Mur tips for cephalosporin & other beta lactams

21/08/2009

Dosage regimen

(NB *Refer to SPC for children's doses and specific infections).

Patient knowledge

Patient should be:

Aware of treatment and/or prophylaxis procedure.
Given appropriate counselling advice.
Advised of any potential side effects and any drug interactions with patients existing medicines (eg cephalosporins can possibly enhance anticoagulant effect of coumarins).

Is the medicine working?
Side effects
Monitoring
Lifestyle

Maintain a varied, healthy diet to build up the immune system.

Ensure adequate hydration (especially in the elderly and children).

Patients should be aware of all possible symptoms in case infection relapses.

Encourage compliance to minimise risk of antibiotic resistance.
Compliance assessment.
Hypersensitivity reactions (eg rashes and anaphylaxis).

Gastro-intestinal disturbances (eg nausea, vomiting).

Diarrhoea and, rarely, antibiotic-associated colitis (CSM warns that these side effects are more likely with higher doses).
Most infections need a short course of antibiotics but if infections are recurrent perhaps patient compliance needs to be analysed.

Modified release preparations, cefpodoxime and cefuroxime should be taken with or after food.

Assess if patient has swallowing difficulties and acquire syrup formulations if necessary.

Anita Bagga is a community pharmacist from Leicester.

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Drugs in this class are used for:

Treatment and/or prophylaxis of infections

Cephalosporins are broad-spectrum antibiotics that work by inhibiting the synthesis of bacterial cell walls. They are closely related, chemically, to penicillins but are less susceptible to beta lactamases.

Cephalosporins are used mainly for the treatment of pneumonia, meningitis, UTIs, peritonitis and septicaemia. They are divided into generations; the first-generation cephalosporins are mostly active against Gram-positive bacteria, and successive generations have more activity against Gram-negative bacteria. However, this increased activity is often at the expense of reduced activity against Gram-positive organisms.

Penicillin class	Drug name	Use	Dosage
Cephalosporins	Cefaclor	Infections due to sensitive Gram-positive and Gram negative bacteria	By mouth: 250mg every eight hours, doubled for severe infection. Max. 4g daily.*
Cefadroxil	See cefaclor	By mouth: Patients ³40kg, 0.5-1g twice daily.*
Cefalexin	See cefaclor	By mouth: 250mg every six hours or 500mg every eight to 12 hours increased to 1-1.5g every six to eight hours for severe infections.*
Cefixime	See cefaclor but acute infections only	By mouth: 200-400mg daily in one or two divided doses.*
Cefotaxime	See cefaclor Gonorrhoea Surgical prophylaxis Haemophilus epiglottis Meningitis	By IM or IV injection or IV infusion: 1g every 12 hours increased for severe infections to 8g daily in four divided doses. Higher doses, up to 12g daily in three to four divided doses, may be required.*
Cefpodoxime	See individual doses	RTI: 100-200mg twice daily. Skin and soft tissue infections: 200mg twice daily Uncomplicated UTI: 100-200mg twice daily. Uncomplicated gonorrhoea: 200mg as a single dose.
Cefradine	See cefaclor	By mouth: 250-500mg every six hours or 0.5-1g every 12 hours. By deep IM injection or IV injection (over three to five minutes) or IV infusion 0.5-1g every six hours, increased to 8g daily in severe infections.* :
	Ceftazidime	See cefaclor	By deep IM injection or IV injection or IV infusion 1g every eight hours or 2g every 12 hours. In severe infections 2g every eight to 12 hours or 3g every12 hours.* :
Ceftriaxone	See cefaclor	By deep IM injection or IV injection (over at least two to four minutes) or IV infusion 1g daily; 2-4g daily in severe infections; intramuscular doses over 1g divided between more than one site.* :
Cefuroxime	Mostly active against Haemophilus influenzae and Neisseria gonorrhoeae Lyme's disease	Oral: By IM injection or IV injection or infusion Every six to eight hours 750mg (1.5g in severe infections); single doses over 750mg intravenous route only.* : 250mg twice daily. UTI: 125mg twice daily (doubled in pyelonephritis). Gonorrhoea: 1g single dose.
Other beta lactams	Aztreonam	Gram-negative bacteria (including Pseudomonas aeruginosa, Haemophilus influenzae and Neisseria gonorrhoeae)	By deep IM injection or iv injection (over three to five minutes) or IV infusion 1g every eight hours or 2g every 12 hours; 2g every six to eight hours for severe infections; single doses over 1g IV route only.* :
Ertapenem	Abdominal infections Acute gynaecological infections Community acquired pneumonia Diabetic foot infections of the skin and soft tissue Prophylaxis for colorectal surgery	By IV infusion: 1g once daily.*
Imipenem with cilastatin	Aerobic and anaerobic Gram-positive bacteria and Gram-negative bacteria infections Surgical prophylaxis Hospital acquired septicaemia	By IV infusion(in terms of imipenem): 1-2g daily in three to four equal doses; less sensitive organisms, max. 4g daily, in three to four equal doses.*
Meropenem	Aerobic and anaerobic Gram-positive bacteria and Gram-negative bacteria infections	By IV injection (over five minutes) or by IV infusion: 500mg every eight hours.*

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