; 250mg/5mL | **Liquid: 125mg/5mL; 250mg/5mL | ||
*Common Trade Names: Keflex | *Common Trade Names: Keflex, Keftab, Biocef | ||
==Adult Dosing== | ==Adult Dosing== | ||
===General=== | ===General=== | ||
250-500mg PO q6h | *250-500mg PO q6h | ||
*Max: 4g/day | |||
===[[Strep Pharyngitis]]=== | ===[[Strep Pharyngitis]]=== | ||
500mg PO q12h x 10 days | *500mg PO q12h x 10 days | ||
===Uncomplicated [[UTI]]=== | ===Uncomplicated [[UTI]]=== | ||
500mg PO q12h x 7-14 days | *500mg PO q12h x 7-14 days | ||
===[[Cellulitis]] and Other Skin Infections=== | ===[[Cellulitis]] and Other Skin Infections=== | ||
*60-120 kg: 500 mg Q6H 1 gram Q8H. | |||
*>120 kg: 1 g Q6H. <ref>Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections. Ann Emerg Med. 2020 Feb 13. pii: S0196-0644(19)31453-2. doi: 10.1016/j.annemergmed.2019.12.012. [Epub ahead of print]</ref> | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===General=== | ===General=== | ||
*25- | *25-50mg/kg/day PO divided q6-12h | ||
*Max: 500mg/dose | |||
===[[Otitis Media]]=== | ===[[Otitis Media]]=== | ||
*75- | *75-100mg/kg/day PO divided q12h x 10 days | ||
*Max: 4, | *Max: 4,000mg/24h | ||
===Community Acquired [[Pneumonia (Peds)|Pneumonia]]=== | ===Community Acquired [[Pneumonia (Peds)|Pneumonia]] (>3 Months)=== | ||
*75- | *75-100mg/kg/day PO divided q12h x 10 days | ||
===Streptococcal [[Pharyngitis]] (>1 Year)=== | |||
*40mg/kg/day PO divided q12h x 10 days | |||
*Max: 500mg/dose | |||
===Skin Infections=== | |||
*25-50mg/kg/day PO divided q12h | |||
*Max: 500mg/dose | |||
==Special Populations== | |||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | |||
*[[Lactation risk categories]]: Enters breast milk/L3 | |||
*Renal | |||
**Adult | |||
***CrCl 50-90: give q6-8h | |||
***CrCl 10-50: give q8-12h | |||
***CrCl <10: give q12-24h | |||
***Hemodialysis: give dose after dialysis, no supplement | |||
***Peritoneal dialysis: no supplement | |||
**Pediatric | |||
***CrCl 30-50: give q8h | |||
***CrCl 10-29: give q12h | |||
***CrCl <10: give q24h | |||
***Hemodialysis: give dose after dialysis, no supplement | |||
***Peritoneal dialysis: no supplement | |||
*Hepatic (Adult & Pediatric) | |||
**Not defined | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | |||
**See also [[Cephalosporin Cross-reactivity]] | |||
*Caution advised with contraceptives | |||
==Adverse Drug Reactions== | |||
===Serious=== | |||
*[[Anaphylaxis]] | |||
*[[Angioedema]] | |||
*Erythema Multiforme | |||
*[[Stevens-Johnson Syndrome]] | |||
*[[Toxic Epidermal Necrolysis]] | |||
*[[Clostridium difficile]] | |||
*Neutropenia | |||
*[[Thrombocytopenia]] | |||
*Hemolytic [[anemia]] | |||
*Hemorrhage | |||
*[[Hepatitis]] | |||
*Cholestatic [[jaundice]] | |||
*[[Seizures]] | |||
== | ===Common=== | ||
* | *[[Diarrhea]] | ||
*Nausea/vomiting | |||
*[[Rash]] | |||
*[[Headache]] | |||
*[[Dizziness]] | |||
*Transaminitis | |||
*Eosinophilia | |||
==Pharmacology== | ==Pharmacology== | ||
Line 43: | Line 97: | ||
**Bactericidal, inhibits cell wall | **Bactericidal, inhibits cell wall | ||
== | ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S''' | |||
|- | |||
| ||[[Strep. Pneumoniae]]||'''S''' | |||
|- | |||
| ||[[Viridans strep]]||'''S''' | |||
|- | |||
| ||Strep. anginosus gp||X1 | |||
|- | |||
| ||[[Enterococcus faecalis]]||R | |||
|- | |||
| ||[[Enterococcus faecium]]||X1 | |||
|- | |||
| ||[[MSSA]]||'''S''' | |||
|- | |||
| ||[[MRSA]]||R | |||
|- | |||
| ||[[CA-MRSA]]||R | |||
|- | |||
| ||[[Staph. Epidermidis]]||I | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||R | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||R | |||
|- | |||
| ||[[N. meningitidis]]||R | |||
|- | |||
| ||[[Moraxella catarrhalis]]||R | |||
|- | |||
| ||[[H. influenzae]]||R | |||
|- | |||
| ||[[E. coli]]||'''S''' | |||
|- | |||
| ||[[Klebsiella]] sp||'''S''' | |||
|- | |||
| ||E. coli/Klebsiella ESBL+||R | |||
|- | |||
| ||E coli/Klebsiella KPC+||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC neg||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC pos||R | |||
|- | |||
