Cephalexin: Package Insert and Label Information
CEPHALEXIN — cephalexin for suspension
Lupin Pharmaceuticals, Inc.
1 INDICATIONS AND USAGE
1.1 Respiratory Tract Infections
Cephalexin for oral suspension is indicated for the treatment of respiratory tract infections caused by susceptible isolates of Streptococcus pneumoniae and Streptococcus pyogenes.
1.2 Otitis Media
Cephalexin for oral suspension is indicated for the treatment of otitis media caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, and Moraxella catarrhalis.
1.3 Skin and Skin Structure Infections
Cephalexin for oral suspension is indicated for the treatment of skin and skin structure infections caused by susceptible isolates of the following Gram-positive bacteria: Staphylococcus aureus and Streptococcus pyogenes.
1.4 Bone Infections
Cephalexin for oral suspension is indicated for the treatment of bone infections caused by susceptible isolates of Staphylococcus aureus and Proteus mirabilis.
1.5 Genitourinary Tract Infections
Cephalexin for oral suspension is indicated for the treatment of genitourinary tract infections, including acute prostatitis, caused by susceptible isolates of Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae.
1.6 Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of cephalexin for oral suspension and other antibacterial drugs, cephalexin for oral suspension should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information is available, this information should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
2 DOSAGE AND ADMINISTRATION
2.1 Adults and Pediatric Patients at Least 15 Years of Age
The usual dose of oral cephalexin is 250 mg every 6 hours, but a dose of 500 mg every 12 hours may be administered. Treatment is administered for 7 to 14 days.
For more severe infections larger doses of oral cephalexin may be needed, up to 4 grams daily in two to four equally divided doses.
2.2 Pediatric Patients (over 1 year of age)
The recommended total daily dose of oral cephalexin for pediatric patients is 25 to 50 mg/kg given in equally divided doses for 7 to 14 days. In the treatment of β-hemolytic streptococcal infections, duration of at least 10 days is recommended. In severe infections, a total daily dose of 50 to 100 mg/kg may be administered in equally divided doses.
For the treatment of otitis media, the recommended daily dose is 75 to 100 mg/kg given in equally divided doses.
| Cephalexin for oral suspension | ||
| Weight 10 kg (22 lb) | 125mg/5mL ½ to 1 tsp q.i.d. | 250mg/5mL ¼ to ½ tsp q.i.d. |
| 20 kg (44 lb) 40 kg (88 lb) | 1 to 2 tsp q.i.d. 2 to 4 tsp q.i.d. Or | ½ to 1 tsp q.i.d. 1 to 2 tsp q.i.d. |
| Weight 10 kg (22 lb) 20 kg (44 lb) | 125mg/5mL 1 to 2 tsp b.i.d. 2 to 4 tsp b.i.d. | 250mg/5mL ½ to 1 tsp b.i.d. 1 to 2 tsp b.i.d. |
| 40 kg (88 lb) | 4 to 8 tsp b.i.d. | 2 to 4 tsp b.i.d. |
125 mg per 5 mL (100 mL when mixed): Prepare suspension time at dispensing. Add to the bottle a total of 69 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain cephalexin monohydrate equivalent to 125 mg cephalexin in each 5 mL (teaspoonful).
125 mg per 5 mL (200 mL when mixed): Prepare suspension time at dispensing. Add to the bottle a total of 138 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain cephalexin monohydrate equivalent to 125 mg cephalexin in each 5 mL (teaspoonful).
250 mg per 5 mL (100 mL when mixed): Prepare suspension time at dispensing. Add to the bottle a total of 69 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain cephalexin monohydrate equivalent to 250 mg cephalexin in each 5 mL (teaspoonful).
250 mg per 5 mL (200 mL when mixed): Prepare suspension time at dispensing. Add to the bottle a total of 138 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain cephalexin monohydrate equivalent to 250 mg cephalexin in each 5 mL (teaspoonful).
* After mixing, store in refrigerator. May be kept for 14 days without significant loss of potency.
2.3 Dosage Adjustments in Adult and Pediatric Patients at Least 15 Years of Age with Renal Impairment
Administer the following dosing regimens for cephalexin for oral suspension to patients with impaired renal function [see Warnings and Precautions (5.4) and Use in Specific Populations (8.6) ].
| Renal function | Dose regimen recommendation |
| Creatinine clearance ≥ 60 mL/min | No dose adjustment |
| Creatinine clearance 30 to 59 mL/min | No dose adjustment; maximum daily dose should not exceed 1 g |
| Creatinine clearance 15 to 29 mL/min | 250 mg, every 8 hours or every 12 hours |
| Creatinine clearance 5 to 14 mL/min not yet on dialysis* | 250 mg, every 24 hours |
| Creatinine clearance 1 to 4 mL/min not yet on dialysis* | 250 mg, every 48 hours or every 60 hours |
* There is insufficient information to make dose adjustment recommendations in patients on hemodialysis.
3 DOSAGE FORMS AND STRENGTHS
Cephalexin for oral suspension USP
125mg/5mL and 250 mg/5mL
4 CONTRAINDICATIONS
Cephalexin is contraindicated in patients with known hypersensitivity to cephalexin or other members of the cephalosporin class of antibacterial drugs.
