Cefalotin

General

• Type: 1st generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 1g, 2g vial
• Routes of Administration: IV, IM (IM is painful)
• Common Trade Names: Keflin

Adult Dosing

General

• Mild-Mod: 500mg-1g IV/IM q4-6h
• Severe: 1g-2g IV/IM q4h
• Max: 12g/day (doses up to 2g q4h have been used in life-threatening infections)

Perioperative Prophylaxis

• 1-2g IV x 1 (administer 30-60 min before skin incision)
• intraoperative redosing: q2-3h

Respiratory Tract Infection

• 500mg IM/IV q6h

Skin/Skin Structure Infection

• 500mg IM/IV q6h

Pediatric Dosing

General

• 20-40mg/kg/dose IV/IM q6h
• Max: 12g/day

Neonatal (<28 Days)

• Postnatal age <7 days: 20 mg/kg IV q12h
• Postnatal age >7 days (<2000g): 20 mg/kg/dose IV q12h
• Postnatal age >7 days (>2000g): 20 mg/kg/dose IV q8h

Special Populations

• Pregnancy: B
• Lactation: Probability of harm is low (excreted in breast milk)
• Renal
  • Adult
    • CrCl >50: No adjustment
    • CrCl 25-50: 1g q6h
    • CrCl 10-25: 1g q12h
    • CrCl 2-10: 500mg q12h
    • CrCl <2: 500mg q24h
    • Hemodialysis: Loading dose 1g, then 500mg q24h
    • Peritoneal dialysis: 500mg q12h
  • Pediatric
    • Renal adjustment required; modify interval based on oliguria/anuria.
• Hepatic
  • No adjustment usually required

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of anaphylaxis to Penicillins

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile
• Hemolytic Anemia
• Neutropenia
• Renal failure (historical association with high doses/concurrent aminoglycosides)

Common

• Thrombophlebitis (Frequent with IV administration; more common than with Cefazolin)
• Nausea and Vomiting
• Diarrhea
• Rash/Pruritus
• Pain at injection site (IM)
• Eosinophilia

Pharmacology

• Half-life: 0.5 - 1 hour (shorter than Cefazolin)
• Metabolism: Hepatic (deacetylation) to active metabolite
• Excretion: Urine
• 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	X1
	N. meningitidis	R
	Moraxella catarrhalis	I
	H. influenzae	I
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Serratia sp	R
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	X1
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	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)
• Cefazolin

References

• Epocrates
• Sanford Guide