| ||[[Serratia]] sp||R | |||
|- | |||
| ||Serratia marcescens||X1 | |||
|- | |||
| ||[[Salmonella]] sp||R | |||
|- | |||
| ||[[Shigella]] sp||R | |||
|- | |||
| ||[[Proteus mirabilis]]||'''S''' | |||
|- | |||
| ||[[Proteus vulgaris]]||R | |||
|- | |||
| ||[[Providencia sp.]]||R | |||
|- | |||
| ||[[Morganella sp.]]||R | |||
|- | |||
| ||[[Citrobacter freundii]]||R | |||
|- | |||
| ||[[Citrobacter diversus]]||R | |||
|- | |||
| ||[[Citrobacter sp.]]||R | |||
|- | |||
| ||[[Aeromonas sp]]||X1 | |||
|- | |||
| ||[[Acinetobacter sp.]]||R | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||R | |||
|- | |||
| ||[[Burkholderia cepacia]]||R | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||R | |||
|- | |||
| ||[[Yersinia enterocolitica]]||X1 | |||
|- | |||
| ||[[Francisella tularensis]]||X1 | |||
|- | |||
| ||[[Brucella sp.]]||X1 | |||
|- | |||
| ||[[Legionella sp.]]||R | |||
|- | |||
| ||[[Pasteurella multocida]]||R | |||
|- | |||
| ||[[Haemophilus ducreyi]]||X1 | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||X1 | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||X1 | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||X1 | |||
|- | |||
| ||[[Bacteroides fragilis]]||R | |||
|- | |||
| ||[[Prevotella melaninogenica]]||X1 | |||
|- | |||
| ||[[Clostridium difficile]]||X1 | |||
|- | |||
| ||[[Clostridium (not difficile)]]||X1 | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||X1 | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||'''S''' | |||
|} | |||
===Key=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
Line 51: | Line 223: | ||
*[[Cephalosporin Cross-reactivity]] | *[[Cephalosporin Cross-reactivity]] | ||
== | ==References== | ||
<references/> | |||
*Sanford 2010 | *Sanford 2010 | ||
*Epocrates | *Epocrates | ||
*Lexicomp | |||
[[Category: | [[Category:Pharmacology]] [[Category:ID]] |
Latest revision as of 23:48, 8 May 2020
General
- Type: 1st generation cephalosporin
- Dosage forms
- Tabs: 250mg, 500mg, 750mg
- Liquid: 125mg/5mL; 250mg/5mL
- Common Trade Names: Keflex, Keftab, Biocef
Adult Dosing
General
- 250-500mg PO q6h
- Max: 4g/day
Strep Pharyngitis
- 500mg PO q12h x 10 days
Uncomplicated UTI
- 500mg PO q12h x 7-14 days
Cellulitis and Other Skin Infections
- 60-120 kg: 500 mg Q6H 1 gram Q8H.
- >120 kg: 1 g Q6H. [1]
Pediatric Dosing
General
- 25-50mg/kg/day PO divided q6-12h
- Max: 500mg/dose
Otitis Media
- 75-100mg/kg/day PO divided q12h x 10 days
- Max: 4,000mg/24h
Community Acquired Pneumonia (>3 Months)
- 75-100mg/kg/day PO divided q12h x 10 days
Streptococcal Pharyngitis (>1 Year)
- 40mg/kg/day PO divided q12h x 10 days
- Max: 500mg/dose
Skin Infections
- 25-50mg/kg/day PO divided q12h
- Max: 500mg/dose
Special Populations
- Pregnancy Rating: B
- Lactation risk categories: Enters breast milk/L3
- Renal
- Adult
- CrCl 50-90: give q6-8h
- CrCl 10-50: give q8-12h
- CrCl <10: give q12-24h
- Hemodialysis: give dose after dialysis, no supplement
- Peritoneal dialysis: no supplement
- Pediatric
- CrCl 30-50: give q8h
- CrCl 10-29: give q12h
- CrCl <10: give q24h
- Hemodialysis: give dose after dialysis, no supplement
- Peritoneal dialysis: no supplement
- Adult
- Hepatic (Adult & Pediatric)
- Not defined
Contraindications
- Allergy to class/drug
- See also Cephalosporin Cross-reactivity
- Caution advised with contraceptives
Adverse Drug Reactions
Serious
- Anaphylaxis
- Angioedema
- Erythema Multiforme
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
- Clostridium difficile
- Neutropenia
- Thrombocytopenia
- Hemolytic anemia
- Hemorrhage
- Hepatitis
- Cholestatic jaundice
- Seizures
Common
Pharmacology
- Half-life: 1h (~20hr ESRD)
- Metabolism: Minimal
- Excretion: Primarily urine (>90% unchanged)
- Mechanism of Action:
- Bactericidal, inhibits cell wall
Antibiotic Sensitivities[2]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections. Ann Emerg Med. 2020 Feb 13. pii: S0196-0644(19)31453-2. doi: 10.1016/j.annemergmed.2019.12.012. [Epub ahead of print]
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- Sanford 2010
- Epocrates
- Lexicomp