Category:

Antibiotic

Description:

Cephalosporin, Second Generation

Indications:

• Oral tablets/suspension:

  • pharyngitis/tonsillitis (S. pyogenes)

  • otitis media (S. pneumoniae, H. influenzae, M. catarrhalis, S. pyogenes)

  • acute bacterial maxillary sinusitis (S. pneumoniae, H. influenzae)

  • acute bacterial exacerbation of chronic bronchitis, secondary infections due to acute bronchitis (S. pneumoniae, H. influenzae, H. parainfluenzae)

  • urinary tract infections (E. coli, K. pneumoniae)

  • skin infections (S. aureus, S. pyogenes)

  • uncomplicated gonorrhea (N. gonorrhoeae)

  • early Lyme disease (Borrelia burgdorferi)

• Parenteral

  • lower respiratory tract (S. pneumoniae, H. influenzae, Klebsiella species, S. aureus, S. pyogenes, E. coli)

  • urinary tract infections (E. coli, K. pneumoniae)

  • septicemia (S. pneumoniae, H. influenzae, Klebsiella species, S. aureus, S. pyogenes, E. coli)

  • meningitis (N. meningitidis)

  • gonorrhea (N. gonorrhoeae)

  • skin, bone and joint infections (S. aureus, S. pyogenes, Enterobacter species, Klebsiella species, E. coli)

Contraindications:

• Cross sensitivity with penicillin allergies

Precautions:

• Pregnancy category B

• Use with caution in patients with penicillin allergy (5-10% chance of cross-reactivity)

• Dosage modifications are generally only required in patients with severe renal impairment

• Counsel patient to finish all medication to prevent development of resistance

• Do not crush tablets, swallow whole or use suspension dosing

• NOTE: oral tablets and suspension are NOT bioequivalent

Adverse Reactions (Side Effects):

• Hypersensitivity reactions

• Gastrointestinal: nausea, vomiting, diarrhea

• Vaginitis

Dosage:

• Administered orally (tablets and suspension) and by injection (IV or IM)

• Pharyngitis/tonsillitis:

  • Adults (> 13 years): 250mg bid for 10 days

  • Children: 125mg tablets bid for 10 days or 20mg/kg/day (susp) divided bid for 10 days

• Otitis media:

  • Adults (>13 years): 250mg bid for 10 days

  • Children: 250mg tablets bid for 10 days or 30mg/kg/day (susp) divided bid for 10 days

• Impetigo:

  • 30mg/kg/day (susp) divided bid for 10 days

• Acute bacterial exacerbation of chronic bronchitis/secondary infections of to acute bronchitis:

  • Adults (> 13 years): 250-500mg bid for 5-10 days

• Urinary tract infections:

  • Adults: 125-250mg bid tablets for 7-10 days or 2.25 grams per day (750mg q8h IV)

• Uncomplicated skin infections:

  • Adults: 250-500mg bid tablets for 10 days or 2.25 grams per day (750mg q8h IV)

• Uncomplicated gonorrhea infections:

  • 1000mg tablets one dose or 1.5 grams IM one dose

• Disseminated gonococcal:

  • 2.25 grams per day (750mg q8h IV)

• Early Lyme disease:

  • Adults: 500mg bid for 20 days

• Uncomplicated pneumonia:

  • 2.25 grams per day (750mg q8h IV)

• Severe or complicated infections and bone or joint infections:

  • 4.5 grams per day (1.5 grams q8h IV)

• Life-threatening infections:

  • 6 grams per day (1.5 grams q6h IV)

• Bacterial meningitis:

  • 9 grams per day (<3 grams q8h IV)

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001