Anti Infectives
- Cephalosporins
Generic Trade Use Dose
n/a Infections due to susceptible
microorganisms, 1–2 g/day orally in divided doses
Cefoxitin Mefoxin 250 mg orally q 8 hr
Infections due to susceptible
microorganisms,
perioperative prophylaxis
Cefadroxil
Generations Of Cephalosporins
•
First generation—cephalexin (Keflex), cefazolin (Ancef)
•
Second generation—cefaclor (Raniclor), cefoxitin (Mefoxin),
cefuroxime (Zinacef)
•
Third generation—cefoperazone (Cefobid),
cefotaxime (Claforan), ceftriaxone (Rocephin)
•
Fourth generation—cefepime (Maxipime)
Nursing management
•
Before administering any antibiotic be sure to evaluate the
results of the culture and sensitivity test.
•
Be sure to question the patient about allergy to penicillin or
cephalosporins before administering the first dose, even when
an accurate drug history has been taken
•
After administering penicillin IM in the outpatient setting, ask
the patient to wait in the area for at least 30 minutes.
Anaphylactic reactions are most likely to occur within 30
minutes after injection.
•
Take the drug at the prescribed time intervals.
•
Complete the entire course of treatment. Do not stop the drug,
except on the advice of a primary health care provider, before
the course of treatment is completed, even if symptoms
improve or disappear. Failure to complete the prescribed
course of treatment may result in a return of the infection.
•
Take drugs that must be taken on an empty stomach 1 hour
before or 2 hours after a meal.
•
Distinguish between immediate- and extended-release
medications. Do not break, chew, or crush
extended-release medications.
How do they work? “Action”
Cephalosporins have a β-lactam ring and target the bacterial cell
wall, making it defective and unstable. This action is similar to
the action of penicillin. The cephalosporins are usually
bactericidal. (Ford 73)
Indications
•
Respiratory infections
•
Otitis media (ear infection)
•
Bone/joint infections
•
Genitourinary tract and other infections caused
by bacteria
Adverse Reactions
•
Nephrotoxicity
•
Malaise
•
Steven johnson syndrome
•
Nausea
•
Vomiting
•
Diarrhea
•
Headache
•
Dizziness
•
Heartburn
•
Fever
•
Aplastic anemia (deficient red blood cell
production)
•
Toxic epidermal necrolysis (death of the epidermal
layer of the skin)
Contraindications & Caution
•
Do not administer cephalosporins if the patient has a history
of allergies to cephalosporins.
•
Cephalosporins should be used cautiously in patients with
renal disease, hepatic impairment, bleeding disorder,
pregnancy (pregnancy category B), and known penicillin
allergy. (Ford 73)
Interactions:
•
Aminoglycosides: Increased risk for nephrotoxicity
•
Oral anticoagulants: Increased risk for bleeding
•
Loop diuretics: Increased cephalosporin blood level
Nursing Alert
• A patient who is allergic to penicillin also may be allergic to the
cephalosporins.
• A disulfiram-like (Antabuse) reaction may occur if alcohol is
consumed within 72 hours after administration of certain
cephalosporins
• Symptoms of a disulfiram-like reaction: include flushing,
throbbing in the head and neck, respiratory difficulty,
vomiting, sweating, chest pain, and hypotension. Severe
reactions may cause dysrhythmias and unconsciousness.
• People with phenylketonuria (PKU) need to be aware that the
oral suspension cefprozil (Cefzil) contains phenylalanine,
a substance that people with PKU cannot process.
