l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous infusion (Amikin ®);
intermittent in Glucose 5% or Sodium chloride 0.9%. To be
l PRESCRIBING AND DISPENSING INFORMATION Once daily
dose regimen not to be used for endocarditis, febrile
neutropenia, or meningitis. Consult local guidelines.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
Amikacin (as Amikacin sulfate) 250 mg per 1 ml Amikacin
500mg/2ml solution for injection vials | 5 vial P £60.00 (Hospital
▶ Amikin (Bristol-Myers Squibb Pharmaceuticals Ltd)
Amikacin (as Amikacin sulfate) 50 mg per 1 ml Amikin 100mg/2ml
solution for injection vials | 5 vial P £10.33
Gram-positive bacterial endocarditis or HACEK
endocarditis (in combination with other antibacterials)
▶ BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult: 1 mg/kg every 12 hours, intravenous injection to
be administered over at least 3 minutes, to be given in
Pneumonia in hospital patients | Adjunct in listerial
▶ BY INTRAVENOUS INFUSION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAMUSCULAR INJECTION
▶ Adult: 3–5 mg/kg daily in 3 divided doses, to be given
in a multiple daily dose regimen, divided doses to be
given every 8 hours, intravenous injection to be
administered over at least 3 minutes
▶ Adult: Initially 5–7 mg/kg, subsequent doses adjusted
according to serum-gentamicin concentration, to be
given in a once daily dose regimen
CNS infections (administered on expert advice)
▶ Adult: 1 mg daily, increased if necessary to 5 mg daily,
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1.5 mg/kg, intravenous injection to be
administered over at least 3 minutes, administer dose
up to 30 minutes before the procedure, dose may be
repeated every 8 hours for high-risk procedures; up to
Surgical prophylaxis in joint replacement surgery
▶ Adult: 5 mg/kg for 1 dose, administer dose up to
30 minutes before the procedure
DOSES AT EXTREMES OF BODY-WEIGHT
▶ With intramuscular use or intravenous use To avoid excessive
dosage in obese patients, use ideal weight for height to
calculate parenteral dose and monitor serum-gentamicin
MHRA/CHM ADVICE: POTENTIAL FOR HISTAMINE-RELATED
ADVERSE DRUG REACTIONS WITH SOME BATCHES (NOVEMBER
Following reports that some batches of gentamicin
sulphate active pharmaceutical ingredient (API) used to
manufacture gentamicin may contain higher than
expected levels of histamine, which is a residual from the
manufacturing process, the MHRA advise to monitor
patients for signs of histamine-related adverse reactions;
particular caution is required in patients taking
concomitant drugs known to cause histamine release, in
children, and in patients with severe renal impairment.
l INTERACTIONS → Appendix 1: aminoglycosides
reaction . neurotoxicity . peripheral neuropathy . seizure . stomatitis . vestibular damage
▶ With intramuscular use or intravenous use For multiple daily
dose regimen, one-hour (‘peak’) serum concentration
should be 5–10 mg/litre; pre-dose (‘trough’) concentration
should be less than 2 mg/litre. For multiple daily dose
regimen in endocarditis, one-hour (‘peak’) serum
concentration should be 3–5 mg/litre; pre-dose (‘trough’)
4 doses, then at least every 3 days and after a dose change
(more frequently in renal impairment).
▶ With intravenous use For once-daily dose regimen, consult
local guidelines on monitoring serum-gentamicin
l DIRECTIONS FOR ADMINISTRATION
▶ With intrathecal use For intrathecal injection, use
preservative-free intrathecal preparations only.
▶ With intravenous use For intravenous infusion (Cidomycin ®);
Gentamicin paediatric injection, Beacon; Gentamicin
injection Hospira), give intermittently or via drip tubing in
Glucose 5% or Sodium Chloride 0.9%. Suggested volume
for intermittent infusion 50–100 ml given over
20–30 minutes (given over 60 minutes for once daily dose
l PRESCRIBING AND DISPENSING INFORMATION
▶ With intravenous use Local guidelines may vary in the dosing
advice provided for once daily administration.
