cefoperazone


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cefoperazone

 [sef″o-per´ah-zōn]
a third-generation cephalosporinantibiotic with a wide range of antimicrobial activity, especially effective against Pseudomonas aeruginosa.

cefoperazone

(sef-oh-per-a-zone)

Classification

Therapeutic: anti infectives
Pharmacologic: third generation cephalosporins
Pregnancy Category: B

Indications

Treatment of the following infections caused by susceptible organisms:
  • Skin and skin structure infections,
  • Urinary tract infections,
  • Gynecological infections including gonorrhea,
  • Respiratory tract infections,
  • Intra-abdominal infections,
  • Septicemia.

Action

Binds to the bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.
Similar to that of second-generation cephalosporins, but activity against staphylococci is less, while activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents.Notable is increased action against:
  • Citrobacter,
  • Enterobacter,
  • Haemophilus influenzae,
  • Escherichia coli,
  • Klebsiella pneumoniae,
  • Morganella morganii,
  • Neisseria gonorrhoeae,
  • Proteus,
  • Providencia,
  • Pseudomonas aeruginosa,
  • Serratia.
Has some activity against enterococci.Has some activity against anaerobes, includingBacteroides fragilis.

Pharmacokinetics

Absorption: Well absorbed following IM administration; IV administration results in complete bioavailability.
Distribution: Widely distributed. Crosses the placenta; enters breast milk in low concentrations. CSF penetration better than with first- and second-generation agents.
Protein Binding: ≥90%.
Metabolism and Excretion: Excreted in bile.
Half-life: 2 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IMrapid1–2 hr12 hr
IVrapidend of infusion12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.
Use Cautiously in: Hepatic/biliary impairment or combined hepatic/biliary/renal impairment (dose ↓/↑ dosing interval recommended); Patients with poor nutritional status, malabsorption states, or alcoholism (may be at ↑ risk of bleeding); History of GI disease, especially colitis; Obstetric / Lactation: Has been used safely.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (high doses) (life-threatening)

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea
  • nausea
  • vomiting

Dermatologic

  • rashes
  • urticaria

Hematologic

  • bleeding
  • eosinophilia
  • neutropenia

Local

  • pain at IM site (most frequent)
  • phlebitis at IV site (most frequent)

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

Ingestion of alcohol within 48–72 hr of cefoperazone may result in a disulfiram-like reaction.May potentiate the effects of anticoagulants and ↑ risk of bleeding.Concurrent use of loop diuretics or aminoglycosides may ↑ risk of nephrotoxicity.

Route/Dosage

Intramuscular Intravenous (Adults) Mild to moderate infections—1–2 g every 12 hr. Severe infections—2–4 g q 8 hr or 1.5–3 g every 6 hr.

Hepatic Impairment

Intravenous (Adults) Impaired hepatic function/biliary obstruction—daily dose should not exceed 4 g; combined hepatic and renal impairment—daily dose should not exceed 1–2 g.

Availability (generic available)

Powder for injection: 1 g, 2 g, 10 g
Premixed containers: 1 g/50 mL, 2 g/50 mL

Nursing implications

Nursing assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
  • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: May cause positive results for Coombs' test.
    • Monitor prothrombin time and assess patient for bleeding (guaiac stools; check for hematuria, bleeding gums, ecchymosis) daily in high-risk patients; may cause hypoprothrombinemia.
    • May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
    • May rarely cause neutropenia and eosinophilia.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)
Diarrhea (Adverse Reactions)

Implementation

  • Intramuscular: Reconstitute IM doses with sterile or bacteriostatic water for injection or 0.9% NaCl for injection. May be diluted with lidocaine to minimize injection discomfort.
    • Inject deep into a well-developed muscle mass; massage well.
  • Intravenous Administration
  • pH: 4.5–6.5.
  • Intravenous: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis.
    • If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.
  • Intermittent Infusion: Reconstitute each gram with 5 mL of sterile or bacteriostatic water for injection, 0.9% NaCl, or D5W. Shake vigorously and allow to stand for visualization and clarity. Solution may be colorless to straw-colored. Diluent: Further dilute each gram in 50–100 mL of 0.9% NaCl, D5W, D10W, D5/0.25% NaCl, D5/0.9% NaCl, D5/LR, or lactated Ringer's solution. Solution is stable for 24 hr at room temperature and 5 days if refrigerated.
  • Rate: Administer over 15–30 min.
  • Y-Site Compatibility: acyclovir, alfentanil, allopurinol, aminophylline, ascorbic acid, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, dexamethasone, dexmedetomidine, digoxin, docetaxel, enalaprilat, epinephrine, epoetin alfa, eptifibatide, etoposide, etoposide phosphate, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, glycopyrrolate, granisetron, heparin, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, isoproterenol, ketorolac, lidocaine, linezolid, mannitol, mechlorethamine, melphalan, methotrexate, methylprednisolone, metoclopramide, metoprolol, metronidazole, multivitamins, nafcillin, naloxone, nitroglycerin, nitroprusside, norepinephrine, oxacillin, oxytocin, paclitaxel, penicillin G, pentobarbital, phenobarbital, phenylephrine, phytonadione, potassium chloride, procainamide, propofol, propranolol, ranitidine, rituximab, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, vasopressin, vincristine
  • Y-Site Incompatibility: amifostine, amikacin, amphotericin B cholesteryl, amphotericin B liposome, atracurium, azathioprine, benztropine, calcium chloride, caspofungin, chlorpromazine, cimetidine, cisatracurium, codeine, dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, dopamine, doxacurium, doxorubicin(, doxorubicin liposome, doxycycline, epirubicin, filgrastim, ganciclovir, gemcitabine, gentamicin, haloperidol, hydralazine, hydroxyzine, idarubicin, indomethacin, insulin, labetalol, levofloxacin, meperidine, metaraminol, methoxamine, methyldopate, midazolam, mitoxantrone, nalbuphine, nesiritide, nicardipine, ondansetron, oxaliplatin, pantoprazole, papaverine, pentamidine, pentazocine, perphenazine, phentolamine, phenytoin, prochlorperazine, promethazine, protamine, pyridoxime, quinupristin/dalfopristin, rocuronium, sargramostim, thiamine, tobramycin, tolazoline, trastuzumab, trimetaphan, trimethoprim/sulfamethoxazole, vancomycin, verapamil, vinorelbine

