cephalosporin

Class Name: cephalosporin (Oral route, Injection route, Intravenous route, Intramuscular route)

Uses For This Medicine

Cephalosporins are used in the treatment of infections caused by bacteria. They work by killing bacteria or preventing their growth.

Cephalosporins are used to treat infections in many different parts of the body. They are sometimes given with other antibiotics. Some cephalosporins given by injection are also used to prevent infections before, during, and after surgery. However, cephalosporins will not work for colds, flu, or other virus infections.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, cephalosporins are used in certain patients with the following medical conditions:

  • Amoxicillin-resistant sinusitis (treatment)—Cefaclor
  • Bacterial endocarditis (prophylaxis)—Cefadroxil, cefazolin, and cephalexin
  • Melioidosis (treatment)—Ceftazidime

Before Using This Medicine

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Many cephalosporins have been tested in children and, in effective doses, have not been shown to cause different side effects or problems than they do in adults. However, there are some cephalosporins that have not been tested in children up to 12 years of age.

Geriatric

Cephalosporins have been used in the elderly, and they are not expected to cause different side effects or problems in older people than they do in younger adults.

Pregnancy

Studies have not been done in humans. However, most cephalosporins have not been reported to cause birth defects or other problems in animal studies. Studies in rabbits have shown that cefoxitin may increase the risk of miscarriages and cause other problems. Before taking a cephalosporin, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast Feeding

It is not known if cefditoren passes into breast milk. Most cephalosporins pass into breast milk, usually in small amounts. However, cephalosporins have not been reported to cause problems in nursing babies. Mothers who are taking a cephalosporin and who wish to breast-feed should discuss this with their doctor.

Interactions with Medicines

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

  • Calcium Acetate
  • Calcium Chloride
  • Calcium Gluceptate
  • Calcium Gluconate
  • Lactated Ringer's Solution
  • Ringer's Solution

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Heparin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bleeding problems, history of (cefamandole, cefditoren, cefoperazone, and cefotetan only)—These medicines may increase the chance of bleeding.
  • Carnitine, low levels—Cefditoren may cause carnitine levels to decrease further.
  • Kidney disease—Some cephalosporins need to be given at a lower dose to people with kidney disease. Cefuroxime may increase the chance of kidney damage.
  • Liver disease (cefoperazone and cefuroxime)—Cefoperazone needs to be given at a lower dose to people with liver disease. Condition may be worsened by cefuroxime use.
  • Phenylketonuria—Cefprozil oral suspension contains phenylalanine.
  • Poor nutritional status—These may be worsened by cefuroxime and you may need to have vitamin K.
  • Stomach or gastrointestinal disease, history of (especially colitis, including colitis caused by antibiotics, or enteritis)—Cephalosporins may cause colitis in some patients.

Proper Use of This Medicine

Cephalosporins may be taken on a full or empty stomach. If this medicine upsets your stomach, it may help to take it with food.

Cefaclor extended-release tablets, cefditoren, cefpodoxime, and cefuroxime axetil should be taken with food to increase absorption of the medicine. Ceftibuten oral suspension should be taken on an empty stomach, at least 2 hours before or 1 hour after a meal.

Loracarbef should be taken at least 1 hour before eating or at least 2 hours after eating.

For patients taking the oral liquid form of this medicine:

  • This medicine is to be taken by mouth. Use a specially marked measuring spoon or other device to measure each dose accurately. The average household teaspoon may not hold the right amount of liquid.
  • Do not use after the expiration date on the label since the medicine may not work properly after that date. Check with your pharmacist if you have any questions about this.

For patients taking cefaclor chewable tablets:

  • Chew tablet completely before swallowing. Do not swallow whole.

To help clear up your infection completely, keep taking this medicine for the full time of treatment, even if you begin to feel better after a few days. If you have a “strep” infection, you should keep taking this medicine for at least 10 days. This is especially important in “strep” infections since serious heart or kidney problems could develop later if your infection is not cleared up completely. Also, if you stop taking this medicine too soon, your symptoms may return.

