Drugs covered:

1st generation 2nd generation 3rd generation .

Cephalexin Cefaclor Cefixime Cefadroxil Cefamandole Cefoperazone Cephadrine Cefotoxitin Cefotaxime Cephalothin Cefuroxime Ceftizoxime Cephapirin Cefonicid Ceftriaxone Cefazolin Cefmetazole Ceftazidime Cefotetan Ceftibuten Cefprozil Cefepime Cefpodoxime Loracarbef

Refer Cephalosporins

Interacting drugs - summary

Cepalosporins +

Ethanol

Alcoholic beverages consumed concurrently with or upto 72 hours after cefamandole, cefaperazone,moxalactum, or cefotetan produce acute alcohol intolerance(disulfram-like reaction). These four antibiotics possess a methyltetrazolethiol side chain that may inhibit aldehyde dehydrogenase . The reaction begins within 30 minutes after alcohol ingestion and may subside 30 minutes to several hours afterwards, the reaction occur up to 3 days after the last dose of the antibiotic

Aminoglycosides

  Aminoglycoside nephrotoxicity potentiated by concurrent use of some cephalosporins, especially cephalothin. Monitor renal function closely.

Anticoagulants

  Hypoprothrombinemic effects of anticoagulants increased by cephalosporins with the methyltetrazolethiol side chain (cefamandole, cefoperazone, cefotetan, moxalactum). Bleeding complications may occur. The concurrent use of heparin theoritically increase the risk of bleeding.

Polypeptide

 The nephrotoxic effects of colistimethate may be increased by antibiotics cephalothin. Monitor renal function

Probenecid

 Probenecid may increase and prolong cephalosporin plasma level by competitively inhibiting renal tubular secretion. This is most significant for cephalosporins eliminated primarily by tubular secretion

Drug/Lab test interactions:

A false-positive reaction for urine glucose may occur with Benedicts solution,Fehlings solution or with Clinitest tablets, but not with enzyme- based tests such as Clinistix and Test tape. Moxalactam does not interfere with Clinitest. There may be a false-positive test for proteinuria with acid and denaturation-precipitation tests.

For susceptible organisms -refer dosages-

Drugs covered:

1st generation 2nd generation 3rd generation . Cephalexin Cefaclor Cefixime Cefadroxil Cefamandole Cefoperazone Cephadrine Cefotoxitin Cefotaxime Cephalothin Cefuroxime Ceftizoxime Cephapirin Cefonicid Ceftriaxone Cefazolin Cefmetazole Ceftazidime Cefotetan Ceftibuten Cefprozil Cefepime Cefpodoxime Loracarbef

Refer Cephalosporins

Most common-

GI disturbances,and hypersensitivity phenomena. The latter are more likely to occur inindividuals who have prevoiusly demonstrated hypersensitivity and in those with a history of allergy,asthma, hay fever, or urticaria.

Miscellaneous-

Hypotension, fever, dyspnea, interstitial pneumonitis, candidal overgrowth consisting of oral candidiasis., vaginitis, genital monoliasis, vaginal discharge, and genito-anal pruritus, elevated CPK, (after ceforanide) revesible hyperactivity, nervousness , insomnia, confusion, hypertonia, dizziness, somnolence.

Hypersensitivity-

Allergic reactions may include- Stevens-Johnson syndrome, erythema mutiforme, toxic epidermal necrolysis, renal dysfunction, toxic nephropathy, hepatic dysfunction, including cholestasis, aplastic anemia, hemolytic anemia, hemorrhage

GI-

Nausea, vomiting, diarrhoea, dysgesia, glossitis, abdominal pain, heartburn, stomach cramps. gallbladder sludge, cholestasis, dyspepsia. Colitis including pseudomembranous colitis, can appear during or after treatment. AdverseGI effects after parentral use of some cephalosporins.

