Pharmacist’s Letter : Prescriber’s Letter

8202019 Pharmacistrsquos Letter Prescriberrsquos Letter

httpslidepdfcomreaderfullpharmacists-letter-prescribers-letter 16



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Copyright copy 2012 by Therapeutic Research CenterPO Box 8190 Stockton CA 95208 ~ Phone 209-472-2240 ~ Fax 209-472-2249

wwwpharmacistslettercom ~ wwwprescriberslettercom ~ wwwpharmacytechnicianslettercom

Generation Organisms Covered12

Fourth

Generationbull Broad coverage of gram positive and gram negative organisms

Coverage of Pseudomonas similar to ceftazidime Coverage of S

pneumonia similar to ceftriaxone

bull Some anaerobic coverage No coverage of B fragilis

bullNo oral agents curr

bullLess susceptible to

lactamases than sec

better against Citrob

FifthGeneration

(MRSA-

active)

bull Enhanced coverage of gram positive organisms MRSA S pneumonia and E faecalis

bull Similar gram negative coverage to third- and fourth-generation agents

Ceftaroline does not cover Pseudomonas

bull Limited anaerobic activity


Drug Routea Approved in

Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available First Generation Agents

Cefadroxil( Duricef ) PO Y(ge6 weeks

depending on

indication

[Canada])

Y(CrCL le50 mLmin) N Ybull

bull

su

Cefazolin( Ancef

Kefzol-US)

IMIV Y Y

(CrCl lt55 mLmin)

N Y bull A

Cephalexin

(Keflex)

PO Y Y

(Some sourcesrecommend dose

reduction with CrCL

lt40 to 50 mLmin)34

N Y bull

su D



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available

Second Generation Agents

Cefaclor(Ceclor )

PO Y

(ge1 month

[US])

N N Y bull

U

bull

su

(U

Cefotetan-

US only

(Cefotan)

IV N Y

(CrCl le30 mLmin)

N Y bull

Cefoxitin( Mefoxin)

IMIV Y

(gt3months

[US])

Y

(CrCl le50 mLmin)

N Y bull

C

Cefprozil(Cefzil)

PO Y

(ge6 months)

Y

(CrCl

le30 mLmin

[Canada]

lt30 mLmin [US])

N Y bull

U

bull

su

Cefuroxime(Ceftin [oral]

Zinacef

[injectable])

POIMIV Y

(ge3 months

[oral])

(gt3 months

[InjectableUS]

Y

(CrCl le20 mLmin

[for injectable] no

data for oral route)

N Y bull

C

bull

p

ta

bull

in

la

bull

c



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available

Third Generation Agents

Cefdinir-US

only

(Omnicef )

PO Y

(ge6 months)

Y

(CrCl lt30 mLmin)

N Y bull

bull

suCefditorenpivoxil-US

only

(Spectracef )

PO N

(ge12 years)

Y(CrCl lt50 mLmin)

N Y bull

Cefixime(Suprax)

PO Y

(ge6 months)

Y

(CrCl lt40 mLmin

[Canada]

lt60 mLmin [US])

N N bull

su

Cefotaxime(Claforan)

IMIV Y Y

(CrCl lt20 mLmin)

N Y bull

Cefpodoxime

proxetil-USonly

(Vantin)

PO Y

(ge2 months)

Y

(CrCl lt30mLmin)

N Y bull

su

Ceftazidime(Fortaz)

IMIV Y Y

(CrCl le50 mLmin

[Canada]

lt50 mLmin [US])

N Y bull

Ceftibuten-

US only

(Cedax)

PO Y

(ge6 months)

Y

(CrCl lt50 mLmin)

N N bull

su

Ceftriaxone( Rocephin)

IMIV Y

(gt28 days)

N N Y bull

C

Fourth Generation

Cefipime ( Maxipime)

IMIV Y

(ge2 months)

Y

(CrCl le50 mLmin

[Canada]

le60 mLmin [US])

N Y bull



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available

Fifth Generation (MRSA-active)

Ceftaroline-US only

(Teflaro)

IV N Y

(CrCl le50 mLmin)

N N bull

a Off-label routes such as intraperitoneal may be appropriate for some drugs

b Consult a neonatal dosing reference such as Neofax for information on use in premature neonates

US product information used for preparation of the above chart cefadroxil (Ranbaxy July 2007) cefazolin(October 2010) cefaclor (Ranbaxy May 2007) cefotetan (B Braun May 2011) Mefoxin (October 2006) cefproz

(August 2010) Ceftin (January 2010) cefdinir (Teva June 2009) Spectracef (2011) Suprax (October 2008) Claf

