Cefoperazone

General

• Type: 3rd generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 1g, 2g, 10g
• Routes of Administration: IV, IM
• Common Trade Names: Cefobid

Adult Dosing

General

• Mild-Moderate: 1-2g IM/IV q12h
• Severe: 2-4g IM/IV q8h or 3-4g q12h
• Max: 12g/day (total daily dose)

Pseudomonas pneumonia (HAP/VAP)

• 2g IV q8h or 3g IV q12h
• Often used in combination with another anti-pseudomonal agent

Complicated intra-abdominal infections

• 2g IV q12h
• Usually combined with metronidazole or used as Cefoperazone/Sulbactam

Complicated UTI and Gynecological Infections

• 2g IV q12h

Pediatric Dosing

General

• Neonates (<8 days): Not recommended
• Infants/Children: 50-200mg/kg/day IM/IV divided q12h
• Max: 12g/day

Special Populations

• Pregnancy: B
• Lactation: Low distribution into milk; generally compatible
• Renal
  • Adult
    • No adjustment necessary for renal impairment alone (primary excretion is biliary)
    • Hemodialysis: Schedule dose to follow dialysis
  • Pediatric
    • No adjustment defined
• Hepatic
  • Modification required in severe obstruction or severe hepatic disease
  • Max dose 1-2g/day if severe hepatic dysfunction + renal impairment exist

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of severe hypersensitivity to penicillin

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile
• Hypoprothrombinemia (Bleeding risk due to MTT side chain)
• Disulfiram-like reaction (Alcohol intolerance)

Common

• Diarrhea (Higher incidence than other cephalosporins due to biliary excretion)
• Rash
• Phlebitis at injection site
• Eosinophilia
• Reversible Neutropenia

Pharmacology

• Half-life: 2.0h
• Metabolism: Hepatic (not extensively metabolized, but extensively excreted via bile)
• Excretion: Bile (70-75%), Urine (20-30%)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis. Contains N-methylthiotetrazole (MTT) side chain.

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	S
	Serratia marcescens	S
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	I
	Citrobacter diversus	S
	Citrobacter sp.	I
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	S
	Vibrio vulnificus	S
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	S
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	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)