Cefminox

General

• Type: 2nd generation Cephalosporin (Cephamycin)
• Dosage Forms: powder for injection
• Dosage Strengths: 500mg, 1g
• Routes of Administration: IV, IM
• Common Trade Names: Meicelin

Adult Dosing

General

• Mild-Moderate: 1g IM/IV q12h
• Severe: 2-3g IM/IV divided q8-12h
• Life Threatening (Sepsis, Peritonitis): Up to 6g/day IM/IV divided q6-8h
• Max: 6g/day

UTI, Complicated/Uncomplicated

• 1g IM/IV q12h

Intra-abdominal Infections (Peritonitis, Cholecystitis)

• 2g IM/IV q12h or 1g q8h

Respiratory Tract Infections

• 1g IM/IV q12h

Pediatric Dosing

General

• Mild-Moderate: 40-80mg/kg/day IM/IV divided q6-8h
• Severe/Sepsis: Up to 160mg/kg/day IM/IV divided q6-8h
• Max: 6g/day (should not exceed adult dose)

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl 30-60: give usual dose q12-24h
    • CrCl 10-29: give usual dose q24h
    • CrCl <10: give usual dose q24-48h
    • Hemodialysis: Give dose after dialysis
    • Peritoneal dialysis: Supplement not usually required
  • Pediatric
    • Renal dosing not well defined; adjust based on adult ratios
• Hepatic
  • Monitor coagulation parameters (PT/INR) due to risk of hypoprothrombinemia

Contraindications

• Allergy to class/drug (Cephalosporins, Cephamycins)
• History of anaphylaxis to Penicillins
• Concurrent alcohol ingestion (Disulfiram-like reaction)

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Hypoprothrombinemia (Bleeding risk - due to NMTT side chain)
• Disulfiram-like reaction (with alcohol)
• Neutropenia
• Thrombocytopenia
• Clostridium difficile associated diarrhea
• Seizures (high doses in renal failure)

Common

• Diarrhea
• Rash
• Nausea and Vomiting
• Abdominal Pain
• Phlebitis at injection site
• Transaminitis

Pharmacology

• Half-life: ~2.5h (Prolonged in renal impairment)
• Metabolism: Not significantly metabolized (Excreted unchanged)
• Excretion: Urine (~90%)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis; binds to PBPs

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	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	X1
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	I
	Serratia marcescens	R
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	I
	Citrobacter sp.	I
	Aeromonas sp	I
	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	S
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	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)