Hemotologic-

Eosinophilia, transcient neutropenia, lynphocytosis, leukocytosis, leukopenia, thrombocytopenia, agranulocytosis, granulocytopenia, hemolytic anemia, bone marrow depression, pancytopenia, decreased platelet function, bleeding in associatiuon with hypothrombinemia, anemia, aplastic anemia, hemorrhage,transcient thrombocytosis. Lymphocytosis, lymphopenia, monocytosis, basophillia, jaundice, glycosuria, brionchospasm, palpitations and epistaxis

Hepatic-

Elevated ALT, AST, GGTP. total bilirubin,alkaline phosphatase, LDH, hepatomegaly, heptitis, significantly elevated liver enzymes with clinical signs and symptoms of hepatitis (cefaperazone) Values tend to return to normal after the end of therapy. Cholestatic jaundice occurred (cefaclor, cephalexin, and cefamandole)

Renal-

Transitory elevations in BUN with and without elevated serum creatinine, dysuria, reversible intestinal nephritis, hematuria, toxic nephropathy, acute renal failure, decreased creatinine clearance in patients with prior renal impairment (cefamandole) casts in urine (ceftriaxone)

CNS-

Headache, dizziness, lethargy, fatigue, paresthesia, confusion, diaphoresis, flushing, generalized tonic-clonic seizures, mild hemipheresis, and extreme confusion following large doses in renal failure (cefazolin)

Local- IM administration commonly results in pain, induration, temperature elevation, and tenderness. sterile abcess have occured following accidental SC injection.Admnistration IV or IM produced local swelling, inflammation, burning, cellulitis, paresthesia, phlebitis and thrombophlebitis.

Hypersensitivity to cephalosporins or relate antibiotics.

Special precautions:

Adminster cautiously to penicillin sensitive patients.

Serum sickness-like reactions (erythema, multiforme or skin rashes accompanied by arthralgia, and frequently fever) have been reported. These reactions occur following a second course of therapy. Several cepahlosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dose was not reduced.

Parentral use- Inject IM preparations deep into musculature, properly dilute IV preparations and administer over an appropiate time interval.

Gonorrhea- In the treatment of gonorrhea, all patients have a serologic test for syphilis. patients with incubating syphilis (seronegative without clinicalsigns of syphilis) are likely to be by the regimens used for gonorrhea.

Superinfection: Use of antibiotics especially over a prolonged or repeated therapy may result in bacterial or fungal overgrowth of susecptible organisms. such overgrowth may lead to secondary infection. Take appropiate measures if this occurs.

Warnings

Close allergenecity with penicillin-

Administer cautiously to penicillin sensitive patients. There is evidence of cross-sensitivity , cephalosporins cannot be assumed to be absolutely safe alternative to penicillin-allergic patient.

Serum sickness-lke reactions - (erythema multiforme or skin rashes aconpanied by polyarthritis, arhlgia and frequently fever,) have been reported . These reactions occured following a second course of therapy. Signs and symptoms occur after a few days of therapy and resolve a few days after drug discontinuation with no seroius sequelae.

Seizures- Several cephalosporins have been impicated to triggering seizures, particularly with renal impairmenr when dosage was not reduced. If seizures associated with drug therapy occurs, discontinue the drug. Anticonvulsant therapy can be given if clinically indicated.

Coagulation abnormalities- Moxalactum, Cefamandole, Cefoperazone can interfere with hemostatis. Alteration in prothrombin times (PT) occurrarely in patients with ceftriaxone.

Pseudomembranous colitis- occurs with cephalosporins. Consider its diagnosis in patients who develop diarrhea with antibiotic use.Colitis may range in severity from mild to life-threatening.

Hypersensitivity- Reactions range from mild to to life-threatening. Before therapy is intituted inquire about previous hypersensitivity reactions to cephalosporins and penicilins. If hypersensitivity reaction occurs, Discontinue therapy and insitute appropiate treatment.

Renal function impairment- Cephalosporins may be nephrotoxic. Use with caution in the presence of markedly impaired renal function. In elderly and in patients with known or suspected renal impairment, monitor carefully prior to and during therapy.

Hepatic function impairment- Cefoperazone is extensively excreted in bile. Serum half-lfe is increased two fold to fourfold in patients with hepatic diseases or bile obstruction. Pregnancy- Cephalosoprins appear to be safe for pregnant patients , but relatively few controlled studies exist.

Lactation- Most of these agents are excreted in breast milk in small quantities.

Use with caution Children- When using cephalosporins in infants, consider the relative benefit to risk in neonates,accumulation of cepholosporins antibiotics(with resulting prolongation of drug half-lfe ) has occured In children > 3 months of age, higher doses of cefoxitin have been associated with an increased incidence of eosinophilia and elevated AST. In children > 6 momths of age ,

Ceftizomine has been associated with transcient elevated levels of eosinophils, AST, ALT, and CPK Safety and and efficacy in children < 1 month (cefaclor, cefamandole, cefazolin and parentral cephradine ) < 3 months (cefuroxime) < 6 months (cefixime, cefpodxime) < 9 months - (oral cephradine ) and , 1 year ( ceforanide) have not established

Safety and efficacy of cepfoperazone and cefotetan in children have not been established.

