Administration in Adults: The usual adult daily dosage of cefoperazone is 2 to 4 grams per day administered in equally divided doses every 12 hours. In severe infections the dosage may be increased to a total of 8 grams per day in equally divided doses every 12 hours. Twelve grams per day have been administered in equally divided doses every 8 hours and usage of up to 16 grams per day in divided doses has been reported without complications. Treatment may be started before results of susceptibility testing are available.
The recommended dosage for uncomplicated gonococcal urethritis is 500 mg intramuscularly as a single dose.
The drug should be given by deep intramuscular injection into the large muscle mass of the gluteus maximus or anterior thigh.
Use in Hepatic Dysfunction: Dose modification may be necessary in cases of severe biliary obstruction, severe hepatic disease or coexistent renal dysfunction. In these cases dosage should not exceed 2 grams/day without close monitoring of serum concentrations.
Use in Renal Dysfunction: Since renal excretion is not the main route for the elimination of cefoperazone, patients with renal failure require no adjustment in dosing when usual dosages (2-4 grams daily) are administered. For patients whose glomerular filtration rate is less than 18 ml/min or whose serum creatinine level is greater than 3.5 mg/dl, the maximum dosage of cefoperazone should be 4 grams per day.
The serum half-life of cefoperazone is reduced slightly during hemodialysis. Thus, dosing should be scheduled to follow a dialysis period.
Use in Patients with Hepatic and Concurrent Renal Dysfunction: In patients with both hepatic dysfunction and concomitant renal impairment, cefoperazone serum concentrations should be monitored and dosage adjusted as necessary. In these cases dosage should not exceed 2 grams/day without close monitoring of serum concentrations.
Administration in Infants and Children: In infants and children a 50 to 200 mg/kg/day dosage of cefoperazone should be given in twodivided doses every 8 to 12 hours. The maximum dose should not to exceed 12 grams/day (see Precautions).
Use in Neonates: For neonates aged less than 8 days, the drug should be given every 12 hours.
Intravenous Administration in Adults and Children: For intermittent intravenous infusion each 1 or 2 gram vial of cefoperazone should be dissolved in 20 to 100 ml of a compatible sterile intravenous solution and infused over a period of 15 minutes to one hour. If sterile water for injection is the preferred diluent, no more than 20 ml should be added to the vial.
For continuous intravenous infusion, each gram of cefoperazone should be dissolved in either 5 ml of Sterile Water for Injection or Bacteriostatic Water for Injection and the solution added to an appropriate intravenous diluent.
For direct intravenous injection, the maximum dose of cefoperazone should be 2 grams per administration for adults and 50 mg/kg per administration for children. The drug should be dissolved in an appropriate diluent to give a final concentration of 100 mg/ml and administered over a period of no less than three to five minutes.
For the antibiotic prophylaxis of surgical procedures, 1 or 2 grams should be administered intravenously 30 to 90 minutes prior to the start of surgery. The dose may be repeated every 12 hours for, in most cases, no longer than 24 hours. In surgery where the incidence of infection is known to be greater (e.g. colorectal surgery) or when the occurrence of infection may be particularly devastating (e.g. open heart surgery and prosthetic arthroplasty), the prophylactic administration of cefoperazone may be continued for 72 hours following the completion of surgery.