▶ With intrathecal use Only preservative-free intrathecal
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Gentamicin (Non-proprietary)
Gentamicin (as Gentamicin sulfate) 5 mg per 1 ml Gentamicin
Intrathecal 5mg/1ml solution for injection ampoules | 5 ampoule P £36.28 DT = £36.28 (Hospital only)
Gentamicin (as Gentamicin sulfate) 10 mg per 1 ml Gentamicin
20mg/2ml solution for injection ampoules | 5 ampoule P £11.25
Gentamicin Paediatric 20mg/2ml solution for injection vials | 5 vial P £11.25 DT = £11.25
Gentamicin (as Gentamicin sulfate) 40 mg per 1 ml Gentamicin
80mg/2ml solution for injection vials | 5 vial P £20.00 DT = £6.88
Gentamicin (as Gentamicin sulfate) 40 mg per 1 ml Cidomycin
Adult Injectable 80mg/2ml solution for injection vials | 5 vial P £6.88 DT = £6.88
BNF 78 Bacterial infection 519
Cidomycin Adult Injectable 80mg/2ml solution for injection ampoules
| 5 ampoule P £6.88 DT = £6.88
▶ Gentamicin (Non-proprietary)
Gentamicin (as Gentamicin sulfate) 1 mg per 1 ml Gentamicin
80mg/80ml infusion bags | 20 bag P £40.17
Gentamicin (as Gentamicin sulfate) 3 mg per 1 ml Gentamicin
240mg/80ml infusion bags | 20 bag P £122.57–£122.58
Gentamicin 360mg/120ml infusion bags | 20 bag P £174.07
Bowel sterilisation before surgery
▶ Adult: 1 g every 1 hour for 4 hours, then 1 g every
▶ Adult: Up to 4 g daily in divided doses usually for
l CONTRA-INDICATIONS Intestinal obstruction . myasthenia
gravis (aminoglycosides may impair neuromuscular
l CAUTIONS Avoid prolonged use
CAUTIONS, FURTHER INFORMATION Although neomycin is
associated with the same cautions as other
aminoglycosides it is generally considered too toxic for
l INTERACTIONS → Appendix 1: neomycin
l SIDE-EFFECTS Blood disorder. confusion . diarrhoea . drug
cross-reactivity . electrolyte imbalance . gastrointestinal
SIDE-EFFECTS, FURTHER INFORMATION Although neomycin
is associated with the same side effects as other
aminoglycosides, it is poorly absorbed after oral
l PREGNANCY There is a risk of auditory or vestibular nerve
damage in the infant when aminoglycosides are used in
the second and third trimesters of pregnancy.
l HEPATIC IMPAIRMENT Manufacturer advises caution
(increased risk of ototoxicity and nephrotoxicity).
l RENAL IMPAIRMENT Avoid–risk of ototoxicity and
▶ Renal function should be assessed before starting an
aminoglycoside and during treatment.
▶ Auditory and vestibular function should also be monitored
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral solution
▶ Neomycin sulfate (Non-proprietary)
Neomycin sulfate 500 mg Neomycin 500mg tablets | 100 tablet P £34.69 DT = £34.69
Tuberculosis, resistant to other treatment, in combination
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 15 mg/kg daily (max. per dose 1 g), reduce dose
in those under 50 kg and those over 40 years
Adjunct to doxycycline in brucellosis (administered on
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: (consult local protocol)
▶ Adult: (consult local protocol)
l UNLICENSED USE Use in tuberculosis is an unlicensed
Side-effects increase after a cumulative dose of 100 g,
which should only be exceeded in exceptional
l INTERACTIONS → Appendix 1: aminoglycosides
l SIDE-EFFECTS Hypersensitivity . oral paraesthesia
Dose adjustments Should preferably be avoided. If
essential, use with great care and consider dose reduction.
▶ One-hour (‘peak’) concentration should be 15–40 mg/litre;
pre-dose (‘trough’) concentration should be less than
5 mg/litre (less than 1 mg/litre in renal impairment or in
l MEDICINAL FORMS Forms available from special-order
manufacturers include: powder for solution for injection
Pneumonia in hospital patients
▶ BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult: 3 mg/kg daily in 3 divided doses; increased if
necessary up to 5 mg/kg daily in 3–4 divided doses,
increased dose used in severe infection; dose to be
reduced back to 3 mg/kg daily as soon as clinically
Chronic Pseudomonas aeruginosa infection in patients
▶ BY INHALATION OF NEBULISED SOLUTION
▶ Adult: 300 mg every 12 hours for 28 days, subsequent
courses repeated after 28-day interval without
▶ Adult: 112 mg every 12 hours for 28 days, subsequent
courses repeated after 28-day interval without
DOSES AT EXTREMES OF BODY-WEIGHT
▶ With intramuscular use or intravenous use To avoid excessive
dosage in obese patients, use ideal weight for height to
calculate parenteral dose and monitor serum-tobramycin
Chronic pulmonary Pseudomonas aeruginosa infection in
▶ BY INHALATION OF NEBULISED SOLUTION
▶ Adult: 170 mg every 12 hours for 28 days, subsequent
courses repeated after 28-day interval without
520 Bacterial infection BNF 78
▶ When used by inhalation conditions characterised by
muscular weakness—may impair neuromuscular
transmission . history of prolonged previous or
concomitant intravenous aminoglycosides—increased risk
of ototoxicity .renal impairment—limited information
available . severe haemoptysis—risk of further
l INTERACTIONS → Appendix 1: aminoglycosides
▶ Rare or very rare Diarrhoea . dizziness
▶ When used by inhalation Dysphonia . malaise .respiratory
disorder. sputum discolouration
▶ When used by inhalation Cough
▶ When used by inhalation Abdominal pain . aphonia . appetite
ulceration . pain .taste altered
▶ When used by inhalation Oropharyngeal pain
SIDE-EFFECTS, FURTHER INFORMATION Manufacturer
advises to monitor serum-tobramycin concentration in
patients with known or suspected signs of auditory
dysfunction; if ototoxicity develops — discontinue
treatment until serum concentration falls below 2 mg/litre.
