Category:

• Antibiotic

Description:

• Cephalosporin, Third Generation

Indications:

• Lower respiratory tract infections (S. pneumoniae, S. pyogenes and other streptococci, H. influenzae, Klebsiella species, S. aureus, E. coli,H. influenzae, H. parainfluenzae, Serratia marcescens, Enterobacter species, P. mirabilis)

• Urinary tract infections (Enterococcus species, S. aureus, S. epidermidis, Citrobacter sepcies, Enterobacter species, E. coli, Klebsiella species, P. mirabilis, P. vulgaris, P. inconstans group B, Providencia rettgeri, Morganella morganii, S. marcescens, Pseudomonas species)

• Uncomplicated gonorrhea (N. gonorrhoeae)

• Gynecological infections (S. epidermidis, streptococci, Enterococcus, Enterobacter species, E. coli, Klebsiella species,P. mirabilis, Bacteroides species, Clostridium species, anaerobic cocci (Peptococcus and Peptostreptococcus), Fusobacterium species)

• Intra-abdominal infections (E. coli, S. epidermidis, Streptococcus species, Enterobacter species, Klebsiella species, Bacteroides species, Peptococcus and Peptostreptococcus species)

• Bacteremia/septicemia (Klebsiella species, E. coli, S. marcescens, S. aureus, streptococci)

• Skin, bone and joint infections (S. aureus, S. epidermidis, S. pyogenes, Actinetobacter species, E. coli, Citrobacter species, Klebsiella species, M. morganii, P. mirabilis, S. marcescens, P. rittgeri, P. vulgaris, Pseudomonas species, Enterococcus, Enterobacter, Bacteriodes species and anaerobic cocci (including Peptococcus and Peptostreptococcus species))

• CNS infections/meningitis (H. influenzae, N. meningitidis, S. pneumoniae, K. pneumoniae, 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

Adverse Reactions (Side Effects):

• Hypersensitivity reactions

• Gastrointestinal: nausea, vomiting, diarrhea

• Vaginitis

Dosage:

• Administered by injection (IM and IV)

• Adults:

  • dose should not exceed 12 grams per day

• gonococcal urethritis/cervicitis: 

  • 500mg IM single dose

• rectal gonorrhea (female): 

  • 500mg IM single dose

• rectal gonorrhea (male): 

  • 1 gram IM single dose

• uncomplicated infections: 

  • 1 gram IV or IM every 12 hours

• moderate to severe infections: 

  • 1-2 grams IV or IM every 8 hours

• other sites 

  • 1 gram IV or IM every 8-12 hours

• infections generally requiring high dose (septicemia): 

  • 2 grams IV every 6-8 hours

• life-threatening infections: 

  • 2 grams IV every 6-8 hours

• peri-operative prophylaxis: 

  • 1 gram IV or IM, 30-90 minutes pre-op

• Cesarean section: 

  • administer 1^st 1 gram dose IV as soon as umbilical cord is clamped, then 2d and 3^rd doses of 1 gram IV or IM at 6 and 12 hour intervals after first dose

• Child (0-1 week)

  • 50mg/kg IV every 12 hours

• Child (1-4 weeks)

  • 50mg/kg IV every 8 hours

• Child (1 month – 12 years)

  • 50-180mg/kg/day IV or IM in 4 to 6 divided doses

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