No

Antibiotic, Cephalosporin (Second Generation)

Treatment of susceptible bacterial infection; mainly respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic, septicemia; active against methicillin-sensitive staphylococci, many streptococci, and various gram-negative bacilli including E. coli, some Klebsiella, P. mirabilis, H. influenzae, and Moraxella.

B

Hypersensitivity to cefonicid sodium, 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

1% to 10%:

Hematologic: Increased eosinophils (2.9%), increased platelets (1.7%)

Hepatic: Altered liver function tests (increased transaminases, LDH, alkaline phosphatase) (1.6%)

Local: Pain, burning at injection site (5.7%)

<1%: Fever, rash, pruritus, erythema, anaphylactoid reactions, diarrhea, pseudomembranous colitis, abdominal pain, increased transaminases, increased BUN, increased creatinine, interstitial nephritis, neutropenia, decreased WBC, thrombocytopenia

Other reactions with cephalosporins include anaphylaxis, seizures, Stevens-Johnson syndrome, toxic epidermal necrolysis, renal dysfunction, toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, pancytopenia, 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 or 72 hours if 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 into most body tissues with low concentrations in CSF and eye

Protein binding: 98%

Metabolism: None

Half-life: 3.5-5.8 hours

Elimination: Unchanged in urine

Adults: I.M., I.V.: 0.5-2 g every 24 hours

Dosing interval in renal impairment: Dosing based on Cl_cr (mL/minute/1.73 m²)

Cl_cr 60-79: 10-24 mg/kg q24h

Cl_cr 40-59: 8-20 mg/kg q24h

Cl_cr 20-39: 4-15 mg/kg q24h

Cl_cr 10-19: 4-15 mg/kg q48h

Cl_cr 5-9: 4-15 mg/kg q3-5d

Cl_cr <5: 3-4 mg/kg q3-5d

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 medication is administered I.M. or I.V. Drink 2-3 L fluid/day. 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.

I.M. injection into relatively large muscle and aspirate; dose of 2 g should be divided in half and administered into two separate sites

Powder for injection, as sodium: 500 mg, 1 g, 10 g

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

Gustaferro CA and Steckelberg JM, "Cephalosporin Antimicrobial Agents and Related Compounds," Mayo Clin Proc, 1991, 66(10):1064-73.

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