Cefamandole

General

• Type: 2nd generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 1g, 2g
• Routes of Administration: IV, IM
• Common Trade Names: Mandol

Adult Dosing

General

• Mild: 500mg IM/IV q4-8h
• Mod-Severe: 1-2g IM/IV q4-6h
• Max: 12g/day

UTI, Uncomplicated

• 500mg IM/IV q8h

Pneumonia

• 500mg IM/IV q6h

Surgical Prophylaxis

• 1-2g IM/IV x1 (30-60 min before procedure)
• 1-2g q6h for 24-48 hours post-op

Pediatric Dosing

General (>1 Month)

• 50-100mg/kg/day IM/IV divided q4-8h
• Severe: 150mg/kg/day IM/IV divided q4-6h
• Max: Not to exceed adult dosage

Special Populations

• Pregnancy: B
• Lactation: Safe
• Renal
  • Adult
    • CrCl 50-80: 1-2g q6h
    • CrCl 25-50: 1-2g q8h
    • CrCl 10-25: 1g q8h or 1.25g q12h
    • CrCl 2-10: 0.67g q8h or 1g q12h
    • CrCl <2: 0.5g q8h or 0.75g q12h
    • Hemodialysis: Give supplement after dialysis
    • Peritoneal dialysis: Not significantly removed
  • Pediatric
    • Adjust frequency based on adult ratios for CrCl
• Hepatic
  • Coagulation parameters should be monitored (risk of hypoprothrombinemia)

Contraindications

• Allergy to class/drug
• History of anaphylaxis to Penicillins

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Hypoprothrombinemia (Bleeding) - due to MTT side chain (preventable with Vitamin K)
• Disulfiram-like reaction (if alcohol consumed) - due to MTT side chain
• Neutropenia
• Thrombocytopenia
• Clostridium difficile
• Seizures (high doses in renal failure)

Common

• Diarrhea
• Rash
• Nausea and Vomiting
• Transaminitis
• Thrombophlebitis
• Pain at injection site

Pharmacology

• Half-life: 30-60 minutes
• Metabolism: Not metabolized
• Excretion: Urine (unchanged)
• 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	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	R
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	I
	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	R
	Prevotella melaninogenica	I
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	I
	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)
• Cephalosporins

References

• Epocrates