Cephalexin: Effective Bacterial Infection Treatment
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Cephalexin is a first-generation cephalosporin antibiotic prescribed to combat a wide range of bacterial infections. It operates by inhibiting bacterial cell wall synthesis, leading to the eradication of susceptible pathogens. This medication is a cornerstone in outpatient treatment due to its reliable efficacy, broad spectrum of activity, and generally favorable safety profile. Proper diagnosis and adherence to prescribed dosing are critical for optimal therapeutic outcomes and mitigating antibiotic resistance.
Features
- Active Ingredient: Cephalexin (as monohydrate)
- Drug Class: First-generation cephalosporin antibiotic
- Available Forms: Oral capsules (250 mg, 500 mg), tablets (250 mg, 500 mg, 750 mg), and oral suspension (125 mg/5 mL, 250 mg/5 mL)
- Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs)
- Spectrum of Activity: Effective against many Gram-positive and some Gram-negative bacteria, including Staphylococcus aureus (non-MRSA), Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis
- Bioavailability: Well-absorbed from the gastrointestinal tract, with peak serum concentrations occurring within 1 hour
- Half-life: Approximately 0.5–1.2 hours in adults with normal renal function
- Excretion: Primarily renal, via glomerular filtration and tubular secretion
Benefits
- Rapid Bactericidal Action: Effectively kills susceptible bacteria, leading to swift symptom relief and infection resolution.
- Broad-Spectrum Coverage: Targets a wide array of common pathogens responsible for respiratory, skin, soft tissue, bone, and urinary tract infections.
- Proven Clinical Efficacy: Supported by decades of clinical use and studies demonstrating high success rates in treating indicated infections.
- Generally Well-Tolerated: Exhibits a favorable safety profile with most adverse effects being mild and transient.
- Convenient Oral Administration: Available in multiple formulations allowing for flexible dosing tailored to patient age, weight, and infection severity.
- Cost-Effective Treatment: Often available as a generic medication, making it an accessible option for many patients.
Common use
Cephalexin is indicated for the treatment of bacterial infections caused by susceptible strains of microorganisms. Common clinical applications include:
- Respiratory Tract Infections: Such as pharyngitis, tonsillitis, and acute bronchitis caused by Streptococcus pyogenes.
- Skin and Skin Structure Infections: Including cellulitis, abscesses, impetigo, and wound infections, often due to Staphylococcus aureus or Streptococcus species.
- Bone and Joint Infections: Osteomyelitis caused by susceptible staphylococci.
- Genitourinary Tract Infections: Acute and uncomplicated cystitis, pyelonephritis, and prostatitis caused by E. coli, P. mirabilis, or Klebsiella species.
- Otitis Media: Middle ear infections where causative organisms are susceptible. Its use should be based on culture and susceptibility testing whenever possible to ensure appropriate therapy and combat antimicrobial resistance.
Dosage and direction
Dosage is individualized based on the infection’s type, severity, and the patient’s renal function.
- Adults: The typical adult dose ranges from 250 mg to 1000 mg (1 gram) every 6 to 12 hours. For most mild to moderate infections, 500 mg every 12 hours is standard. Severe infections may require 1 gram every 6 to 12 hours. The maximum daily dose is 4 grams.
- Pediatric Patients: The recommended dosage is 25 to 100 mg/kg/day in divided doses every 6 to 12 hours. For otitis media, the dose is 75 to 100 mg/kg/day in four divided doses.
- Renal Impairment: Dosage adjustment is necessary. For creatinine clearance (CrCl) below 10 mL/min, a maximum dose of 500 mg every 8-12 hours is recommended. For CrCl 10-50 mL/min, a full loading dose can be given with subsequent doses reduced or intervals extended.
- Administration: Can be taken with or without food; taking with food may minimize gastrointestinal upset. The oral suspension should be shaken well before each use. The full prescribed course must be completed even if symptoms improve earlier to prevent recurrence and resistance development.
Precautions
- Hypersensitivity: Use with caution in patients with a history of hypersensitivity reactions to penicillins or other beta-lactam antibiotics due to the risk of cross-reactivity.