This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take four doses a day, the doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For cefaclor:
    • For bacterial infections:
      • For oral dosage form (capsules or oral suspension):
        • Adults and teenagers—250 to 500 milligrams (mg) every eight hours.
        • Infants and children 1 month of age and older—6.7 to 13.4 mg per kilogram (kg) (3.04 to 6.09 mg per pound) of body weight every eight hours, or 10 to 20 mg per kg (4.54 to 9.09 mg per pound) of body weight every twelve hours.
      • For oral dosage form (chewable tablets):
        • Adults and teenagers—250 to 500 mg every eight hours.
        • Children—20 mg per kg (9.09 mg per pound) of body weight every eight hours.
      • For long-acting oral dosage form (extended-release tablets):
        • Adults and teenagers 16 years of age and older—375 to 500 mg every twelve hours for seven to ten days.
        • Children up to 16 years of age—Use and dose must be determined by your doctor.
    • For pharyngitis (strep throat):
      • For oral dosage form (chewable tablets):
        • Children—20 mg per kg (9.09 mg per pound) of body weight every twelve hours.
    • For otitis media (ear infection):
      • For oral dosage form (chewable tablets):
        • Children—40 mg per kg (18.18 mg per pound) of body weight every eight or twelve hours as directed by the doctor.
  • For cefadroxil:
    • For bacterial infections:
      • For oral dosage form (capsules, oral suspension, or tablets):
        • Adults and teenagers—500 milligrams (mg) or 1 gram every twelve hours, or 1 or 2 grams once a day.
        • Children—15 mg per kilogram (kg) (6.81 mg per pound) of body weight every twelve hours, or 30 mg per kg (13.63 mg per pound) of body weight once a day.
  • For cefamandole:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—500 milligrams (mg) to 2 grams every four to eight hours, injected into a muscle or vein.
        • Infants and children 1 month of age and older—8.3 to 50 mg per kilogram (kg) (3.77 to 22.72 mg per pound) of body weight every four to eight hours, injected into a muscle or vein.
  • For cefazolin:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—250 milligrams (mg) to 1.5 grams every six to twelve hours, injected into a muscle or vein.
        • Infants and children 1 month of age and older—6.25 to 25 mg per kilogram (kg) (2.84 to 11.36 mg per pound) of body weight every six hours, or 8.3 to 33.3 mg per kg (3.77 to 15.13 mg per pound) of body weight every eight hours, injected into a muscle or vein.
        • Newborns—20 mg per kg (9.09 mg per pound) of body weight every eight to twelve hours, injected into a vein.
  • For cefdinir:
    • For bacterial infections:
      • For oral dosage form (capsules or oral suspension):
        • Adults and teenagers—300 milligrams (mg) ever twelve hours or 600 mg once a day for 5 to 10 days.
        • Infants and children 6 months of age and older—7 milligrams (mg) per kilogram (3.18 mg per pound) of body weight every twelve hours or 14 mg per kilogram (6.36 mg per pound) once a day for 5 to 10 days.
  • For cefditoren:
    • For oral dosage form (tablets):
      • For bacterial bronchitis:
        • For oral dosage form (tablets):
          • Adults and children 12 years of age and older—400 milligrams (mg) twice a day for 10 days
          • Children under 12 years of age—Dose must be determined by your doctor
      • For bacterial throat infections or tonsillitis:
        • For oral dosage form (tablets):
          • Adults and children 12 years of age and older—200 milligrams (mg) twice a day for 10 days
          • Children under 12 years of age—Dose must be determined by your doctor
  • For cefepime:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—500 milligrams to 2 grams every eight to twelve hours, injected into a muscle or vein, for seven to ten days.
        • Infants and children 2 months to 16 years of age—50 milligrams per kilogram body weight injected into muscle or vein, every eight to twelve hours, for seven to ten days.
  • For cefixime:
    • For bacterial infections:
      • For oral dosage form (oral suspension or tablets):
        • Adults and teenagers—200 milligrams (mg) every twelve hours, or 400 mg once a day. Gonorrhea is treated with a single, oral dose of 400 mg.
        • Children 6 months to 12 years of age—4 mg per kilogram (kg) (1.81 mg per pound) of body weight every twelve hours, or 8 mg per kg (3.63 mg per pound) of body weight once a day.
        • Infants up to 6 months of age—Use and dose must be determined by your doctor.
  • For cefonicid:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—500 milligrams (mg) to 2 grams every twenty-four hours, injected into a muscle or vein.