▶ When used by inhalation Manufacturer advises monitor
serum-tobramycin concentration; if nephrotoxicity
develops—discontinue treatment until serum
concentration falls below 2 mg/litre.
▶ With intramuscular use or intravenous use One-hour (‘peak’)
▶ When used by inhalation Measure lung function before and
after initial dose of tobramycin and monitor for
bronchospasm; if bronchospasm occurs in a patient not
using a bronchodilator, repeat test using bronchodilator.
Manufacturer advises monitor renal function before
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous infusion (Nebcin ®);
intermittent or via drip tubing in Glucose 5% or Sodium
chloride 0.9%. For adult intermittent infusion suggested
volume 50–100 mL given over 20–60 minutes.
▶ When used by inhalation Other inhaled drugs should be
administered before tobramycin.
▶ When used by inhalation Patient counselling is advised for
Tobramycin dry powder for inhalation (administration).
Missed doses ▶ When used by inhalation Manufacturer
advises if a dose is more than 6 hours late, the missed dose
should not be taken and the next dose should be taken at
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Tobramycin by dry powder inhalation for pseudomonal lung
infection in cystic fibrosis (March 2013) NICE TA276
▶ When used by inhalation Tobramycin dry powder for
inhalation is recommended for chronic pulmonary
infection caused by Pseudomonas aeruginosa in patients
with cystic fibrosis only if there is an inadequate response
to colistimethate sodium, or if colistimethate sodium
cannot be used because of contra-indications or
intolerance. The manufacturer must provide tobramycin
dry powder for inhalation at the discount agreed as part of
the patient access scheme to primary, secondary and
tertiary care in the NHS. Patients currently receiving
tobramycin dry powder for inhalation can continue
treatment until they and their clinician consider it
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Tobramycin (Non-proprietary)
Tobramycin 40 mg per 1 ml Tobramycin 80mg/2ml solution for
injection vials | 5 vial P £20.80 DT = £20.80
Tobramycin 240mg/6ml solution for injection vials | 1 vial P £19.20 DT = £19.20
Tobramycin 40 mg per 1 ml Nebcin 80mg/2ml solution for injection
vials | 1 vial P £5.37 DT = £5.37
▶ Tobi Podhaler (Novartis Pharmaceuticals UK Ltd)
Tobramycin 28 mg Tobi Podhaler 28mg inhalation powder capsules
with device | 224 capsule P £1,790.00 DT = £1,790.00
▶ Tobramycin (Non-proprietary)
Tobramycin 60 mg per 1 ml Tobramycin 300mg/5ml nebuliser liquid
ampoules | 56 ampoule P £1,187.00 DT = £780.00
Tobramycin 75 mg per 1 ml Bramitob 300mg/4ml nebuliser solution
4ml ampoules | 56 ampoule P £1,187.00 DT = £1,187.00
▶ TOBI (Novartis Pharmaceuticals UK Ltd)
Tobramycin 60 mg per 1 ml Tobi 300mg/5ml nebuliser solution 5ml
ampoules | 56 ampoule P £1,305.92 DT = £780.00
Tobramycin 60 mg per 1 ml Tymbrineb 300mg/5ml nebuliser
solution 5ml ampoules | 56 ampoule P £780.00 DT = £780.00
Tobramycin 100 mg per 1 ml Vantobra 170mg/1.7ml nebuliser
solution 1.7ml ampoules | 56 ampoule P £1,305.00
The carbapenems are beta-lactam antibacterials with a
imipenem (imipenem with cilastatin p. 522) and
meropenem p. 523 have good activity against Pseudomonas
aeruginosa. The carbapenems are not active against
meticillin-resistant Staphylococcus aureus and Enterococcus
Imipenem (imipenem with cilastatin) and meropenem are
used for the treatment of severe hospital-acquired infections
and polymicrobial infections including septicaemia,
hospital-acquired pneumonia, intra-abdominal infections,
skin and soft-tissue infections, and complicated urinarytract infections.
