ceftaroline

ceftaroline

(sef-tar-oh-leen) ,

Teflaro

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: cephalosporin derivatives
Pregnancy Category: B

Indications

Treatment of acute bacterial skin/skin structure infections and community-acquired pneumonia.

Action

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.
Treatment of skin/skin structure infections—Active against Staphylococcus aureus (including methicillin-susceptible and -resistant strains), Streptococcus pyogenes, Streptococcus agalactiae, Escherichia coli, Klebsiella pneumoniae, and Klebsiella oxytoca; Treatment of community acquired pneumonia—Streptococcus pneumoniae(including pneumonia with bacteremia), Staphylococcus aureus(methicillin-susceptible strains only), Haemophilus influenzae, Klebsiella pneumoniae, Klebsiella oxytoca, and Escherichia coli.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability of parent drug.
Distribution: Unknown.
Metabolism and Excretion: Ceftaroline fosamil is rapidly converted by plasma phosphatases to ceftaroline, the active metabolite; 88% excreted in urine, 6% in feces.
Half-life: 2.6 hr (after multiple doses).

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusion12 hr

Contraindications/Precautions

Contraindicated in: Known serious hypersensitivity to cephalosporins.
Use Cautiously in: Known hypersensitivity to other beta-lactams;Renal impairment (dosage ↓ required for CCr ≤50 mL/min); Geriatric: Dose adjustment may be necessary for age-related ↓ in renal function; Obstetric: Use only if potential benefit outweighs potential risk to fetus; Lactation: Use cautiously if breast feeding; Pediatric: Safety and effectiveness not established.

Adverse Reactions/Side Effects

Gastrointestinal

  • Pseudomembranous colitis (life-threatening)
  • diarrhea
  • nausea

Dermatologic

  • rash

Hematologic

  • hemolytic anemia

Local

  • phlebitis at injection site

Miscellaneous

  • hypersensitivity reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Intravenous (Adults 18 yr) Skin/skin structure infections—600 mg every 12 hr for 5–14 days; Community-acquired pneumonia—600 mg every 12 hr for 5–7 days.

Renal Impairment

Intravenous (Adults >18 yr) CCr >30 to ≤50 mL/min—400 mg every 12 hr; CCr ≥15 to ≤30 mL/min—300 mg every 12 hr; CCr <15 mL/min—200 mg every 12 hr.

Availability

Powder for injection (requires reconstitution): 400 mg/vial, 600 mg/vial

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, cephalosporins, or carbapenems. Persons with a negative history of 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 mo following cessation of therapy.
  • Lab Test Considerations: May cause seroconversion from a negative to a positive direct Coombs' test. If anemia develops during or after therapy, perform a direct Coombs' test. If drug-induced hemolytic anemia is suspected, discontinue ceftaroline and provide supportive care.

Potential Nursing Diagnoses

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

Implementation

  • Intravenous Administration
  • pH: 4.8–6.5.
  • Intermittent Infusion: Reconstitute with 20 mL of sterile water for injection, 0.9% NaCl, D5W, or LR. Diluent: Dilute further with 50–250 mL of same diluent unless reconstituted with Sterile Water for Injection, then use 0.9% NaCl, D5W, D2.5W, 0.45% NaCl, or LR. Mix gently to dissolve. Solution is clear to light or dark yellow; do not administer solutions that are discolored or contain particulate matter. Solution is stable for 6 hr at room temperature or 24 hr if refrigerated.
  • Rate: Infuse over 1 hr.
  • Y-Site Compatibility: acyclovir, aminophylline, amiodarone, azithromycin, bumetanide, calcium chloride, calcium gluconate, ciprofloxacin, cisatracurium, clindamycin, cyclosporine, dexamethasone, digoxin, diltiazem, diphenhydramine, dopamine, doripenem, enalaprilat, esomeprazole, famotidine, fentanyl, fluconazole, furosemide, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, insulin, insulin lispro, levofloxacin, lidocaine, lorazepam, mannitol, meperidine, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, morphine, moxifloxacin, multivitamins, norepinephrine, ondansetron, pantoprazole, potassium chloride, promethazine, propofol, ranitidine, remifentanil, sodium bicarbonate, trimethoprim/sulfamethoxazole, vasopressin, voriconazole
  • Y-Site Incompatibility: amphotericin B colloidal, caspofungin, diazepam, filgrastim, labetalol, potassium phosphates, sodium phosphates
  • Additive Incompatibility: Do not mix with other drugs or solutions.

Patient/Family Teaching

  • Explain the purpose of ceftaroline to patient. Emphasize the importance of completing therapy, even if feeling better.
  • 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.
References in periodicals archive ?
Tenders are invited for delivery of the drug ceftaroline fosamil in accordance with the specification.
This poses a serious problem for drug therapy because the treatment options become limited to potentially toxic antimicrobials like vancomycin, teicoplanin, streptogramins, linezolid and ceftaroline leading to increased mortality and morbidity.
Additional agents with activity against coagulase-negative staphylococci and MRSA include daptomycin, tedizolid, telavancin, dalba-vancin, oritavancin, ceftaroline, and quinupristin-dalfopristin.
Ceftaroline fosamil is the latest, fifth generation cephalosporin.
Initial empiric antibiotic therapy for infectious aortitis should generally cover Gram-positive and Gram-negative bacteria, taking into consideration risk factors for multidrug-resistant organisms and/or extended spectrum beta-lactamase-resistant bacteria that may require specific antibiotics (e.g., vancomycin, ceftaroline, daptomycin, linezolid, carbapenem, or newer agents) [17, 18].
Ceftaroline is the only beta-lactam antibiotic that has demonstrated activity against MRSA and is now widely used against pulmonary and soft-tissue infections.
Three days later, reexploration and laminectomy from T4-T7 were performed and antibiotic treatment was continued with vancomycin and ceftaroline fosamil.
In Brazil, the following antimicrobials are considered acceptable for use in OPAT: amikacin, gentamicin, ceftriaxone, cefepime, ceftazidime, ceftaroline, ertapenem, linezolid (when formulation for oral use is not available), tigecycline, daptomycin, teicoplanin, vancomycin, amphotericin B (lipid formulations), caspofungin, anidulafungin, micafungin and voriconazole (when formulation for oral use is not available).
The patient was placed on IV ceftaroline, an advanced-generation cephalosporin, for 6 weeks.
Resistance to other antibiotics, such as levofloxacin, clindamycin, and erythromycin, also showed some decrease during the same period, whereas susceptibility to ceftaroline, trimethoprimsulfanethoxazole, and tetracycline remained stable.
Prior to Regulus, he was president of Cerexa, Inc., where he was involved with the development of a portfolio of antibiotics for multidrug-resistant infections including ceftaroline and ceftazidime/avibactam combination.