5 WARNINGS AND PRECAUTIONS
5.1 Hypersensitivity Reactions
Allergic reactions in the form of rash, urticaria, angioedema, anaphylaxis, erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis have been reported with the use of cephalexin. Before therapy with cephalexin for oral suspension is instituted, inquire whether the patient has a history of hypersensitivity reactions to cephalexin, cephalosporins, penicillins, or other drugs. Cross-hypersensitivity among beta-lactam antibacterial drugs may occur in up to 10% of patients with a history of penicillin allergy.
If an allergic reaction to cephalexin for oral suspension occurs, discontinue the drug and institute appropriate treatment.
5.2 Clostridium difficile-Associated Diarrhea
Clostridium difficile -associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including cephalexin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile , and surgical evaluation should be instituted as clinically indicated.
5.3 Direct Coombs’ Test Seroconversion
Positive direct Coombs’ tests have been reported during treatment with the cephalosporin antibacterial drugs including cephalexin. Acute intravascular hemolysis induced by cephalexin therapy has been reported. If anemia develops during or after cephalexin therapy, perform a diagnostic work-up for drug-induced hemolytic anemia, discontinue cephalexin and institute appropriate therapy.
5.4 Seizure Potential
Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced. If seizures occur, discontinue cephalexin for oral suspension. Anticonvulsant therapy can be given if clinically indicated.
5.5 Prolonged Prothrombin Time
Cephalosporins may be associated with prolonged prothrombin time. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antibacterial therapy, and patients receiving anticoagulant therapy. Monitor prothrombin time in patients at risk and manage as indicated.
5.6 Development of Drug-Resistant Bacteria
Prescribing cephalexin for oral suspension in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Prolonged use of cephalexin for oral suspension may result in the overgrowth of nonsusceptible organisms. Careful observation of the patient is essential. If superinfection occurs during therapy, appropriate measures should be taken.
6 ADVERSE REACTIONS
The following serious events are described in greater detail in the Warning and Precautions section:
- Hypersensitivity reactions [see Warning and Precautions (5.1) ]
- Clostridium difficile -associated diarrhea [see Warnings and Precautions (5.2) ]
- Direct Coombs’ Test Seroconversion [see Warnings and Precautions (5.3) ]
- Seizure Potential [see Warnings and Precautions (5.4) ]
- Effect on Prothrombin Activity [see Warnings and Precautions (5.5)]
- Development of Drug-Resistant Bacteria [see Warnings and Precautions (5.6)]
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
In clinical trials, the most frequent adverse reaction was diarrhea. Nausea and vomiting, dyspepsia, gastritis, and abdominal pain have also occurred. As with penicillins and other cephalosporins, transient hepatitis and cholestatic jaundice have been reported.
Other reactions have included hypersensitivity reactions, genital and anal pruritus, genital candidiasis, vaginitis and vaginal discharge, dizziness, fatigue, headache, agitation, confusion, hallucinations, arthralgia, arthritis, and joint disorder. Reversible interstitial nephritis has been reported. Eosinophilia, neutropenia, thrombocytopenia, hemolytic anemia, and slight elevations in aspartate transaminase (AST) and alanine transaminase (ALT) have been reported.
In addition to the adverse reactions listed above that have been observed in patients treated with cephalexin, the following adverse reactions and other altered laboratory tests have been reported for cephalosporin class antibacterial drugs:
Other Adverse Reactions: Fever, colitis, aplastic anemia, hemorrhage, renal dysfunction, and toxic nephropathy.
Altered Laboratory Tests: Prolonged prothrombin time, increased blood urea nitrogen (BUN), increased creatinine, elevated alkaline phosphatase, elevated bilirubin, elevated lactate dehydrogenase (LDH), pancytopenia, leukopenia, and agranulocytosis.
7 DRUG INTERACTIONS
7.1 Metformin
Administration of cephalexin with metformin results in increased plasma metformin concentrations and decreased renal clearance of metformin.
Careful patient monitoring and dose adjustment of metformin is recommended in patients concomitantly taking cephalexin and metformin [see Clinical Pharmacology (12.3) ].
7.2 Probenecid
The renal excretion of cephalexin is inhibited by probenecid. Co-administration of probenecid with cephalexin is not recommended.
7.3 Interaction with Laboratory or Diagnostic Testing
A false-positive reaction may occur when testing for the presence of glucose in the urine using Benedict’s solution or Fehling’s solution.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Reproduction studies have been performed on mice and rats using oral doses of cephalexin monohydrate 0.6 and 1.5 times the maximum daily human dose (66 mg/kg/day) based upon body surface area basis, and have revealed no evidence of impaired fertility or harm to the fetus.
8.3 Nursing Mothers
Cephalexin is excreted in human milk. Caution should be exercised when cephalexin is administered to a nursing woman.
8.4 Pediatric Use
The safety and effectiveness of cephalexin in pediatric patients was established in clinical trials for the dosages described in the dosage and administration section [see Dosage and Administration (2.2) ].
8.5 Geriatric Use
Of the 701 subjects in 3 published clinical studies of cephalexin, 433 (62%) were 65 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients.
This drug is substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection [see Warnings and Precautions (5.4) ].
8.6 Renal Impairment
Cephalexin should be administered with caution in the presence of impaired renal function (creatinine clearance < 30 mL/min, with or without dialysis). Under such conditions, careful clinical observation and laboratory studies renal function monitoring should be conducted because safe dosage may be lower than that usually recommended [see Dosage and Administration (2.3) ].
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