Ertapenem p. 522 is licensed for treating abdominal and
gynaecological infections and for community-acquired
pneumonia, but it is not active against atypical respiratory
infections of the skin and soft tissue in patients with
diabetes. Unlike the other carbapenems, ertapenem is not
active against Pseudomonas or against Acinetobacter spp.
BNF 78 Bacterial infection 521
Imipenem is partially inactivated in the kidney by enzymatic
activity and is therefore administered in combination with
cilastatin (imipenem with cilastatin), a specific enzyme
inhibitor, which blocks its renal metabolism. Meropenem
and ertapenem are stable to the renal enzyme which
inactivates imipenem and therefore can be given without
Side-effects of imipenem with cilastatin are similar to
those of other beta-lactam antibiotics. Meropenem has less
seizure-inducing potential and can be used to treat central
Abdominal infections | Acute gynaecological infections |
Diabetic foot infections of the skin and soft-tissue
Surgical prophylaxis, colorectal surgery
▶ Adult: 1 g for 1 dose, dose to be completed within
l CAUTIONS CNS disorders—risk of seizures . elderly
l INTERACTIONS → Appendix 1: carbapenems
▶ Common or very common Diarrhoea . headache . nausea . skin reactions .thrombophlebitis . vomiting
mouth . gastrointestinal discomfort. gastrointestinal
▶ Frequency not known Aggression . delirium . drug reaction
with eosinophilia and systemic symptoms (DRESS). gait
l ALLERGY AND CROSS-SENSITIVITY Avoid if history of
immediate hypersensitivity reaction to beta-lactam
Use with caution in patients with sensitivity to betalactam antibacterials.
l PREGNANCY Manufacturer advises avoid unless potential
l BREAST FEEDING Present in milk—manufacturer advises
Dose adjustments Risk of seizures; max. 500 mg daily if
eGFR less than 30 mL/minute/1.73 m2
l DIRECTIONS FOR ADMINISTRATION For intravenous infusion
(Invanz ®), give intermittently in Sodium chloride 0.9%.
Reconstitute 1 g with 10 mL Water for injections or Sodium
chloride 0.9%; dilute requisite dose in infusion fluid to a
final concentration not exceeding 20 mg/mL; give over
30 minutes; incompatible with glucose solutions.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for infusion
ELECTROLYTES: May contain Sodium
Ertapenem (as Ertapenem sodium) 1 gram Ertapenem 1g powder
for concentrate for solution for infusion vials | 10 vial P s
▶ Invanz (Merck Sharp & Dohme Ltd)
Ertapenem (as Ertapenem sodium) 1 gram Invanz 1g powder for
solution for infusion vials | 1 vial P £31.65 DT = £31.65
Imipenem with cilastatin 07-Feb-2019
Aerobic and anaerobic Gram-positive and Gram-negative
infections (not indicated for CNS infections)| Hospitalacquired septicaemia
▶ Adult: 500 mg every 6 hours, alternatively 1 g every
Infection caused by Pseudomonas or other less sensitive
organisms | Empirical treatment of infection in febrile
patients with neutropenia | Life-threatening infection
DOSE EQUIVALENCE AND CONVERSION
▶ Dose expressed in terms of imipenem.
l CAUTIONS CNS disorders . epilepsy
l INTERACTIONS → Appendix 1: carbapenems
▶ Frequency not known Agitation
l ALLERGY AND CROSS-SENSITIVITY Avoid if history of
immediate hypersensitivity reaction to beta-lactam
Use with caution in patients with sensitivity to betalactam antibacterials.
l PREGNANCY Manufacturer advises avoid unless potential
benefit outweighs risk (toxicity in animal studies).
l BREAST FEEDING Present in milk but unlikely to be
l RENAL IMPAIRMENT Manufacturer advises avoid if
creatinine clearance less than 15 mL/minute.
