Cefonicid

General

• Type: 2nd generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 500mg, 1g, 10g
• Routes of Administration: IV, IM
• Common Trade Names: Monocid

Adult Dosing

General

• Uncomplicated: 1g IM/IV q24h
• Severe/Complicated: 2g IM/IV q24h
• Max: 2g/day

UTI, Uncomplicated

• 500mg IM/IV q24h

Pneumonia / LRTI

• 1g IM/IV q24h

Surgical Prophylaxis

• 1g IM/IV x1 (60 min before procedure)
• Cesarean Section: 1g IV after umbilical cord is clamped

Pediatric Dosing

General (>1 Year)

• 20-50mg/kg/day IM/IV given once daily (q24h)
• Max: 2g/day (should not exceed adult dose)

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult (Initial dose: 7.5mg/kg IM/IV)
    • CrCl 60-79: 10-25mg/kg q24h
    • CrCl 40-59: 8-20mg/kg q24h
    • CrCl 20-39: 4-15mg/kg q24h
    • CrCl 10-19: 4-15mg/kg q48h
    • CrCl 5-9: 4-15mg/kg q3-5 days
    • CrCl <5: 3-4mg/kg q3-5 days
    • Hemodialysis: Give dose after dialysis
  • Pediatric
    • Renal dosing not well defined; generally avoid or strictly adjust based on adult guidelines
• Hepatic
  • Not defined

Contraindications

• Allergy to class/drug (Cephalosporin)
• Immediate hypersensitivity to Penicillins

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile associated diarrhea
• Neutropenia
• Thrombocytopenia
• Seizures
• Nephrotoxicity (rare)

Common

• Injection site pain (IM)
• Phlebitis
• Diarrhea
• Rash
• Nausea and Vomiting
• Transaminitis
• Eosinophilia
• Increased BUN/Creatinine

Pharmacology

• Half-life: 3.5 - 4.5h (Allows for once-daily dosing)
• Metabolism: Not metabolized
• Excretion: Urine (99% unchanged)
• 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	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	R
	Serratia marcescens	R
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	I
	Providencia sp.	I
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	I
	Citrobacter sp.	I
	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
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	I
	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)
• Cephalosporins