Cefamandole

Parenteral
Susceptible infections
Adult: 0.5-2 g every 4-8 hr depending on severity of the infection. Dose may be given by deep IM, slow IV over 3-5 minutes or by intermittent or continuous infusion.
Child: >1 mth: 50-100 mg/kg/day in divided doses; up to 150 mg/kg/day may be used in severe infections.
Renal impairment: CrCl <2 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.25-0.75 g every 12 hours. CrCl 2-10 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.5-1 g every 12 hours. CrCl 10-25 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.5-1.25 g every 8 hours. CrCl 25-50 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.75-2 g every 8 hours. CrCl 50-80 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.75-2 g every 6 hours.
Incompatibility: Incompatible with aminoglycosides and metronidazole.

Parenteral
Prophylaxis of surgical infections
Adult: 1 or 2 g IV or IM, given 30-60 minutes before surgical incision followed by 1 or 2 g every 6 hr for 24-48 hr. For procedures involving implantation of prosthetic devices, may continue treatment for up to 72 hr.
Child: >3 mth: 50-100 mg/kg/day IV or IM, given 30-60 minutes before surgical incision; followed by every 6 hr for 24-48 hr. For procedures involving implantation of prosthetic devices, may continue treatment for up to 72 hr.
Renal impairment: CrCl <2 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.25-0.75 g every 12 hours. CrCl 2-10 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.5-1 g every 12 hours. CrCl 10-25 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.5-1.25 g every 8 hours. CrCl 25-50 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.75-2 g every 8 hours. CrCl 50-80 mL/min/1.73 m²: Initially, 1-2 g, followed by maintenance doses of 0.75-2 g every 6 hours.
Incompatibility: Incompatible with aminoglycosides and metronidazole.

Hypersensitivity.

Hypersensitivity to penicillins; renal impairment; porphyria. Monitor renal and haematologic status. May cause bleeding (reversible with vitamin K admin).

Nausea; vomiting; diarrhoea; hypersensitivity reactions; nephrotoxicity; convulsions; CNS toxicity; pseudomembranous colitis; hepatic dysfunction; haematologic disorders; pain at inj site (IM); thrombophloebitis (IV infusion); superinfection with prolonged use.

Disulfiram-like interaction with alcohol. May enhance hypoprothrombinemic response to anticoagulants. Renal clearance reduced by probenecid.

Positive direct antiglobulin Coombs' test; falsely high values with Jaffe method of measuring creatinine concentrations; transient increases in liver enzyme values.

Cefamandole inhibits the final cross-linking stage of peptidoglycan production through binding and inactivation of transpeptidases on the inner surface of the bacterial cell membrane thus inhibiting bacterial cell wall synthesis.
Absorption: Poorly absorbed from the GI tract.
Distribution: 70% bound to plasma proteins. Widely distributed in body tissues and fluids including bone, joint fluid and pleural fluid.
Excretion: Plasma half-life ranges from 0.5-1.2 hr depending on the route of admin. Rapidly excreted unchanged by glomerular filtration and renal tubular secretion.

Cephalosporins

J01DC03 - cefamandole ; Belongs to the class of second-generation cephalosporins. Used in the systemic treatment of infections.