Yes

Antibiotic, Cephalosporin (First Generation)

Treatment of infections when caused by susceptible strains in respiratory, genitourinary, gastrointestinal, skin and soft tissue, bone and joint infections; treatment of susceptible gram-positive bacilli and cocci (never enterococcus); some gram-negative bacilli including E. coli, Proteus, and Klebsiella may be susceptible

B

Hypersensitivity to cephradine, 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%: Gastrointestinal: Diarrhea

<1%: Rash, nausea, vomiting, pseudomembranous colitis, increased BUN, increased creatinine

Other reactions with cephalosporins include anaphylaxis, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome, dizziness, fever, headache, encephalopathy, asterixis, neuromuscular excitability, seizures, neutropenia, leukopenia, agranulocytosis, pancytopenia, aplastic anemia, hemolytic anemia, interstitial nephritis, toxic nephropathy, vaginitis, angioedema, cholestasis, hemorrhage, prolonged PT, serum-sickness reactions, 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: High-dose probenecid decreases clearance

Increased toxicity: Aminoglycosides increase nephrotoxic potential

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: Well absorbed

Distribution: Widely distributed into most body tissues and fluids including gallbladder, liver, kidneys, bone, sputum, bile, and pleural and synovial fluids; CSF penetration is poor; crosses the placenta and appears in breast milk

Protein binding: 18% to 20%

Half-life: 1-2 hours

Time to peak serum concentration: Oral: Within 1-2 hours

Elimination: ~80% to 90% unchanged drug is recovered in urine within 6 hours

Oral:

Adults: 250-500 mg every 6-12 hours

Dosing adjustment in renal impairment: Adults:

Cl_cr 10-50 mL/minute: 250 mg every 6 hours

Cl_cr <10 mL/minute: 125 mg every 6 hours

May administer with food to decrease GI distress; however there is delayed absorption

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, false-positive urinary proteins and steroids

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

Oral: Take as directed, at regular intervals around-the-clock (with or without food). Chilling oral suspension improves flavor (do not freeze). Complete full course of medication, even if you feel better. 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.

Administer around-the-clock to promote less variation in peak and trough serum levels; I.M. doses should be administered deep into a large muscle mass (ie, gluteus maximus)

Stability: Reconstituted solution is stable for 2 hours at room temperature and 24 hours when refrigerated; for I.V. infusion in normal saline or D₅W solution is stable for 10 hours at room temperature, 48 hours when refrigerated or 6 weeks when frozen; after freezing, thawed solution is stable for 10 hours at room temperature or 48 hours when refrigerated

Capsule: 250 mg, 500 mg

Powder for injection: 250 mg, 500 mg, 1 g, 2 g, (in ready-to-use infusion bottles)

Powder for oral suspension: 125 mg/5 mL (5 mL, 100 mL, 200 mL); 250 mg/5 mL (5 mL, 100 mL, 200 mL)

"Advisory Statement. Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements. American Dental Association; American Academy of Orthopedic Surgeons," J Am Dent Assoc, 1997, 128(7):1004-8.

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.

Smith GH, "Oral Cephalosporins in Perspective," DICP, 1990, 24(1):45-51.

Wise R, "The Pharmacokinetics of the Oral Cephalosporins - A Review," J Antimicrob Chemother, 1990, 26(Suppl E):13-20.