Dose adjustments Manufacturer advises reduce dose if
creatinine clearance less than 90 mL/minute (risk of CNS
side-effects)—consult product literature.
l EFFECT ON LABORATORY TESTS Positive Coombs’ test.
l DIRECTIONS FOR ADMINISTRATION For intravenous infusion
dilute to a concentration of 5 mg (as imipenem)/mL in
Sodium chloride 0.9%; give up to 500 mg (as imipenem)
522 Bacterial infection BNF 78
over 20–30 minutes, give dose greater than 500 mg (as
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for infusion
ELECTROLYTES: May contain Sodium
▶ Imipenem with cilastatin (Non-proprietary)
Cilastatin (as Cilastatin sodium) 500 mg, Imipenem (as Imipenem
monohydrate) 500 mg Imipenem 500mg / Cilastatin 500mg powder
for solution for infusion vials | 10 vial P £124.10
▶ Primaxin I.V. (Merck Sharp & Dohme Ltd)
Cilastatin (as Cilastatin sodium) 500 mg, Imipenem (as Imipenem
monohydrate) 500 mg Primaxin IV 500mg powder for solution for
infusion vials | 1 vial P £12.00
Aerobic and anaerobic Gram-positive and Gram-negative
infections | Hospital-acquired septicaemia
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: 0.5–1 g every 8 hours
Exacerbations of chronic lower respiratory-tract infection
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
Endocarditis (in combination with another antibacterial)
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
l UNLICENSED USE Not licensed for use in endocarditis.
l INTERACTIONS → Appendix 1: carbapenems
infection . leucopenia . neutropenia . paraesthesia . severe
cutaneous adverse reactions (SCARs).thrombocytopenia . thrombophlebitis
l ALLERGY AND CROSS-SENSITIVITY Avoid if history of
immediate hypersensitivity reaction to beta-lactam
Use with caution in patients with sensitivity to betalactam antibacterials.
l PREGNANCY Use only if potential benefit outweighs risk—
l BREAST FEEDING Unlikely to be absorbed (however,
Dose adjustments Use normal dose every 12 hours if eGFR
Use half normal dose every 12 hours if eGFR
Use half normal dose every 24 hours if eGFR less than
l MONITORING REQUIREMENTS Manufacturer advises
monitor liver function—risk of hepatotoxicity.
l EFFECT ON LABORATORY TESTS Positive Coombs’ test.
l DIRECTIONS FOR ADMINISTRATION Intravenous injection to
be administered over 5 minutes.
For intravenous infusion (Meronem®), give intermittently
in Glucose 5% or Sodium chloride 0.9%.
Dilute dose in infusion fluid to a final concentration of
1–20 mg/mL; give over 15–30 minutes.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for injection
ELECTROLYTES: May contain Sodium
Meropenem (as Meropenem trihydrate) 500 mg Meropenem
500mg powder for solution for injection vials | 10 vial P £83.00–
£103.14 DT = £88.90 (Hospital only) | 10 vial P £88.90–£103.14 DT
Meropenem (as Meropenem trihydrate) 1 gram Meropenem 1g
powder for solution for injection vials | 10 vial P £160.00–£206.28
DT = £177.80 (Hospital only) | 10 vial P £177.80–£206.30 DT =
Meropenem (as Meropenem trihydrate) 500 mg Meronem 500mg
powder for solution for injection vials | 10 vial P £103.14 DT =
Meropenem (as Meropenem trihydrate) 1 gram Meronem 1g
powder for solution for injection vials | 10 vial P £206.28 DT =
ANTIBACTERIALS › CEPHALOSPORINS
The cephalosporins are broad-spectrum antibiotics which
are used for the treatment of septicaemia, pneumonia,
similar to that of the penicillins, excretion being principally
renal. Cephalosporins penetrate the cerebrospinal fluid
poorly unless the meninges are inflamed; cefotaxime p. 527
and ceftriaxone p. 528 are suitable cephalosporins for
infections of the CNS (e.g meningitis).
The principal side-effect of the cephalosporins is
hypersensitivity and about 0.5–6.5% of penicillin-sensitive
patients will also be allergic to the cephalosporins. If a
cephalosporin is essential in patients with a history of
immediate hypersensitivity to penicillin, because a suitable
alternative antibacterial is not available, then cefixime
p. 527, cefotaxime, ceftazidime p. 528, ceftriaxone, or
cefuroxime p. 526 can be used with caution; cefaclor p. 525,
cefadroxil p. 524, cefalexin p. 524, cefradine p. 525, and
ceftaroline fosamil p. 531 should be avoided.
The orally active ‘first generation’ cephalosporins,
cefalexin, cefradine, and cefadroxil and the ‘second
generation’ cephalosporin, cefaclor, have a similar
antimicrobial spectrum. They are useful for urinary-tract
infections which do not respond to other drugs or which
occur in pregnancy, respiratory-tract infections, otitis
media, and skin and soft-tissue infections. Cefaclor has good
activity against H. influenzae. Cefadroxil has a long duration
of action and can be given twice daily; it has poor activity
against H. influenzae. Cefuroxime axetil, an ester of the
‘second generation’ cephalosporin cefuroxime, has the same
antibacterial spectrum as the parent compound; it is poorly
absorbed and needs to be given with food to maximise
Cefixime is an orally active ‘third generation’
cephalosporin. It has a longer duration of action than the
other cephalosporins that are active by mouth. It is only
licensed for acute infections.
