Adult: Usual dose: 1-2 g 12 hourly, may be increased up to 12 g daily in 2-4 divided doses in severe infections. Doses are given via IM inj or via intermittent (over 15 minutes to 1 hour) or continuous IV infusion. Child: Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal Impairment
In patients undergoing haemodialysis: Dosing must be scheduled to follow a dialysis period. In patients with coexisting hepatic impairment: Max: 1-2 g daily.
Hepatic Impairment
Adjust dose based on patient response and degree of impairment. Max: 4 g daily. In patients with coexisting renal impairment: Max: 1-2 g daily.
Reconstitution
IV/IM inj: Reconstitute vial with an appropriate diluent (e.g. 0.9% NaCl, 5% dextrose in water, sterile water for inj, bacteriostatic water). Recommendations may vary due to route of administration or patient age. Refer to detailed product guidelines for further information.
Incompatibility
Incompatible with aminoglycosides.
Contraindications
Hypersensitivity to cefoperazone or other cephalosporins. History of severe hypersensitivity to β-lactams.
Special Precautions
Patient with history of hypersensitivity reaction to multiple allergens, poor diet, malabsorption state (e.g. cystic fibrosis), history of gastrointestinal disease (particularly colitis). Patient on prolonged IV alimentation regimen or receiving anticoagulant therapy and exogenous vitamin K. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Vitamin K deficiency resulting in coagulopathy; overgrowth of nonsusceptible organisms (prolonged use). Blood and lymphatic system disorders: Neutropenia, thrombocytopenia, eosinophilia. Gastrointestinal disorders: Diarrhoea. General disorders and administration site conditions: Infusion site phlebitis. Hepatobiliary disorders: Jaundice. Investigations: Decreased Hb and haematocrit; increased AST, ALT, and blood alkaline phosphatase. Skin and subcutaneous tissue disorders: Rash maculopapular, pruritus, urticaria. Potentially Fatal: Serious hypersensitivity reactions (including anaphylactoid), severe cutaneous adverse reactions, severe haemorrhage, Clostridium difficile-associated diarrhoea or pseudomembranous colitis.
Perform culture and susceptibility tests as necessary; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor platelets and prothrombin time. Observe for signs and symptoms of bleeding, coagulation abnormalities, and anaphylaxis. In patients with renal and/or hepatic impairment: Monitor serum concentrations during administration of higher doses.
Food Interaction
May cause disulfiram-like reaction (e.g. flushing, sweating, headache, tachycardia) when given concomitantly with alcohol and for 5 days following treatment.
Lab Interference
May lead to a false-positive reaction for glucose in urine with Benedict's or Fehling's solution, and false-positive direct Coombs' test.
Action
Description: Cefoperazone, a 3rd generation cephalosporin, binds to penicillin-binding proteins (PBPs) which inhibits the peptidoglycan synthesis in the bacterial cell walls, thus preventing cell wall biosynthesis. Pharmacokinetics: Absorption: Time to peak plasma concentration: 1-2 hours (IM). Distribution: Widely distributed into body tissues and fluids. Crosses the placenta; enters breast milk (small amounts). Plasma protein binding: 82-93% (depending on the concentration). Excretion: Mainly via bile; urine (20-30%). Elimination half-life: Approx 2 hours.
Chemical Structure
Cefoperazone Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 44187, Cefoperazone. https://pubchem.ncbi.nlm.nih.gov/compound/44187. Accessed Aug. 25, 2022.
Storage
Store intact vials below 30°C. Refer to detailed product guidelines for further storage recommendations of reconstituted solutions.
J01DD12 - cefoperazone ; Belongs to the class of third-generation cephalosporins. Used in the systemic treatment of infections.
References
Anon. Cefoperazone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/07/2022.Buckingham R (ed). Cefoperazone Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/07/2022.Cefobid 1 g Parenteral (Pfizer [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 11/07/2022.Cefoperazone. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 12/07/2022.
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