CEPHRADINE

CEPHRADINE
(sef'ra-deen)
Anspor, Velosef
Classifications: antibiotic; first-generation cephalosporin;
Therapeutic: antibiotic
; cephalosporin
Prototype: Cefazolin
Pregnancy Category: B

Availability

250 mg, 500 mg capsules; 125 mg/5 mL, 250 mg/5 mL suspension

Action

Semisynthetic acid-stable, first-generation cephalosporin. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium.

Therapeutic Effect

Broad-spectrum antibiotic that is active against many gram-positive aerobic cocci and much less active against gram-negative bacteria.

Uses

Serious infections of respiratory and urinary tracts, skin and soft tissues, and for otitis media caused by susceptible pathogens; for perioperative prophylaxis, in cesarean section (intraoperative and postoperative); in septicemia (due to Streptococcus pneumoniae, Staphylococcus aureus, Proteus mirabilis, and Escherichia coli). Also used to treat urinary tract infections due to Klebsiella sp. and enterococci (Streptococcus faecalis).

Contraindications

Hypersensitivity to cephalosporins and related antibiotics; viral infections. Safe use in children <9 mo not established.

Cautious Use

History of penicillin or other allergies, particularly to drugs; impaired renal function, sodium restriction (parenteral cephradine); coagulopathy, GI disease, colitis, pregnancy (category B), lactation.

Route & Dosage

Mild to Moderate Infection
Adult: PO 250–500 mg q6h or 500 mg–1 g q12h up to 4 g/d
Child: PO 25–50 mg/kg/d in 2–4 divided doses up to 4 g/d

Perioperative Prophylaxis
Adult: PO 1 g 30–60 min before surgery; 1 g during surgery; then 1 g q4–6h for 24 h

Administration

Oral
  • Oral cephradine may be given without regard to meals (acid stable); however, the presence of food may delay absorption.

Adverse Effects (≥1%)

Body as a Whole: Joint pains, eosinophilia, tightness in chest, pain, induration and tissue sloughing (IM injection site); thrombophlebitis (IV site); paresthesias, superinfections. GI: Diarrhea or loose stools, abdominal pain, heartburn. CNS: Dizziness. Skin: Urticaria, rash, pruritus.

Diagnostic Test Interference

Cephradine causes false-positive (black-brown or green-brown color) urine glucose reaction with copper reduction reagents (e.g., as Benedict's or Clinitest), but not with enzymatic glucose oxidase reagents (e.g., Clinistix, TesTape). False-positive direct Coombs' test (may interfere with cross-matching procedures and hematologic studies) has also been reported.

Interactions

Drug: Probenecid decreases renal elimination of cephradine.

Pharmacokinetics

Absorption: Well absorbed from GI tract. Peak: 1 h. Distribution: Widely distributed in body fluids, with highest concentration in kidney; crosses placenta. Elimination: 80–90% eliminated unchanged in urine in 6 h; excreted in breast milk. Half-Life: 1–2 h.

Nursing Implications

Assessment & Drug Effects

  • Determine history of previous hypersensitivity to cephalosporins, penicillins, and other drug allergies before therapy is initiated.
  • Inspect IV insertion site frequently for thrombophlebitis (see Signs & Symptoms, Appendix F).
  • Lab tests: Perform culture and sensitivity tests and renal function studies before and periodically during drug therapy.
  • Consult physician if patient's creatinine clearance is below normal. Recommended dosage schedule in patients with reduced renal function is lowered based on creatinine clearance determinations and severity of infection.
  • Pseudomembranous enterocolitis, a potentially life-threatening superinfection caused by Clostridium difficile, may occur during or after cephalosporin therapy. If diarrhea occurs, check for fever. Report diarrhea and fever promptly.
  • Monitor for signs of superinfection (see Appendix F). Report their appearance promptly.

Patient & Family Education

  • Take this medication for the full course of therapy as directed by your physician. Therapy is usually continued for at least 48–72 h after you become asymptomatic.
  • Superinfections caused by overgrowth of nonsusceptible organisms may occur. Report early S&S (see Appendix F) promptly.
  • Report loose stools or diarrhea promptly.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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