        • Children—Use and dose must be determined by your doctor.
  • For cefoperazone:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—1 to 6 grams every twelve hours, or 2 to 4 grams every eight hours, injected into a muscle or vein.
        • Children—Use and dose must be determined by your doctor.
  • For cefotaxime:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—1 to 2 grams every four to twelve hours, injected into a muscle or vein. Gonorrhea is usually treated with a single dose of 500 milligrams (mg) or 1 gram, injected into a muscle.
        • Children over 50 kg of body weight (110 pounds)—1 to 2 grams every four to twelve hours, injected into a muscle or vein.
        • Infants and children 1 month of age and older and up to 50 kg of body weight (110 pounds)—8.3 to 30 mg per kg (3.77 to 13.63 mg per pound) of body weight every four hours, or 12.5 to 45 mg per kg (5.68 to 20.45 mg per pound) of body weight every six hours, injected into a muscle or vein.
        • Newborns 1 to 4 weeks of age—50 mg per kg (22.72 mg per pound) of body weight every eight hours, injected into a vein.
        • Newborns up to 1 week of age—50 mg per kilogram (kg) (22.72 mg per pound) of body weight every twelve hours, injected into a vein.
  • For cefotetan:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—500 milligrams to 3 grams every twelve hours, or 1 or 2 grams every twenty-four hours, injected into a muscle or vein.
        • Children—Use and dose must be determined by your doctor.
  • For cefoxitin:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—1 to 3 grams every four to eight hours, injected into a vein.
        • Infants and children 3 months of age and older—13.3 to 26.7 milligrams (mg) per kilogram (kg) (6.04 to 12.13 mg per pound) of body weight every four hours, or 20 to 40 mg per kg (9.09 to 18.18 mg per pound) of body weight every six hours, injected into a vein.
        • Infants 1 to 3 months of age—20 to 40 mg per kg (9.09 to 18.18 mg per pound) of body weight every six to eight hours, injected into a vein.
        • Newborns 1 to 4 weeks of age—20 to 40 mg per kg (9.09 to 18.18 mg per pound) of body weight every eight hours, injected into a vein.
        • Premature infants weighing 1500 grams and over to newborns up to 1 week of age—20 to 40 mg per kg (9.09 to 18.18 mg per pound) of body weight every twelve hours, injected into a vein.
  • For cefpodoxime:
    • For bacterial infections:
      • For oral dosage form (oral suspension or tablets):
        • Adults and teenagers—100 to 400 milligrams (mg) every twelve hours for five to fourteen days. Gonorrhea is treated with a single, oral dose of 200 mg.
        • Infants and children 5 months to 12 years of age—5 mg per kilogram (kg) (2.27 mg per pound) of body weight every twelve hours for five to ten days, or 10 mg per kg (4.54 mg per pound) of body weight every twenty-four hours for ten days.
        • Infants up to 5 months of age—Use and dose must be determined by your doctor.
  • For cefprozil:
    • For bacterial infections:
      • For oral dosage form (oral suspension or tablets):
        • Adults and teenagers—250 or 500 milligrams (mg) every twelve to twenty-four hours for ten days.
        • Children 2 to 12 years of age—7.5 to 20 mg per kilogram (kg) (3.4 to 9.09 mg per pound) of body weight every twelve to twenty-four hours for ten days.
        • Infants and children 6 months to 12 years of age—7.5 to 15 mg per kg (3.4 to 6.81 mg per pound) of body weight every twelve hours for ten days.
        • Infants up to 6 months of age—Use and dose must be determined by your doctor.
  • For ceftazidime:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—250 milligrams (mg) to 2 grams every eight to twelve hours, injected into a muscle or vein. Patients with cystic fibrosis may receive 30 to 50 mg per kilogram (kg) (13.63 to 22.72 mg per pound) of body weight every eight hours, injected into a vein.
        • Infants and children 1 month to 12 years of age—30 to 50 mg per kg (13.63 to 22.72 mg per pound) of body weight every eight hours, injected into a vein.
        • Newborns up to 4 weeks of age—30 mg per kg (13.63 mg per pound) of body weight every twelve hours, injected into a vein.
  • For ceftibuten:
    • For bacterial infections:
      • For oral dosage form (capsules or oral suspension):
        • Adults and teenagers—400 milligrams (mg) once a day for ten days.
        • Infants and children 6 months to 12 years of age—9 mg per kilogram (4.09 mg per pound) of body weight once a day for ten days.
        • Infants up to 6 months of age—Use and dose must be determined by your doctor.
  • For ceftizoxime:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—500 milligrams (mg) to 4 grams every eight to twelve hours, injected into a muscle or vein. Gonorrhea is treated with a single dose of 1 gram, injected into a muscle.