Cefuroxime is a ‘second generation’ cephalosporin that is
less susceptible than the earlier cephalosporins to
inactivation by beta-lactamases. It is, therefore, active
against certain bacteria which are resistant to the other
drugs and has greater activity against Haemophilus
Cefotaxime, ceftazidime and ceftriaxone are ‘third
generation’ cephalosporins with greater activity than the
BNF 78 Bacterial infection 523
cefuroxime against Gram-positive bacteria, most notably
Staphylococcus aureus. Their broad antibacterial spectrum
may encourage superinfection with resistant bacteria or
Ceftazidime has good activity against pseudomonas. It is
also active against other Gram-negative bacteria.
Ceftriaxone has a longer half-life and therefore needs to be
given only once daily. Indications include serious infections
such as septicaemia, pneumonia, and meningitis. The
calcium salt of ceftriaxone forms a precipitate in the gall
bladder which may rarely cause symptoms but these usually
resolve when the antibiotic is stopped.
Ceftaroline fosamil is a ‘fifth generation’ cephalosporin
with bactericidal activity similar to cefotaxime; however,
ceftaroline fosamil has an extended spectrum of activity
Streptococcus pneumoniae. Ceftaroline fosamil is licensed for
the treatment of community-acquired pneumonia and
complicated skin and soft-tissue infections, but there is no
experience of its use in pneumonia caused by meticillinresistant S. aureus.
l DRUG ACTION Cephalosporins are antibacterials that
attach to penicillin binding proteins to interrupt cell wall
biosynthesis, leading to bacterial cell lysis and death.
infection . leucopenia . nausea . neutropenia . skin
reactions .thrombocytopenia . vomiting
▶ Uncommon Anaphylactic reaction . antibiotic associated
▶ Rare or very rare Agranulocytosis . angioedema . nephritis
tubulointerstitial (reversible). severe cutaneous adverse
▶ Frequency not known Haemolytic anaemia
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated in
patients with cephalosporin hypersensitivity.
▶ Cross-sensitivity with other beta-lactam antibacterials About
0.5–6.5% of penicillin-sensitive patients will also be
allergic to the cephalosporins. Patients with a history of
immediate hypersensitivity to penicillin and other betalactams should not receive a cephalosporin.
Cephalosporins should be used with caution in patients
with sensitivity to penicillin and other beta-lactams.
l EFFECT ON LABORATORY TESTS False positive urinary
glucose (if tested for reducing substances). False positive
ANTIBACTERIALS › CEPHALOSPORINS,
Susceptible infections due to sensitive Gram-positive and
▶ Child 6–17 years (body-weight up to 40 kg): 0.5 g twice
▶ Child 6–17 years (body-weight 40 kg and above): 0.5–1 g
Skin infections | Soft-tissue infections | Uncomplicated
▶ Child 6–17 years (body-weight 40 kg and above): 1 g once
l INTERACTIONS → Appendix 1: cephalosporins
▶ Common or very common Dyspepsia . glossitis
▶ Rare or very rare Arthralgia . drug fever.fatigue . hepatic
disorders . insomnia . nervousness . serum sickness-like
l PREGNANCY Not known to be harmful.
l BREAST FEEDING Present in milk in low concentration, but
Dose adjustments ▶ In adults 1 g initially, then 500 mg
every 12 hours if eGFR 26–50 mL/minute/1.73 m2
initially, then 500 mg every 24 hours if eGFR
. 1 g initially, then 500 mg every
36 hours if eGFR less than 11 mL/minute/1.73 m2
▶ In children Reduce dose if estimated glomerular filtration
rate less than 50 mL/minute/1.73 m2
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 9
▶ Cefadroxil (Non-proprietary)
Cefadroxil (as Cefadroxil monohydrate) 500 mg Cefadroxil 500mg
capsules | 20 capsule P £6.45 DT = £6.45
Susceptible infections due to sensitive Gram-positive and
▶ Child 1–11 months: 12.5 mg/kg twice daily, alternatively
▶ Child 1–4 years: 12.5 mg/kg twice daily, alternatively
▶ Child 5–11 years: 12.5 mg/kg twice daily, alternatively
▶ Child 12–17 years: 500 mg 2–3 times a day
▶ Adult: 250 mg every 6 hours, alternatively 500 mg every
8–12 hours; increased to 1–1.5 g every 6–8 hours,
increased dose to be used for severe infections
Serious susceptible infections due to sensitive Grampositive and Gram-negative bacteria
▶ Child 1 month–11 years: 25 mg/kg 2–4 times a day (max.