2007) Fortaz (August 2010) Cedax (April 2010) Rocephin (November 2010) Maxipime (August 2010) Teflaro

Canadian product monographs used for preparation of the above chart cefadroxil (Teva March 2012) cefa(May 2012) Ceclor (February 2012) cefoxitin (Hospira August 2010) Cefzil (December 2010) Ceftin (Novemb

(Pharmaceutical Partners of Canada January 2008) Suprax (November 2010) Claforan (November 2010) Forta

(Novopharm February 2012) Maxipime (September 2008)

Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary o

clinical judgments based on the content of this document Our editors have researched the information with input from exp

organizations Information and internet links in this article were current as of the date of publication



(PL Detail-Document 280706 Page 6 of 6)

Project Leader in preparation of this PL Detail- Document Stacy A Hester RPh BCPS

Assistant Editor

References1 Andes DR Craig WA Cephalosporins In Mandell

GL Bennett JE Dolin R Eds Principles andPractice of Infectious Diseases 7

th ed Philadelphia

PA Churchill Livngstone Elsevier 20092 Chambers HF Eliopoulos GM Gilbert DN et al The

Sanford Guide to Antimicrobial Therapy WebEdition Sperryville VA Antimicrobial Therapy Inc2012 httpwebeditionsanfordguidecom(Accessed June 14 2012)

3 Clinical Pharmacology [database online] TampaFL Cold Standard Inc 2012httpwwwclinicalpharmacologycom (AccessedOctober 1 2012)

4 Lexicomp Online Hudson OH Lexi-Comp Inchttponlinelexicom (Accessed October 1 2012)

Cite this document as follows PL Detail-Document Comparison of Cephalosporins Pharmacistrsquos

LetterPrescriberrsquos Letter July 2012

Evidence and Recommendations You Can Trusthellip

3120 West March Lane PO Box 8190 Stockton CA 95208 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249Copyright 983209 2012 by Therapeutic Research Center

Subscribers to the Letter can get PL Detail-Documents like this oneon any topic covered in any issue by going to wwwpharmacistslettercomwwwprescriberslettercom or wwwpharmacytechnicianslettercom



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Generation Organisms Covered12

Fourth

Generationbull Broad coverage of gram positive and gram negative organisms

Coverage of Pseudomonas similar to ceftazidime Coverage of S

pneumonia similar to ceftriaxone

bull Some anaerobic coverage No coverage of B fragilis


bullLess susceptible to

lactamases than sec

better against Citrob

FifthGeneration

(MRSA-

active)

bull Enhanced coverage of gram positive organisms MRSA S pneumonia and E faecalis

bull Similar gram negative coverage to third- and fourth-generation agents

Ceftaroline does not cover Pseudomonas

bull Limited anaerobic activity



Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available First Generation Agents

Cefadroxil( Duricef ) PO Y(ge6 weeks

depending on

indication

[Canada])

Y(CrCL le50 mLmin) N Ybull

bull

su

Cefazolin( Ancef

Kefzol-US)

IMIV Y Y

(CrCl lt55 mLmin)

N Y bull A

Cephalexin

(Keflex)

PO Y Y

(Some sourcesrecommend dose

reduction with CrCL

lt40 to 50 mLmin)34

N Y bull

su D



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Cefaclor(Ceclor )

PO Y

(ge1 month

[US])

N N Y bull

U

bull

su

(U

Cefotetan-

US only

(Cefotan)

IV N Y

(CrCl le30 mLmin)

N Y bull

Cefoxitin( Mefoxin)

IMIV Y

(gt3months

[US])

Y

(CrCl le50 mLmin)

N Y bull

C

Cefprozil(Cefzil)

PO Y

(ge6 months)

Y

(CrCl

le30 mLmin

[Canada]

lt30 mLmin [US])

N Y bull

U

bull

su


Zinacef

[injectable])

POIMIV Y

(ge3 months

[oral])

(gt3 months

[InjectableUS]

Y

(CrCl le20 mLmin

[for injectable] no


N Y bull

C

bull

p

ta

bull

in

la

bull

c



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Cefdinir-US

only

(Omnicef )

PO Y

(ge6 months)

Y

(CrCl lt30 mLmin)

N Y bull

bull


only

(Spectracef )

PO N

(ge12 years)

Y(CrCl lt50 mLmin)

N Y bull

Cefixime(Suprax)

PO Y

(ge6 months)

Y

(CrCl lt40 mLmin

[Canada]

lt60 mLmin [US])

N N bull

su


IMIV Y Y

(CrCl lt20 mLmin)

N Y bull

Cefpodoxime

proxetil-USonly

(Vantin)

