CEFOPERAZONE SODIUM
(sef-oh-per'a-zone)
Cefobid
Classifications: antiinfective; antibiotic; third-generation cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B

Availability

1 g, 2 g injection

Actions

Semisynthetic third-generation cephalosporin antibiotic. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Spectrum of activity is similar to that of cefotaxime.

Therapeutic Effects

Generally active against a wide variety of gram-negative bacteria, including some strains of Pseudomonas aeruginosa. Also active against some organisms resistant to first and second generation cephalosporins and currently available aminoglycoside antibiotics and penicillins: e.g., Escherichia coli, Klebsiella pneumoniae, and Serratia marcescens. Other susceptible organisms include Proteus mirabilis, Salmonella, Shigella, Haemophilus influenzae, Neisseria gonorrhoeae, groups A and B Streptococci, Staphylococcus aureus, and some strains of Pseudomonas sp. Cefoperazone inhibits some strains of Clostridium, but C. difficle is resistant to the drug, as is Listeria monocytogenes. It has a broad antibacterial spectrum, including gram-positive bacteria and Pseudomonas aeruginosa. Effectively treats biliary tract infections, gynecologic infections and gonorrhea, intra-abdominal and soft tissue infections, respiratory tract infections, urinary tract infections, skin infections, septicemia, and surgical infections, reducing or eliminating signs and symptoms of infection.

Uses

Infections of skin and skin structures, urinary tract, respiratory tract; peritonitis and other intra-abdominal infections, pelvic inflammatory disease, endometritis and other infections of the female genital tract; bacterial septicemia.

Unlabeled Uses

Children <12 y.

Contraindications

Hypersensitivity to cephalosporins and related beta-lactam antibiotics; pregnancy (category B).

Cautious Use

History of hypersensitivity to penicillins, history of allergy, particularly to drugs; hepatic disease, history of colitis or other GI disease, history of bleeding disorders; lactation.

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 1–2 g q12h; 16 g/d in 2–4 divided doses
Child <12 y : IV/IM 100–150 mg/kg/d divided q8–12h (max: 12 g/d)

Administration

Intramuscular
Intravenous
  • IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.
  • Rapid, direct (bolus) IV injections are not recommended.

PREPARE: Intermittent: Dilute each 1 g with 5 mL sterile water. Shake vigorously to dissolve, then dilute in 50–100 mL of D5W or NS.  Continuous:   Further dilute in 500–1000 mL of the selected IV solution.  

ADMINISTER: Intermittent: Give over 15–30 min.  Continuous: Give 500–1000 mL over 6–24 h.  

INCOMPATIBILITIES Solution/additive: aminoglycosides, doxapram. Y-site: aminoglycosides, amifostine, amphotericin B cholesteryl complex, cisatracurium, diltiazem, doxorubicin liposome, filgrastim, gemcitabine, hetastarch, labetalol, meperidine, ondansetron, pentamidine, perphenazine, promethazine, sargramostim, vinorelbine.

Adverse Effects (1%)

Body as a Whole: Fever, eosinophilia, phlebitis (IV site), transient pain (IM site), superinfections. GI: Abdominal cramps, bloating, loose stools or diarrhea, pseudomembranous colitis, elevated liver function tests (AST, ALT, alkaline phosphatase). Hematologic: Abnormal PT/INR and PTT; hypoprothrombinemia. Skin: Skin rash, urticaria, pruritus. Urogenital: Transient increases in serum creatinine and BUN, oliguria.

Diagnostic Test Interference

Cefoperazone can cause positive direct Coombs' test, which may result in interferences with hematologic studies and cross-matching procedures. False-positive results for urine glucose using copper sulfate tests (Benedict's, Clinitest), but not with glucose enzymatic tests, e.g., Clinistix, TesTape, Diastix. Also causes prolonged prothrombin twice during therapy.

Interactions

Drug: Probenecid decreases renal elimination of cefoperazone; alcohol produces disulfiram reaction.

Pharmacokinetics

Peak: 1–2 h after IM; 15–20 min after IV. Distribution: Low CNS penetration except with inflamed meninges; highest concentrations in bile; crosses placenta. Elimination: 70–75% excreted unchanged in bile in 6–12 h, small amount excreted in breast milk. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug