Cefsulodin

General

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

Adult Dosing

General

• Standard: 500mg-1g IM/IV q6h
• Severe: 2g IM/IV q6h
• Max: 6-12g/day (depending on severity of infection)

Pseudomonal Infections (Pneumonia, Soft Tissue, UTI)

• 1-2g IV q6h
• Often used in combination with an aminoglycoside for serious infections

Pediatric Dosing

General

• 20-50mg/kg/day IM/IV divided q6h
• Severe: Up to 100mg/kg/day IM/IV divided q6h

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl 50-80: 1g q8h
    • CrCl 20-49: 1g q12h
    • CrCl <20: 500mg-1g q24h
    • Hemodialysis: Give supplement after dialysis
  • Pediatric
    • Adjust based on adult GFR guidelines (extend interval)
• Hepatic
  • No dosage adjustment typically required

Contraindications

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

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile
• Seizures (high doses in renal impairment)
• Nephrotoxicity (rare, increased risk with aminoglycosides)
• Hemolytic Anemia

Common

• Nausea and Vomiting
• Diarrhea
• Rash / Pruritus
• Injection site pain/phlebitis
• Eosinophilia
• Elevated liver enzymes

Pharmacology

• Half-life: 1.5h (Prolonged in renal failure)
• Metabolism: Minimal
• Excretion: Urine (mostly unchanged)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
• Spectra Note: Unlike most 3rd generation cephalosporins, Cefsulodin has a very narrow spectrum, highly specific for *Pseudomonas aeruginosa* and very weak against other Gram-negatives and Gram-positives.

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	R
	Strep. Pneumoniae	R
	Viridans strep	R
	Strep. anginosus gp	R
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	R
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	R
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	R
	N. meningitidis	R
	Moraxella catarrhalis	R
	H. influenzae	R
	E. coli	R
	Klebsiella sp	R
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	R
	Salmonella sp	R
	Shigella sp	R
	Proteus mirabilis	R
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	X1
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	R
	Brucella sp.	R
	Legionella sp.	R
	Pasteurella multocida	R
	Haemophilus ducreyi	R
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	R
	Bacteroides fragilis	R
	Prevotella melaninogenica	R
	Clostridium difficile	X1
	Clostridium (not difficile)	R
	Fusobacterium necrophorum	R
	Peptostreptococcus sp.	R

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)