PO Y

(ge2 months)

Y

(CrCl lt30mLmin)

N Y bull

su

Ceftazidime(Fortaz)

IMIV Y Y

(CrCl le50 mLmin

[Canada]

lt50 mLmin [US])

N Y bull

Ceftibuten-

US only

(Cedax)

PO Y

(ge6 months)

Y

(CrCl lt50 mLmin)

N N bull

su


IMIV Y

(gt28 days)

N N Y bull

C

Fourth Generation


IMIV Y

(ge2 months)

Y

(CrCl le50 mLmin

[Canada]

le60 mLmin [US])

N Y bull



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Ceftaroline-US only

(Teflaro)

IV N Y

(CrCl le50 mLmin)

N N bull
















Assistant Editor



th ed Philadelphia












(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Cefaclor(Ceclor )

PO Y

(ge1 month

[US])

N N Y bull

U

bull

su

(U

Cefotetan-

US only

(Cefotan)

IV N Y

(CrCl le30 mLmin)

N Y bull

Cefoxitin( Mefoxin)

IMIV Y

(gt3months

[US])

Y

(CrCl le50 mLmin)

N Y bull

C

Cefprozil(Cefzil)

PO Y

(ge6 months)

Y

(CrCl

le30 mLmin

[Canada]

lt30 mLmin [US])

N Y bull

U

bull

su


Zinacef

[injectable])

POIMIV Y

(ge3 months

[oral])

(gt3 months

[InjectableUS]

Y

(CrCl le20 mLmin

[for injectable] no


N Y bull

C

bull

p

ta

bull

in

la

bull

c



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Cefdinir-US

only

(Omnicef )

PO Y

(ge6 months)

Y

(CrCl lt30 mLmin)

N Y bull

bull


only

(Spectracef )

PO N

(ge12 years)

Y(CrCl lt50 mLmin)

N Y bull

Cefixime(Suprax)

PO Y

(ge6 months)

Y

(CrCl lt40 mLmin

[Canada]

lt60 mLmin [US])

N N bull

su


IMIV Y Y

(CrCl lt20 mLmin)

N Y bull

Cefpodoxime

proxetil-USonly

(Vantin)

PO Y

(ge2 months)

Y

(CrCl lt30mLmin)

N Y bull

su

Ceftazidime(Fortaz)

IMIV Y Y

(CrCl le50 mLmin

[Canada]

lt50 mLmin [US])

N Y bull

Ceftibuten-

US only

(Cedax)

PO Y

(ge6 months)

Y

(CrCl lt50 mLmin)

N N bull

su


IMIV Y

(gt28 days)

N N Y bull

C

Fourth Generation


IMIV Y

(ge2 months)

Y

(CrCl le50 mLmin

[Canada]

le60 mLmin [US])

N Y bull



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Ceftaroline-US only

(Teflaro)

IV N Y

(CrCl le50 mLmin)

N N bull
















Assistant Editor



th ed Philadelphia












(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Cefdinir-US

only

(Omnicef )

PO Y

(ge6 months)

Y

(CrCl lt30 mLmin)

N Y bull

bull


only

(Spectracef )

PO N

(ge12 years)

Y(CrCl lt50 mLmin)

N Y bull

Cefixime(Suprax)

PO Y

(ge6 months)

Y

(CrCl lt40 mLmin

[Canada]

lt60 mLmin [US])

N N bull

su


IMIV Y Y

(CrCl lt20 mLmin)

N Y bull

Cefpodoxime

proxetil-USonly

(Vantin)

PO Y

(ge2 months)

Y

(CrCl lt30mLmin)

N Y bull

su

Ceftazidime(Fortaz)

IMIV Y Y

(CrCl le50 mLmin

[Canada]

lt50 mLmin [US])

N Y bull

Ceftibuten-

US only

(Cedax)

PO Y

(ge6 months)

Y

(CrCl lt50 mLmin)

N N bull

su


IMIV Y

(gt28 days)

N N Y bull

C

Fourth Generation


IMIV Y

(ge2 months)

Y

(CrCl le50 mLmin

[Canada]

le60 mLmin [US])

N Y bull



(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Ceftaroline-US only

(Teflaro)

IV N Y

(CrCl le50 mLmin)

N N bull
















Assistant Editor



th ed Philadelphia












(P




Childrenb

Renal Dose

Adjustment

Hepatic Dose

Adjustment

Generic

Available


Ceftaroline-US only

(Teflaro)

IV N Y

(CrCl le50 mLmin)

N N bull
















Assistant Editor



th ed Philadelphia














Assistant Editor



th ed Philadelphia








