Cefapirin

General

• Type: 1st generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 500mg; 1g, 2g, 4g, 20g
• Routes of Administration: IV, IM
• Common Trade Names: Cefadyl

Adult Dosing

General

• Mild-Moderate: 500mg-1g IM/IV q4-6h
• Severe: 1g-2g IM/IV q4h
• Max: 12g/day

Perioperative Prophylaxis

• 1-2g IM/IV x1 (30-60 min before procedure)
• Intraoperative: 1-2g may be repeated during lengthy surgeries
• Postoperative: 1-2g q6h for 24 hours

Pediatric Dosing

General (>3 Months)

• 40-80mg/kg/day IM/IV divided q6h
• Max: 12g/day (should not exceed adult dose)

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl > 50: usual dose
    • CrCl 10-50: 500mg-1g q6-8h
    • CrCl <10: 500mg-1g q12h
    • Hemodialysis: Give dose before dialysis and boost with 0.5-1g after each session
  • Pediatric
    • Renal dosing not well defined; adjust based on adult ratios or avoid
• Hepatic
  • Not defined

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of anaphylactic reaction to Penicillins

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Neutropenia (prolonged use)
• Thrombocytopenia
• Clostridium difficile associated diarrhea
• Nephrotoxicity (rare, higher risk with aminoglycosides)
• Seizures (high doses in renal failure)

Common

• Nausea and Vomiting
• Diarrhea
• Rash
• Phlebitis at injection site
• Pain at injection site (IM)
• Eosinophilia
• Transaminitis

Pharmacology

• Half-life: 0.6-0.8h (Prolonged in renal impairment)
• Metabolism: Partially metabolized in liver and blood to desacetylcefapirin
• Excretion: Urine (approx 70% as unchanged drug)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	X1
	N. meningitidis	X1
	Moraxella catarrhalis	I
	H. influenzae	X1
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	R
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	X1
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)
• Cefazolin

References

• Epocrates