Cefpiramide

General

• Type: 3rd generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 500mg, 1g
• Routes of Administration: IV, IM
• Common Trade Names: Sepatren, Suncefal

Adult Dosing

General

• Standard: 1-2g IM/IV q12h
• Severe: 2g IM/IV q12h (or divided q8h in rare cases)
• Max: 4g/day

Pneumonia / Respiratory Tract Infections

• 1g IM/IV q12h
• Effective against Pseudomonas aeruginosa in respiratory infections

UTI, Complicated

• 1g IM/IV q12h

Biliary Tract Infections

• 1g IM/IV q12h
• Achieves very high concentrations in the bile

Pediatric Dosing

General

• 30-80mg/kg/day IM/IV divided q12h
• Severe Infections: Up to 150mg/kg/day IM/IV divided q6-12h
• Max: 4g/day

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl > 30: No adjustment necessary
    • CrCl < 30: No adjustment usually necessary if hepatic function is normal (primarily biliary excretion)
    • Hemodialysis: Give supplement after dialysis
  • Pediatric
    • Not routinely defined; generally no adjustment needed for renal impairment alone
• Hepatic
  • Adult
    • Significant hepatic dysfunction requires dosage reduction or extended interval (e.g., 1g q24h)
    • Combined renal and hepatic dysfunction requires significant dose reduction and monitoring

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of anaphylactic shock/severe reaction to Penicillin

Adverse Reactions

Serious

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

Common

• Diarrhea (Higher incidence due to high biliary excretion)
• Rash
• Nausea and Vomiting
• Abdominal Pain
• Injection site pain/phlebitis
• Elevation of AST/ALT

Pharmacology

• Half-life: 4-5h (Long half-life compared to other cephalosporins)
• Metabolism: Minimally metabolized
• Excretion: Bile (Main route, ~70-80%), Urine (~20-30%)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
• Side Chain Note: Contains N-methylthiotetrazole (MTT) ring associated with Vitamin K inhibition (bleeding risk) and disulfiram-like reactions.

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	I
	Serratia marcescens	I
	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	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	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)