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Paul A. Pham Pharm.D. and John G. Bartlett M.D.
10-21-2008
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Available formulation in Zambia: Capsule: 250 mg, 500 mg. Powder for Suspension: 125 mg/5mL, 250 mg/5mL.
- First generation cephalosporin that can be used as alternative to PCN for treatment of skin and soft tissue infections.
- Usual adult dose: 250-500 mg every 6 hours
- Pediatric dose: 25-50 mg/kg divided q6h
Zambia Information Author: Paul A. Pham, Pharm. D.
- Respiratory tract infections S. pneumoniae and S. pyogenes (author's comment: generally not recommended)
- Otitis media caused by S. pneumoniae, H. influenzae, MSSA, S. pyogenes, and M. catarrhalis
- Skin and skin-structure infections caused by S. pyogenes and S. aureus (MSSA)
- Osteomyelitis : MSSA and/or P. mirabilis (author's comment: not a first-line agent)
- Urinary tract infections including acute prostatitis caused by E. coli, P. mirabilis, and K. pneumoniae (author's comment: not a first-line agent)
- Furuncle/Carbuncle (MSSA)
- Impetigo
- Cellulitis/Erysipelas
- Folliculitis (MSSA)
- Bacterial Cystitis, Acute, Uncomplicated
- Mastitis (MSSA)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Panixine Disperdose | Cephalexin | Ranbaxy | PO
tab
250mg | $1.14 |
|
|
|
| PO
tab
500mg | $2.25 |
| Keflex | Cephalexin | Advantus Pharm | PO
cap
250mg | $0.69 |
|
|
|
| PO
cap
500mg | $1.21 |
|
|
|
| PO
cap
750mg | $3.12 |
|
|
|
| PO
susp
125mg/5mL | $8.93 per 100mL |
|
|
|
| PO
susp
250mg/5ml | $18.90 per 100mL |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
.
- Mild skin infections (Streptococcal pharyngitis and uncomplicated cystitis): consider 500mg PO q12h.
- Mild to moderate infections: 250-500 mg PO q6h
- Severe infections: consider an IV cephalosporin
Usual dose.
0.25Gm-1.0Gm q8-12h.
0.25Gm-1Gm q24-48h.
0.25Gm-1Gm q24h plus 0.25-1.0 Gm post-dialysis.
250 mg three times a day.
No data. Consider 1Gm q12h.
- Allergic reactions (eosinophilia)
- Diarrhea and C. difficile colitis
- Positive Coombs' test (without hemolytic anemia)
- Drug fever
- Neutropenia and thrombocytopenia
- Hepatitis
- Anaphylaxis reaction
- CNS: convulsions (high dose with renal failure), confusion, disorientation, and hallucinations.
- Hemolytic anemia (theoretical, case reports with ceftriaxone, cefotetan, cefoxitin, cefamandole, ceftazidime, and cefalothin)
Probenecid: increase in cephalosporin serum concentration due to inhibition of tubular secretion by probenecid. No dose adjustment needed, but close monitoring recommended in ESRD.
Well absorbed 1st generation cephalosporin with good gram positive coverage and a low price but q6-8h dosing may decrease patient compliance. With the increasing prevalence of community-acquired MRSA soft tissue infections, use of cephalexin for moderate or serious infections should be guided by sensitivity data.
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