▶ Child 12–17 years: 1–1.5 g 3–4 times a day
Prophylaxis of recurrent urinary-tract infection
▶ Child: 12.5 mg/kg once daily (max. per dose 125 mg),
▶ Adult: 125 mg once daily, dose to be taken at night
l INTERACTIONS → Appendix 1: cephalosporins
l PREGNANCY Not known to be harmful.
524 Bacterial infection BNF 78
l BREAST FEEDING Present in milk in low concentration, but
Dose adjustments ▶ In adults Max. 3 g daily if eGFR
. Max. 750 mg daily if eGFR less
▶ In children Reduce dose in moderate impairment.
Medicines for Children leaflet: Cefalexin for bacterial infections
www.medicinesforchildren.org.uk/cefalexin-bacterialinfections-0
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Cefalexin Capsules may be prescribed.
Cefalexin Tablets may be prescribed.
Cefalexin Oral Suspension may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 9
Cefalexin 25 mg per 1 ml Cefalexin 125mg/5ml oral suspension
sugar free sugar-free | 100 ml P £0.84–£1.65
Cefalexin 125mg/5ml oral suspension | 100 ml P £1.64 DT =
Cefalexin 50 mg per 1 ml Cefalexin 250mg/5ml oral suspension
sugar free sugar-free | 100 ml P £1.72–£2.03
Cefalexin 25 mg per 1 ml Keflex 125mg/5ml oral suspension | 100 ml P £0.84 DT = £0.84
Cefalexin 50 mg per 1 ml Keflex 250mg/5ml oral suspension | 100 ml P £1.40 DT = £1.40
CAUTIONARY AND ADVISORY LABELS 9
Cefalexin 250 mg Cefalexin 250mg tablets | 28 tablet P £2.55
Cefalexin 500 mg Cefalexin 500mg tablets | 21 tablet P £5.35
Cefalexin 250 mg Keflex 250mg tablets | 28 tablet P £1.60 DT =
Cefalexin 500 mg Keflex 500mg tablets | 21 tablet P £2.08 DT =
CAUTIONARY AND ADVISORY LABELS 9
Cefalexin 250 mg Cefalexin 250mg capsules | 28 capsule P £1.82 DT = £1.82
Cefalexin 500 mg Cefalexin 500mg capsules | 21 capsule P £2.04 DT = £1.99
Cefalexin 250 mg Keflex 250mg capsules | 28 capsule P £1.46
Cefalexin 500 mg Keflex 500mg capsules | 21 capsule P £1.98
Susceptible infections due to sensitive Gram-positive and
Gram-negative bacteria | Surgical prophylaxis
▶ Child 7–11 years: 25–50 mg/kg daily in 2–4 divided doses
▶ Child 12–17 years: 250–500 mg 4 times a day,
alternatively 0.5–1 g twice daily; increased if necessary
up to 1 g 4 times a day, increased dose may be used in
▶ Adult: 250–500 mg 4 times a day, alternatively 0.5–1 g
twice daily; increased if necessary up to 1 g 4 times a
day, increased dose may be used in severe infections
▶ In children Not licensed for use in children for prevention
of Staphylococcus aureus lung infection in cystic fibrosis.
l INTERACTIONS → Appendix 1: cephalosporins
increased . nervousness . oedema . sleep disorder
l PREGNANCY Not known to be harmful.
