Cefbuperazone
General
- Type: 2nd generation Cephalosporin
- Technically a Cephamycin antibotic
- Dosage Forms: powder for injection
- Dosage Strengths: 500mg, 1g
- Routes of Administration: IV, IM
- Common Trade Names: Tomiporan, Keiperazon
Adult Dosing
General
- 1g IM/IV q12h
- Max: 4g/day
Severe Infection/Sepsis
- 2g IM/IV q12h
Pre-operative Prophylaxis
- 1g IM/IV x1 (30-60 min before procedure)
Pediatric Dosing
General
- 30-50mg/kg/day IM/IV divided q12h
- Max: 2g/day
Severe Infection
- Up to 100mg/kg/day IM/IV divided q12h
Special Populations
- Pregnancy: Not formally categorized (FDA); presumed similar to other cephalosporins (Use if benefit outweighs risk)
- Lactation: Excreted in breast milk; caution advised
- Renal
- Adult
- CrCl >50: No adjustment
- CrCl 25-50: 500mg q12h or 1g q24h
- CrCl <25: 500mg q24-48h
- Pediatric
- Renal impairment guidelines not well defined; decrease dose/frequency proportional to adult reduction
- Adult
- Hepatic
- No adjustment usually necessary; monitor INR due to N-MTT side chain risks
Contraindications
- Allergy to class/drug
- History of alcohol use (due to Disulfiram-like reaction)
Adverse Reactions
Serious
- Anaphylaxis
- Hypoprothrombinemia (Bleeding risk) due to N-methylthiotetrazole (NMTT) side chain (Check INR/PT)
- Stevens-Johnson Syndrome
- Pseudomembranous colitis (Clostridium difficile)
- Disulfiram-like reaction with alcohol intake
Common
- Diarrhea
- Rash (Maculopapular)
- Nausea and Vomiting
- Injection site pain
- Eosinophilia
Pharmacology
- Half-life: 1.6 - 2.0h
- Metabolism: Not actively metabolized
- Excretion: Urine (unchanged)
- Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
- Note: As a cephamycin, it has a 7-alpha-methoxy group providing high stability against beta-lactamases.
Antibiotic Sensitivities
| Group | Organism | Sensitivity |
| Gram Positive | Strep. Group A, B, C, G | S |
| Strep. Pneumoniae | S | |
| Enterococcus faecalis | R | |
| MSSA | S | |
| MRSA | R | |
| Gram Negatives | N. gonorrhoeae | S |
| E. coli | S | |
| Klebsiella sp | S | |
| Indole-positive Proteus | S | |
| Serratia sp | I | |
| Pseudomonas aeruginosa | I/R | |
| Anaerobes | Bacteroides fragilis | S |
| Clostridium difficile | X1 |
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