No

Antibiotic, Cephalosporin (Second Generation)

Second generation cephalosporin, useful for susceptible aerobic and anaerobic gram-positive and gram-negative bacteria; surgical prophylaxis, specifically colorectal and OB-GYN

B

Hypersensitivity to cefmetazole or any component or cephalosporins

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; use with caution in patients with a history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis, urticaria); may cause antibiotic-associated colitis or colitis secondary to C. difficile

Contains MTT side chain which may lead to increased risk of hypoprothrombinemia and bleeding.

Dermatologic: Rash

Gastrointestinal: Diarrhea

<1%: Pain at injection site, phlebitis, pseudomembranous colitis, epigastric pain, candidiasis, bleeding, shock, hypotension, headache, hot flashes, dyspnea, epistaxis, respiratory distress, fever, vaginitis

Other reactions with cephalosporins include anaphylaxis, seizures, toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, renal dysfunction, interstitial nephritis, toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, pancytopenia, neutropenia, agranulocytosis, colitis, superinfection

Symptoms of overdose include neuromuscular hypersensitivity, convulsions especially with renal insufficiency; many beta-lactam antibiotics have the potential to cause neuromuscular hyperirritability or seizures

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed.

Increased effect: Probenecid may decrease cephalosporin elimination

Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity

Reconstituted solution and I.V. infusion in NS or D₅W solution are stable for 24 hours at room temperature, 7 days when refrigerated, or 6 weeks when frozen; after freezing, thawed solution is stable for 24 hours at room temperature or 7 days when refrigerated

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: I.M.: Well absorbed

Distribution: Widely distributed

Protein binding: 65%

Metabolism: <15%

Half-life: 72 minutes

Elimination: Renal

Adults: I.V.:

Prophylaxis: 2 g 30-90 minutes before surgery or 1 g 30-90 minutes before surgery; repeat 8 and 16 hours later

Dosing interval in renal impairment:

Cl_cr 50-90 mL/minute: Administer every 12 hours

Cl_cr 10-50 mL/minute: Administer every 16-24 hours

Cl_cr <10 mL/minute: Administer every 48 hours

Monitor prothrombin times; observe for signs and symptoms of anaphylaxis during first dose

Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction

May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins

May rarely cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This drug is administered I.V. or I.M. Drink 2-3 L fluid/day. Avoid alcohol during therapy and for 72 hours after last dose (may cause severe disulfiram-like reactions). If diarrhea occurs, yogurt or buttermilk may help. May cause false-positive test with Clinitest®; use another form of testing. May interfere with oral contraceptives; additional contraceptive measures are necessary. Report severe, unresolved diarrhea; vaginal itching or drainage; sores in mouth; blood, pus, or mucus in stool or urine; easy bleeding or bruising; unusual fever or chills; rash; or respiratory difficulty. Breast-feeding precautions: Consult prescriber if breast-feeding.

Do not admix with aminoglycosides in same bottle/bag

Powder for injection, as sodium: 1 g, 2 g

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Donowitz GR and Mandell GL, "Drug Therapy. Beta-Lactam Antibiotics (1)," N Engl J Med, 1988, 318(7):419-26.

Donowitz GR and Mandell GL, "Drug Therapy. Beta-Lactam Antibiotics (2)," N Engl J Med, 1988, 318(8):490-500.

Jones RN, "Review of the In vitro Spectrum and Characteristics of Cefmetazole (CS-1170)," J Antimicrob Chemother, 1989, 23(Suppl D):1-12.

Marshall WF and Blair JE, "The Cephalosporins," Mayo Clin Proc, 1999, 74(2):187-95.

Plouffe JF, "Cefmetazole Versus Cefoxitin in Prevention of Infections After Abdominal Surgery," J Antimicrob Chemother, 1989, 23(Suppl D):85-8.