l BREAST FEEDING Present in milk in low concentration, but
Dose adjustments ▶ In adults Use half normal dose if eGFR
. Use one-quarter normal dose if
eGFR less than 5 mL/minute/1.73 m2
▶ In children Reduce dose if estimated glomerular filtration
rate less than 20 mL/minute/1.73 m2
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Cefradine Capsules may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 9
Cefradine 250 mg Cefradine 250mg capsules | 20 capsule P £6.00 DT = £2.86
Cefradine 500 mg Cefradine 500mg capsules | 20 capsule P £8.75 DT = £4.04
ANTIBACTERIALS › CEPHALOSPORINS,
Susceptible infections due to sensitive Gram-positive and
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1–11 months: 20 mg/kg daily in 3 divided doses,
alternatively 62.5 mg 3 times a day
▶ Child 1–4 years: 20 mg/kg daily in 3 divided doses,
alternatively 125 mg 3 times a day
▶ Child 5–11 years: 20 mg/kg daily in 3 divided doses, usual
max. 1 g daily, alternatively 250 mg 3 times a day
▶ Child 12–17 years: 250 mg 3 times a day; maximum 4 g
▶ Adult: 250 mg 3 times a day; maximum 4 g per day
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Child 12–17 years: 375 mg every 12 hours, dose to be
▶ Adult: 375 mg every 12 hours, dose to be taken with
Severe susceptible infections due to sensitive Grampositive and Gram-negative bacteria
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1–11 months: 40 mg/kg daily in 3 divided doses,
usual max. 1 g daily, alternatively 125 mg 3 times a day
▶ Child 1–4 years: 40 mg/kg daily in 3 divided doses, usual
max. 1 g daily, alternatively 250 mg 3 times a day
▶ Child 5–11 years: 40 mg/kg daily in 3 divided doses, usual
▶ Child 12–17 years: 500 mg 3 times a day; maximum 4 g
BNF 78 Bacterial infection 525
▶ Adult: 500 mg 3 times a day; maximum 4 g per day
▶ BY MOUTH USING MODIFIED-RELEASE TABLETS
▶ Child 12–17 years: 750 mg every 12 hours, dose to be
▶ Adult: 750 mg every 12 hours, dose to be taken with
Lower urinary-tract infections
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Child 12–17 years: 375 mg every 12 hours, dose to be
▶ Adult: 375 mg every 12 hours, dose to be taken with
Asymptomatic carriage of Haemophilus influenzae or mild
exacerbations in cystic fibrosis
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1–11 months: 125 mg every 8 hours
▶ Child 1–6 years: 250 mg 3 times a day
▶ Child 7–17 years: 500 mg 3 times a day
l INTERACTIONS → Appendix 1: cephalosporins
SIDE-EFFECTS, FURTHER INFORMATION Cefaclor is
associated with protracted skin reactions, especially in
l PREGNANCY Not known to be harmful.
l BREAST FEEDING Present in milk in low concentration, but
l RENAL IMPAIRMENT Manufacturer advises caution.
Dose adjustments No dose adjustment required.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 9
▶ Distaclor (Flynn Pharma Ltd)
Cefaclor (as Cefaclor monohydrate) 25 mg per 1 ml Distaclor
125mg/5ml oral suspension | 100 ml P £4.13 DT = £4.13
Cefaclor (as Cefaclor monohydrate) 50 mg per 1 ml Distaclor
250mg/5ml oral suspension | 100 ml P £8.26 DT = £8.26
CAUTIONARY AND ADVISORY LABELS 9, 21, 25
▶ Distaclor MR (Flynn Pharma Ltd)
Cefaclor (as Cefaclor monohydrate) 375 mg Distaclor MR 375mg
tablets | 14 tablet P £9.10 DT = £9.10
CAUTIONARY AND ADVISORY LABELS 9
▶ Distaclor (Flynn Pharma Ltd)
Cefaclor (as Cefaclor monohydrate) 500 mg Distaclor 500mg
capsules | 21 capsule P £7.50 DT = £7.50
Susceptible infections due to Gram-positive and Gramnegative bacteria
▶ Child 3 months–1 year: 10 mg/kg twice daily (max. per
▶ Child 2–11 years: 15 mg/kg twice daily (max. per dose
▶ Child 12–17 years: 250 mg twice daily, dose may be
doubled in severe lower respiratory-tract infections or
▶ Adult: 250 mg twice daily, dose may be doubled in
severe lower respiratory-tract infections or if
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION,
▶ Child: 20 mg/kg every 8 hours (max. per dose 750 mg);
increased to 50–60 mg/kg every 6–8 hours (max. per
dose 1.5 g), increased dose used for severe infection
▶ Adult: 750 mg every 6–8 hours; increased if necessary
up to 1.5 g every 6–8 hours, increased dose used for
▶ Adult: 500 mg twice daily for 14–21 days (for 28 days in
▶ Child 12–17 years: 125 mg twice daily
▶ INITIALLY BY INTRAVENOUS INJECTION
▶ Adult: 1.5 g, to be administered up to 30 minutes
before the procedure, then (by intravenous injection or
by intramuscular injection) 750 mg every 8 hours if
required for up to 3 doses (in high risk procedures)
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: 1.5 g every 8 hours until soft tissue closure
l UNLICENSED USE Duration of treatment in Lyme disease is
l INTERACTIONS → Appendix 1: cephalosporins
▶ With parenteral use Gastrointestinal disorder
▶ With oral use Drug fever. hepatic disorders . JarischHerxheimer reaction . serum sickness
▶ With parenteral use Cutaneous vasculitis . drug fever
l PREGNANCY Not known to be harmful.
l BREAST FEEDING Present in milk in low concentration, but
Dose adjustments ▶ With intravenous use in adults Use
parenteral dose of 750 mg twice daily if eGFR
. Use parenteral dose of 750 mg
once daily if eGFR less than 10 mL/minute/1.73 m2
▶ In children Reduce parenteral dose if estimated
No comments:
Post a Comment
اكتب تعليق حول الموضوع