        • Infants and children 6 months of age and older—50 mg per kilogram (22.72 mg per pound) of body weight every six to eight hours, injected into a muscle or vein.
        • Infants up to 6 months of age—Use and dose must be determined by your doctor.
  • For ceftriaxone:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—1 to 2 grams every twenty-four hours, or 500 milligrams (mg) to 1 gram every twelve hours, injected into a muscle or vein. Gonorrhea is treated with a single 250-mg dose, injected into a muscle.
        • Infants and children—25 to 37.5 mg per kilogram (kg) (11.36 to 17.04 mg per pound) of body weight every twelve hours, or 50 to 75 mg per kg (22.72 to 34.09 mg per pound) of body weight once a day, injected into a muscle or vein. Meningitis is treated with an initial dose of 100 mg per kg, then 100 mg per kg once a day or 50 mg per kg two times a day.
  • For cefuroxime:
    • For bacterial infections:
      • For oral dosage form (oral suspension):
        • Adults and teenagers—The oral suspension is usually used only for children. Refer to the dosing for cefuroxime tablets.
        • Infants and children 3 months to 12 years of age—10 to 15 milligrams (mg) per kilogram (kg) (4.54 to 6.81 mg per pound) of body weight every twelve hours for ten days.
      • For oral dosage form (tablets):
        • Adults and teenagers—250 to 500 mg every twelve hours. Gonorrhea is treated with a single, oral 1-gram dose.
        • Children up to 12 years of age who can swallow tablets whole—250 mg every twelve hours for ten days.
      • For injection dosage form:
        • Adults and teenagers—750 mg to 3 grams every six to eight hours usually for 5 to 14 days, injected into a muscle or vein. Gonorrhea is treated with a single dose of 1.5 grams, injected into a muscle; the total 1.5-gram dose is divided into two doses and injected into muscles at two separate places on the body, and given along with a single, oral 1-gram dose of probenecid.
        • Infants and children 1 month of age and older—12.5 to 150 mg per kg (5.68 to mg per pound) of body weight every six to eight hours, injected into a muscle or vein.
        • Newborns—10 to 100 mg per kg (4.54 to 45.5 mg per pound) of body weight every eight to twelve hours, injected into a vein.
  • For cephalexin:
    • For bacterial infections:
      • For oral dosage form (capsules, oral suspension, or tablets):
        • Adults and teenagers—250 milligrams (mg) to 1 gram every six to twelve hours.
        • Children 40 kg (88 pounds) of body weight and over—250 mg to 1 gram every six to twelve hours.
        • Children 1 year of age and older and up to 40 kg (88 pounds) of body weight—6.25 to 25 mg per kilogram (kg) (2.84 to 11.36 mg per pound) of body weight every six hours, or 12.5 to 50 mg per kg (5.68 to 22.72 mg per pound) of body weight every twelve hours.
        • Infants and children 1 month to 1 year of age—6.25 to 12.5 mg per kg (2.84 to 5.68 mg per pound) of body weight every six hours.
  • For cephapirin:
    • For bacterial infections:
      • For injection dosage form:
        • Adults and teenagers—500 milligrams (mg) to 1 gram every four to six hours, injected into a muscle or vein.
        • Infants and children 3 months of age and older—10 to 20 mg per kilogram (kg) (4.54 to 9.09 mg per pound) of body weight every six hours, injected into a muscle or vein.
  • For cephradine:
    • For bacterial infections:
      • For oral dosage form (capsules or oral suspension):
        • Adults and teenagers—250 milligrams (mg) to 1 gram every six to twelve hours.
        • Infants and children 9 months of age and older—6.25 mg to 1 gram per kilogram (kg) (2.84 to 454 mg per pound) of body weight every six hours, or 12.5 to 50 mg per kg (5.68 to 22.72 mg per pound) of body weight every twelve hours.
  • For loracarbef:
    • For bacterial infections:
      • For oral dosage form (capsules and oral suspension):
        • Adults and teenagers—200 to 400 mg every 12 hours for 7 to 14 days.
        • Infants and children 6 months of age and older—15 to 30 mg per kg (6.81 to 13.62 mg per pound) of body weight every 12 hours for 7 to 10 days.
        • The oral suspension should be taken for an ear infection rather than the capsule form.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Store the oral liquid form of most cephalosporins in the refrigerator because heat will cause this medicine to break down. However, keep the medicine from freezing. Follow the directions on the label. Cefixime oral suspension (Suprax), cefuroxime axetil oral suspension (Ceftin), cefdinir oral suspension (Omnicef), and loracarbef oral suspension (Lorabid) do not need to be refrigerated.

