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Cephalothin Side Effects

Medically reviewed by Drugs.com. Last updated on Dec 2, 2023.

Applies to cephalothin: injectable powder for injection, intravenous solution.

Hypersensitivity

Hypersensitivity reactions occur in up to 15% of patients with a history of penicillin allergy. Manifestations may include urticarial or maculopapular rash, bronchospasm, and drug fever. Anaphylaxis, including severe hypotension and cardiac arrest, is reported.[Ref]

Rare cases of renal insufficiency associated with cephalothin may be hypersensitivity-mediated since fever, eosinophilia, and rash are often also present.

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]

Renal

Renal side effects including renal insufficiency is rarely reported during therapy with most cephalosporins. Nephrotoxicity appears to be slightly more likely during cephalothin therapy, however. Risk factors include concomitant aminoglycoside therapy, preexisting renal insufficiency, elevated serum aminoglycoside levels, and high dose cephalothin therapy. Cephalothin may worsen renal function in patients with renal insufficiency. Frequent monitoring of the serum creatinine, maintenance of intravascular volume, and avoidance of potentially nephrotoxic agents during cephalothin therapy is recommended.[Ref]

Predisposing risk factors for nephrotoxicity include preexisting renal insufficiency, concomitant use of other potentially nephrotoxic drugs, and dehydration. Renal biopsy results in patients with suspected cephalothin-induced renal insufficiency have shown tubulo-interstitial nephritis. The mechanism may be hypersensitivity-mediated.[Ref]

Hematologic

Hematologic side effects include thrombocytopenia, hemolytic anemia, and rare cases of pancytopenia.[Ref]

One case of reversible aplastic anemia associated with cephalothin has been reported.[Ref]

Gastrointestinal

Gastrointestinal side effects are unusual. Rare cases of pseudomembranous colitis associated with cephalothin are reported.[Ref]

Hepatic

Hepatic side effects are rare. Increases in serum transaminases associated with cephalothin are reported.[Ref]

Nervous system

Nervous system side effects are rare, and include reports of delirium and confusion.[Ref]

In rare cases of suspected cephalothin-associated confusion, cerebrospinal fluid has been sterile, but has, in rare cases shown high levels of drug.[Ref]

Other

Intravenous site phlebitis has been reported in up to 55% of patients.[Ref]

The incidence of phlebitis may be reduced by frequent intravenous site care and the addition of heparin 500 units and hydrocortisone 10 mg to each liter of intravenous cephalothin.[Ref]

Women may experience an increased incidence of vaginal yeast infections while receiving cephalothin.[Ref]

References

1. Velazquez JL, Gold MI. Anaphylactic reaction to cephalothin during anesthesia. Anesthesiology. 1975;43:476-8.

2. Barrientos A, Bello I, Gutierrez-Millet V. Letter; Renal failure and cephalothin. Ann Intern Med. 1976;84:612.

3. Wilson FM, Retan JW, Lerner AM. Clinical studies with cephalothin. J Urol. 1966;96:534-40.

4. Scholand JF, Tennenbaum JI, Cerilli GJ. Anaphylaxis to cephalothin in a patient allergic to penicillin. JAMA. 1968;206:130-2.

5. Thoburn R, Johnson JE, Cluff LE. Studies on the epidemiology of adverse drug reactions. IV. The relationship of cephalothin and penicillin allergy. JAMA. 1966;198:345-8.

6. Jeannet M, Bloch A, Dayer JM, Farquet JJ, Girard JP, Cruchaud A. Cephalothin-induced immune hemolytic anemia. Acta Haematol. 1976;55:109-17.

7. Filipe P, Almeida RSLS, Rodrigo FG. Occupational allergic contact dermatitis from cephalosporins. Contact Dermatitis. 1996;34:226.

8. Pasternak DP, Stephens BG. Reversible nephrotoxicity associated with cephalothin therapy. Arch Intern Med. 1975;135:599-602.

9. Fanning WL, Gump D, Jick H. Gentamicin- and cephalothin-associated rises in blood urea nitrogen. Antimicrob Agents Chemother. 1976;10:80-2.

10. Wade JC, Schimpff SC, Wiernik PH. Antibiotic combination - associated nephrotoxicity in granulocytopenic patients with cancer. Arch Intern Med. 1981;141:1789-93.