- Clostridium difficile-Associated Diarrhea (CDAD): Antibiotic use can predispose patients to C. difficile infection, which may range from mild diarrhea to fatal colitis. Evaluate if diarrhea occurs during or after therapy.
- Renal Impairment: Dosage adjustment is required in patients with significantly impaired renal function (CrCl <50 mL/min) to prevent accumulation and potential toxicity.
- Prolonged Use: May result in overgrowth of non-susceptible organisms, including fungi. Monitor for superinfection.
- Laboratory Tests: Perform culture and susceptibility studies to guide therapy. In prolonged therapy, periodic assessment of renal, hepatic, and hematopoietic function is advisable.
- Pregnancy and Lactation: Category B. Should be used during pregnancy only if clearly needed. Cephalexin is excreted in human milk; caution is advised when administering to a nursing woman.
Contraindications
Cephalexin is contraindicated in patients with:
- A known hypersensitivity to cephalexin or any other cephalosporin antibiotic.
- A history of severe immediate hypersensitivity reactions (e.g., anaphylaxis) to penicillins or other beta-lactam antibiotics, due to the potential for cross-sensitivity.
Possible side effect
The most common adverse reactions are gastrointestinal and are generally mild.
- Common (≥1%): Diarrhea, nausea, vomiting, dyspepsia, abdominal pain.
- Uncommon (0.1%–1%): Dizziness, fatigue, headache, vaginitis and genital pruritus, transient elevations in hepatic enzymes.
- Rare (<0.1%): Hypersensitivity reactions (rash, urticaria, angioedema, anaphylaxis), eosinophilia, neutropenia, thrombocytopenia, reversible interstitial nephritis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridium difficile-associated diarrhea (CDAD), hallucinations, agitation, confusion. Most side effects are self-limiting. Discontinue and seek medical attention for severe reactions like anaphylaxis, severe skin reactions, or persistent diarrhea.
Drug interaction
- Probenecid: Concurrent administration may inhibit the renal tubular secretion of cephalexin, leading to increased and prolonged blood levels.
- Metformin: Cephalexin may increase the blood concentration and enhance the effects of metformin; monitor blood glucose levels.
- Oral Anticoagulants (e.g., Warfarin): Some cephalosporins have been associated with hypoprothrombinemia and potentiating the effect of warfarin; monitor prothrombin time.
- Other Nephrotoxic Drugs (e.g., Aminoglycosides, Loop Diuretics): Concomitant use may increase the risk of nephrotoxicity; monitor renal function. Always inform the healthcare provider of all concomitant medications, including over-the-counter drugs and supplements.
Missed dose
If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended, as it may increase the risk of adverse effects.
Overdose
Symptoms of overdose are primarily extensions of adverse effects, notably nausea, vomiting, epigastric distress, diarrhea, and hematuria. Management is supportive and symptomatic. Gastric lavage may be considered if ingestion was recent. Cephalexin is removed by hemodialysis; this may be employed in cases of significant overdose, especially in patients with renal impairment.
Storage
- Store at controlled room temperature, 20°C to 25°C (68°F to 77°F).
- Keep the container tightly closed to protect from moisture.
- The reconstituted oral suspension is stable for 14 days when refrigerated (2°C to 8°C / 36°F to 46°F); discard any unused portion after this period.
- Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“Cephalexin has been a reliable first-line agent in my practice for decades for uncomplicated skin and soft tissue infections. Its predictable pharmacokinetics and generally mild side effect profile make it a go-to choice for many outpatient scenarios.” – Dr. A. Reynolds, Infectious Disease Specialist “As a primary care physician, I find cephalexin’s oral formulation and broad spectrum incredibly practical for treating common community-acquired infections. Patient compliance is typically high due to its tolerability.” – Dr. L. Chen, Family Medicine “Prescribed for a stubborn cellulitis. Symptoms began improving within 48 hours. Completed the full course with no side effects aside from mild initial nausea.” – Patient M.T. “Effective for my child’s ear infection. The suspension was easy to administer. Important to finish the entire bottle as directed.” – Parent, J. Kumar