Drugs: cephalexin

cephalexin
sef-a-LEX-in

Apo-Cephalex , , Keflex

Therapeutic class: Antibiotics

Pharmacologic class: First-generation cephalosporins

Available Forms
Capsules: 250 mg; 500 mg; 750 mg
Oral suspension: 125 mg/5 mL; 250 mg/5 mL
Tablets: 250 mg; 500 mg

Indications & Dosages

Adjust-a-dose (for all indications): For adults and children with CrCl of 30 to 59 mL/minute, no dosage
adjustment is needed but maximum daily dose shouldn’t exceed 1 g; for CrCl of 15 to 29 mL/minute, reduce
dose to 250 mg every 8 or 12 hours; for CrCl of 5 to 14 mL/minute in patients not yet on dialysis, reduce
dose to 250 mg every 24 hours; and for CrCl of 1 to 4 mL/minute in patients not yet on dialysis, reduce dose
to 250 mg every 48 or 60 hours.
Respiratory tract infections caused by susceptible isolates of Streptococcus pneumoniae and
Streptococcus pyogenes; GU tract infections caused by susceptible isolates of Escherichia coli,
Proteus mirabilis, and Klebsiella pneumoniae; skin and skin-structure infections caused by
susceptible isolates of Staphylococcus aureus or S. pyogenes; bone infections caused by
susceptible isolates of S. aureus and P. mirabilis; and otitis media caused by susceptible
isolates of S. pneumoniae, Haemophilus influenzae, S. aureus, S. pyogenes, and Moraxella
catarrhalis
Adults and children age 15 and older: 250 mg to 1 g PO every 6 hours or 500 mg every 12 hours for 7 to
14 days. Maximum, 4 g daily.
Children older than age 1: 25 to 50 mg/kg/day PO in two to four equally divided doses for 7 to 14 days. For
otitis media, 75 to 100 mg/kg PO in equally divided doses every 6 hours. For severe infections, 50 to 100
mg/kg PO in equally divided doses. Don’t exceed recommended adult dosage.

Administration
PO
Before giving, ensure patient isn’t allergic to penicillins or cephalosporins.
Obtain specimen for culture and sensitivity tests before giving. Begin therapy while awaiting results.
To prepare oral suspension, add required amount of water to powder in two portions. Shake well after
each addition. After mixing, store in refrigerator. Mixture will remain stable for 14 days. Keep tightly
closed and shake well before using.
May give without regard to meals but give drug with food or milk to lessen GI discomfort.

Action
Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.

Route Onset Peak Duration

PO Unknown 1 hr Unknown
Half-life: Adults, 30 minutes to 11/4 hours; children ages 3 to 12 months, 21/2 hours; neonates, 5 hours.

Adverse Reactions
CNS: dizziness, headache, fatigue, agitation, confusion, hallucinations.
GI: anorexia, diarrhea, pseudomembranous colitis, gastritis, glossitis, dyspepsia, abdominal pain, anal
pruritus, tenesmus, oral candidiasis.
GU: genital pruritus, candidiasis, vaginitis, interstitial nephritis.
Hematologic: neutropenia, thrombocytopenia, eosinophilia, anemia.
Musculoskeletal: arthritis, arthralgia, joint pain.
Skin: maculopapular and erythematous rashes, urticaria.
Other: anaphylaxis, hypersensitivity reactions, serum sickness.

Interactions
Drug-drug
Aminoglycosides: May increase risk of nephrotoxicity. Avoid using together.
Estrogen-based contraceptives: May decrease contraceptive absorption and effectiveness. Patient should
avoid use together or use nonhormonal contraception for duration of antibiotic (or 14 days, whichever is
longer) and for 7 days after completion of antibiotic.
Live-virus vaccines: May decrease effectiveness of live-virus vaccines. Concurrent use isn’t recommended.
Metformin: May increase metformin level. Monitor blood glucose level closely.
Multivitamins containing zinc: May decrease cephalexin absorption. Consider administering at least 3 hours
after cephalexin. Consider therapy modification.
Probenecid: May increase cephalosporin level. Use together isn’t recommended.
Warfarin: May enhance anticoagulant effects. Monitor therapy.

Effects on Lab Test Results

May increase alkaline phosphatase, ALT, AST, bilirubin, and LDH levels. May decrease Hb level and
prolong PT.
May increase eosinophil count. May decrease neutrophil and platelet counts.
May falsely increase serum or urine creatinine level in tests using Jaffé reaction. May cause false-positive
results of Coombs test and urine glucose tests that use cupric sulfate, such as Benedict reagent and
Clinitest.

Contraindications & Cautions

Contraindicated in patients hypersensitive to cephalosporins.
Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other
beta-lactam antibiotics.
Severe hypersensitivity reactions can occur. If an allergic reaction occurs, discontinue drug immediately
and treat appropriately.
Drug may increase risk of seizures. Use cautiously in patients with history of seizures.
Use cautiously in patients with history of colitis and in those with renal insufficiency.
Alert: Drug can cause superinfection and CDAD and pseudomembranous colitis ranging from mild to
life-threatening, which can occur even 2 months after therapy.
Dialyzable drug: Unknown.
Overdose Signs & Symptoms: Nausea, vomiting, epigastric distress, diarrhea, hematuria.

Pregnancy-Lactation-Reproduction
There are no adequate studies in pregnant women. Use during pregnancy only if clearly needed and
potential benefit justifies potential risk to the fetus.
Drug appears in human milk. Use cautiously in breastfeeding women.
Nursing Considerations
If large doses are given or if therapy is prolonged, monitor patient for superinfection and diarrhea,
especially if patient is high risk.
Treat group A beta-hemolytic streptococcal infections for a minimum of 10 days.
If anemia develops during or after cephalexin therapy, obtain a diagnostic work-up for drug-induced
hemolytic anemia, discontinue drug, and institute appropriate therapy.
Look alike-sound alike: Don’t confuse Keflex with Keppra. Don’t confuse drug with other
cephalosporins that sound alike.

Patient Teaching
Tell patient to take drug exactly as prescribed, even if feeling better.
Instruct patient to take drug with food or milk to lessen GI discomfort.
Tell patient taking suspension form to shake container well before measuring dose and to store in
refrigerator.
Tell patient to report all adverse reactions and to immediately report rash and signs and symptoms of
superinfection or diarrhea.