11. Hansen MM, Kaaber K. Nephrotoxicity in combined cephalothin and gentamicin therapy. Acta Med Scand. 1977;201:463-7.

12. Engle JE, Drago J, Carlin B, Schoolwerth AC. Letter: Reversible acute renal failure after cephalothin. Ann Intern Med. 1975;83:232-3.

13. Carling PC, Idelson BA, Casano AA, Alexander EA, McCabe WR. Nephrotoxicity associated with cephalothin administration. Arch Intern Med. 1975;135:797-801.

14. Burton JR, Lichtenstein NS, Colvin RB, Hyslop NE, Jr. Acute renal failure during cephalothin therapy. JAMA. 1974;229:679-82.

15. Simpson IJ. Nephrotoxicity and acute renal failure associated with cephalothin and cephaloridine. N Z Med J. 1971;74:312-5.

16. Pickering MJ, Spooner GR, Quesada A, de Cade JR. Declining renal function associated with administration of cephalothin. South Med J. 1970;63:426-8.

17. Benner EJ. Renal damage associated with prolonged administration of ampicillin, cephaloridine, and cephalothin. Antimicrob Agents Chemother. 1969;9:417-20.

18. Foord RD. Cephaloridine, cephalothin and the kidney. J Antimicrob Chemother. 1975;1:119-33.

19. Tartas NE, Bullorsky EO, Hevia JEJ, Avalos JCS. Pancytopenia induced by cephalothin. JAMA. 1981;245:1148-9.

20. Gralnick HR, McGinniss M, Halterman R. Thrombocytopenia with sodium cephalothin therapy. Ann Intern Med. 1972;77:401-4.

21. Sheiman L, Spielvogel AR, Horowitz HI. Thrombocytopenia caused by cephalothin sodium. Occurrence in a penicillin-sensitive individual. JAMA. 1968;203:601-3.

22. Molthan L, Reidenberg MM, Eichman MF. Positive direct Coombs tests due to cephalothin. N Engl J Med. 1967;277:123-5.

23. Moake JL, Butler CF, Hewell GM, Cheek J, Spruell MA. Hemolysis induced by cefazolin and cephalothin in a patient with penicillin sensitivity. Transfusion. 1978;18:369-73.

24. Coleman DL, Juergensen PH, Brand MH, Finkelstein FO. Antibiotic associated diarrhoea during administration of intraperitoneal cephalothin. Lancet. 1981;May:1004.

25. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR. Cephalosporin-associated pseudomembranous colitis. Am J Dig Dis. 1978;23:321-6.

26. Miller WI, Souney PF, Chang JT. Hepatic dysfunction following nafcillin and cephalothin therapy in a patient with a history of oxacillin hepatitis. Clin Pharm. 1983;2:465-8.

27. Wu MJ, Narsette TA, Hussey JL, Weinstein AB, Wen SF. Cephalothin neurotoxicity in renal failure. Ann Intern Med. 1978;89:429.

28. Sorrentino AP, Haughey EJ, JR, Cronin DW, Bohen LN. Phlebitis associated with the intravenous use of cephalothin and cephapirin. Am J Hosp Pharm. 1976;33:642-4.

29. Siebert WT, Westerman EL, Smilack JD, Bradshaw MW, Williams TW, Jr. Comparison of thrombophlebitis associated with three cephalosporin antibiotics. Antimicrob Agents Chemother. 1976;10:467-9.

30. Cross AS, Tramont EC. Comparison of phlebitis produced by cephapirin and cephalothin. Antimicrob Agents Chemother. 1976;9:722-4.

31. Carrizosa J, Levison ME, Kaye D. Double-blind controlled comparison of phlebitis produced by cephapirin and cephalothin. Antimicrob Agents Chemother. 1973;3:306-7.

32. Spruill FG, Minette LJ, Sturner WQ. Two surgical deaths associated with cephalothin. JAMA. 1974;229:440-1.

33. Maddox RR, Rush DR, Rapp RP, Foster TS, Mazella V, McKean HE. Double-blind study to investigate methods to prevent cephalothin- induced phlebitis. Am J Hosp Pharm. 1977;34:29-34.

34. Shemonsky NK, Carrizosa JC, Kaye D, Levison ME. Double-blind comparison of phlebitis produced by cefazolin versus cephalothin. Antimicrob Agents Chemother. 1975;7:481-2.

35. Product Information. Keflin (cephalothin). Lilly, Eli and Company. 2001;PROD.

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