Patient/Family Teaching

  • Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
  • Caution patients that concurrent use of alcohol with cefoperazone may cause a disulfiram-like reaction (abdominal cramps, nausea, vomiting, headache, hypotension, palpitations, dyspnea, tachycardia, sweating, flushing). Alcohol and alcohol-containing medications should be avoided during and for several days after therapy.
  • Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

cefoperazone

/cef·o·per·a·zone/ (sef″o-per´ah-zōn) a β–resistant, third-generation cephalosporin effective against a wide range of aerobic and anaerobic gram-positive and gram-negative bacteria; used as the sodium salt.

cefoperazone

a third generation cephalosporin antibiotic.
References in periodicals archive ?
baumannii LMG 1025 LMG 1041 Coriander oil 1 4 Cefoperazone 32(I) 64(R) Chloramphenicol 32(R) 64(R) Ciprofloxacin 0.
LF Enterobacteriaceae with two different antibiograms (R to cefoperazone, gentamicin, co-trimoxazole, nalidixic acid, norfloxacin, ciprofloxacin, cefotaxime, amikacin; and R to cefoperazone, gentamicin, cotrimoxazole, nalidixic acid, norfloxacin, ciprofloxacin, cefotaxime but susceptible to amikacin) constituted 28 and 22 per cent of the isolates.
aeruginosa, 64 (70%) were resistant to ceftazidime, 68 (75%) to piperacillin, 54 (59%) to piperacilin/tazobactam, 81 (89%) to ticarcillin/ clavulinic acid, 75 (82%) to cefoperazone, 67 (74%) to amikacin, 74 (81%) to cefepime, 65 (71%) to levofloxacin, 72 (79%) to ciprofloxacin and 63 (69%) to aztreonam by the disc diffusion method.
Antibiotic sensitivity (%) of MBL positive (n=50) and MBL negative (n=10) isolates Antibiotics ([micro]g) MBL positive MBL negative Amikacin * (30) 0 10 Gentamicin (10) 0 0 Netilmicin * (30) 0 20 Tobramycin (10) 0 0 Cefoperazone (75) 0 0 Cefepime * (30) 0 30 Cetazidime * (30) 4 40 Ceftriaxone * (30) 0 20 Ceftizoxime (30) 0 0 Ciprofloxacin * (5) 2 40 Gatifloxacin (5) 36 30 Lomefloxacin * (10) 2 10 Chloramphenicol (30) 0 0 Pipracillin/tazobactam (100/10) 42 70 Imipenem (10) 0 0 Meropenem (10) 0 0 * P<0.
064% sodium cefoperazone in brucella broth) (11) were added to the suspension, gently mixed, and incubated under microaerobic atmosphere at 37[degrees]C for 4 h, then at 42[degrees]C for 48 h.
In the selective agar method, the fecal suspension (approximately 1 g/mL of saline) was plated onto Butzler's medium comprising Mueller-Hinton agar (Oxoid Ltd, Basingstoke, United Kingdom) containing 5% sheep blood and the antimicrobial supplement cefoperazone 30 mg/L, rifampicin 10 mg/L, and amphotericin B 2 mg/L (Institute Virion, Ruschlikon, Switzerland) (13).
Tenders are invited for Inj Cefoperazone 1000Mg And Sulbactam 500Mg Vial
ESBL production was tested by DDST (1) using a disc of ceftazidime-clavulanate along with four cephalosporins; 3GC-cefotaxime, ceftriaxone, cefoperazone and 4GC-cefepime.
Thus 10 [micro]l of agar gel contained one of the antimicrobial in concentration ([micro]g) of ampicillin (10), gentamycin (10), cefazolin (30), cefotaxime (30), ceftazidime (30), cefoperazone (75), ciprofloxacin (5), norfloxacin (10), amikacin (30), and imipenem (10).
After enrichment, the tube was again centrifuged, and 100 [micro]L of the sample from each of 49 tubes was streaked onto modified cefoperazone charcoal deoxycholate agar (mCCDA) (blood-free agar base supplemented with CM739 + SR155) (Oxoid).
Prior Information Notice: Delivery of antibacterials for systemic use - cefoperazone and cefuroxime.
Various antimicrobial agents ([micro]g) used were amikacin (30), gentamicin (10), tobramycin (10), ceftazidime (30), ceftriaxone (30), ceftizoxime (30), cefoperazone (75), carnbenicillin (100), piperacillin (100), Ticarcillin (75), ciprofloxacin (5), lomefloxacin (10) and imipenem (10) (Hi-media, Mumbai, India).