Continue administration for a minimum of 48 to 72 hours after fever abates or evidence of bacterial eradication have been obtained,

A minimum of 10 days treatment is recommended for group A beta -hemolytic streptococci infectionsto guard against risk of rheumatic fever or glomerulonephritis

Perioperative prophylaxis- discontune prophylactic use within 24 hours after surgical procedure.

In surgery where infection may be particularly devastating (eg open heart surgery, prosthetic arthoplasty) may continue prophylactic treatment for 3 to 5 days following surgery completion..

It there are signs of infection, obtain cultures and perform sensitivity tests so appropiate therapy may be instituted.

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Airway obstruction - ( Bronchiospasm, Asthma )

Asthma is the disease of airways that is characterized by increased responsiveness to the tracheobronchial tree to a muliticiplity of stimuli.. Asthma is manifested phisiologically by a widespread narrowing of the air passage which may be relieved spontaneously or as a result of therapy. Asthma is manifested clinically by paroxysms of dypnea, cough, and wheezing.

Drugs causing adverse reactions - 

1. Betablockers

2. NSAIDs

3. Cholinergic drugs

4. Tetrazine

5. Penicillins

6. Cephalosporins

7. Streptomycin

8. Pentozocine

Drugs covered:

1st generation 2nd generation 3rd generation .

Cephalexin Cefaclor Cefixime Cefadroxil Cefamandole Cefoperazone Cephadrine Cefotoxitin Cefotaxime Cephalothin Cefuroxime Ceftizoxime Cephapirin Cefonicid Ceftriaxone Cefazolin Cefmetazole Ceftazidime Cefotetan Ceftibuten Cefprozil Cefepime Cefpodoxime Loracarbef

Refer Cephalosporins

1.Complete full course of therapy.

2. May cause GI upset; may take with food or milk. Take cefapodoxime and cefuroxime with food to increase absorption.

3. Notify your physician or pharmacist if you have experienced allergic reactions to cephalosprins penicillin or their relatives.

4. Notify physician of nausea, vomiting, or diarrhoea, especially if the diarrhoea is severe or contains blood, mucus or pus.

5. Notify physican, if breastfeeding; cephalosporin enter breast milk.

6. Allergy- Tell your doctor if have ever had any unusual or allergic reaction to any cephalosporins, penicillins, penicilin-lke medicines, or penicillamine. Also tell your doctor if you allergic to any food subtances or dyes.

7. Pregnancy- most cephalosporins have not been reported to cause birth defects or other problems in animal studies

8. Breast-feeding- cephalosorins have not been reported to cause problems in nursing mothers

9. Children- tested innchildren and have ben shown to cause different side efects or problems than they do in adults.

10. Elderly- have been used in elderly anfd they are not expected to cause differentbside effects or problems in older people older people than in younger adults.

11. Other medicines- Tel your doctor if you are taking any other  medicines- Alcohol or alcohol caonatoining medicines - using alcohol with cephalosporins may cause abdominal or stomach cramps, nausea, vomiting, headache, dizziness, or lightheadedness.

12 Other medical problems- tell your doctor if your any other medical problems- Bleeding problems- these medicines may increase the chance of bleeding Kidney disease- may increase the chance of kidney damage Liver disease- cefoperazone needs to be given at a lower dose to people with liver and kidney disease

13. Missed dose- if you mis a dose of this medicine take it as soon as possible, this will hekp to keep a constant amount of medicine in the blood or urine. However if it is almost time for the next dose skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Not significant

Pregnancy:

Safety for use during pregnancy is not established. Use only when potential benefits outweigh potential hazards to the fetus. Cephalosprins appear safe for pregnant patients, but relatively few controlled studies exist.

Lactation:

Most of these agents are excreted in breast milk in small quantities. Levels range from 0.16 to 4mcg/ml or a breast milk: maternal serum ratio of 0.01 to 0.5 following 0.5 to 2g doses. Consider these problems for the nursing infant.

Children:

When using cephalosprins in infants, consider the relative benefit to risk.

Safety and efficacy in children not established.