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Cefamandole Side Effects

Applies to cefamandole: injectable powder for injection


Gastrointestinal side effects, such as nausea and vomiting, are rare, and are more likely to occur if the patient consumes alcohol. This is due to inactivation of aldehyde dehydrogenase by cefamandole, which causes an accumulation of acetaldehyde and a disulfiram-like reaction in the presence of alcohol. Pseudomembranous colitis has been associated with cefamandole therapy.[Ref]


Hepatic abnormalities, such as increases in serum transaminases, are usually mild and transient, and return to normal within two weeks after therapy is stopped. In most cases these changes do not necessitate drug discontinuation.[Ref]


Toxic epidermal necrolysis (TEN) is reported with cefamandole therapy. In one case, TEN occurred approximately ten days following a ten-day course of cefamandole for pneumonia. Intravenous steroids were initiated; however, the patient again developed pneumonia and succumbed to septic shock.

Erythema multiforme is also associated with cefamandole therapy. One affected patient had known allergies to penicillin and sulfonamides and a history of eczematous dermatitis. She was given cefamandole for fever of unknown origin. Within three days of starting therapy, she developed red, tender plaques, some of which progressed to large bullae. Treatment with intravenous steroids improved her skin condition.

A case of occupational contact dermatitis due to cephalosporin allergy has been reported in a nurse who prepared cephalosporin solutions for administration to patients. The dermatitis resolved after the nurse stopped preparing the solutions.[Ref]

Hypersensitivity reactions, such as rash, may occur. Cross-reactivity may occur in penicillin allergic patients. Toxic epidermal necrolysis and erythema multiforme have been reported in cefamandole treated patients.[Ref]


Hematologic side effects can be clinically significant. Cefamandole-induced hypoprothrombinemia may be associated with clinically significant bleeding. Vitamin K may correct the coagulopathy, although in most cases, substitution with another antibiotic will be necessary. In rare cases, transfusion of fresh frozen plasma or whole blood may be needed.[Ref]


New or worsened renal insufficiency has only rarely been associated with cefamandole.[Ref]


1. Yangco BG, Palumbo JA, Nolen T, et al "Comparative multicentre evaluation of the safety and efficacy of ceftazidime versus cefamandole for pneumonia." J Antimicrob Chemother 18 (1986): 521-9

2. Franson TR, Nelson JW, Rose HD "Pseudomembranous colitis complicated by bacteremia due to Streptoc occus faecalis." J Infect Dis 147 (1983): 165

3. Freundt KJ, Schreiner E, Christmann-Kleiss U "Cefamandole: a competitive inhibitor of aldehyde dehydrogenase." Infection 13 (1985): 91

4. Freundt KJ, Kitson TM "Inactivation of aldehyde dehydrogenase by a putative metabolite of cefamandole." Infection 14 (1986): 44-7

5. "Product Information. Mandol (cefamandole)." Lilly, Eli and Company, Indianapolis, IN.

6. Filipe P, Almeida RSLS, Rodrigo FG "Occupational allergic contact dermatitis from cephalosporins." Contact Dermatitis 34 (1996): 226

7. Argenyi ZB, Bergfeld WF, Valenzuela R, et al "Adult linear IgA disease associated with an erythema multiforme-like drug reaction." Cleve Clin J Med 54 (1987): 445-50

8. Rienhoff HY "Toxic epidermal necrolysis." Johns Hopkins Med J 151 (1982): 326-31

9. O'Donnell D "Hypoprothrombinaemia associated with use of cephamandole." Aust N Z J Surg 61 (1991): 471-2

10. Sanburg AL, Hughes JD, Nichols C "Antibiotic-induced hypoprothrombinaemia." Med J Aust 143 (1985): 387-8

11. Bertino JS, Kozak AJ, Reese RE, Chiarello LA "Hypoprothrombinemia associated with cefamandole use in a rural teaching hospital." Arch Intern Med 146 (1986): 1125-8

12. Tibbitts JS, Lipsky JJ "Effect of biliary diversion on the ability of cefamandole to inhibit vitamin K metabolism." Drug Metabol Drug Interact 7 (1989): 149-60

13. Clark J, Hochman R, Rolla A, et al "Coagulopathy associated with the use of cephalosporin or moxalactam antibiotics in acute and chronic renal failure." Clin Exp Dial Apheresis 7 (1983): 177-90

14. Csanyi P, Rado JP, Hormay M "Acute renal failure due to cephamandole." Br Med J 296 (1988): 455

Some side effects of cefamandole may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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