Precautions While Using This Medicine

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

For patients with diabetes:

  • This medicine may cause false test results with some urine sugar tests. Check with your doctor before changing your diet or the dosage of your diabetes medicine.

For patients with phenylketonuria (PKU):

  • Cefprozil oral suspension (Cefzil) contains phenylalanine. Check with your doctor before taking this medicine.

In some patients, cephalosporins may cause diarrhea:

  • Severe diarrhea may be a sign of a serious side effect. Do not take any diarrhea medicine without first checking with your doctor. Diarrhea medicines may make your diarrhea worse or make it last longer.
  • For mild diarrhea, medicine containing kaolin or attapulgite (e.g., Kaopectate®, Diasorb®) may be taken. However, other kinds of diarrhea medicine should not be taken. They may make your diarrhea worse or make it last longer.
  • If you have any questions about this or if mild diarrhea continues or gets worse, check with your health care professional

For patients receiving cefamandole, cefoperazone, or cefotetan by injection:

  • Drinking alcoholic beverages or taking other alcohol-containing preparations (for example, elixirs, cough syrups, tonics, or injections of alcohol) while receiving these medicines may cause problems. The problems may occur if you consume alcohol even several days after you stop taking the cephalosporin. Drinking alcoholic beverages may result in increased side effects such as abdominal or stomach cramps, nausea, vomiting, headache, fainting, fast or irregular heartbeat, difficult breathing, sweating, or redness of the face or skin. These effects usually start within 15 to 30 minutes after you drink alcohol and may not go away for up to several hours. Therefore, you should not drink alcoholic beverages or take other alcohol-containing preparations while you are receiving these medicines and for several days after stopping them.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Black, tarry stools
  • chest pain
  • chills
  • cough
  • fever
  • painful or difficult urination
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on lips or in mouth
  • swollen glands
  • unusual bleeding or bruising (more common for cefamandole, cefoperazone, cefotetan and cefuroxime)
  • unusual tiredness or weakness
Less common or rare
  • Abdominal or stomach cramps and pain (severe)
  • abdominal tenderness
  • diarrhea (watery and severe, which may also be bloody)
  • hives or welts, itching redness of skin, or skin rash
  • pain, redness and swelling at site of injection
  • peeling of skin
  • seizures

After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

Rare
  • Blistering, peeling, or loosening of skin
  • decrease in urine output
  • hearing loss (more common with cefuroxime treatment for meningitis)
  • joint pain
  • loss of appetite, nausea, or vomiting (more common with ceftriaxone)
  • red or irritated eyes
  • trouble in breathing
  • yellowing of the eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common (less common with some cephalosporins)
  • Diarrhea (mild)
  • headache
  • sore mouth or tongue
  • stomach cramps (mild)
  • vaginal itching or discharge

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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