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Drugs & Diseases

Brand and Other Names:Ceftin, Zinacef

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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension (discontinued; anticipated final availability early 2018)

  • 125mg/5mL
  • 250mg/5mL

powder for ciprofloxacin iv to po switch injection

  • 750mg
  • 1.5g
  • 7.5g
  • 75g
  • 225g

tablet

  • 250mg
  • 500mg

more...

Pharyngitis/Tonsillitis

250 mg PO q12hr for 10 days

Acute Bacterial Maxillary Sinusitis

250 mg PO q12hr for 10 days

Acute Bacterial Exacerbations of Chronic Bronchitis

250-500 mg PO q12hr for 10 days

500-750 mg IV q8hr; switch to oral therapy as soon as clinically possible

Secondary Bacterial Infections of Acute Bronchitis

250-500 mg PO q12hr for 5-10 days

Uncomplicated Pneumonia

750 mg IV/IM q8hr

Uncomplicated Skin/Skin Structure Infections

250-500 mg PO q12hr for 10 days

750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Uncomplicated Urinary Tract Infections

125-250 mg PO q12hr for 7-10 days

750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Gonorrhea

Uncomplicated: 1 g PO once or 1.5 g IM once at 2 different sites with 1 g probenecid PO

Disseminated: 750 mg IV/IM q8hr

Early Lyme Disease

500 mg PO q12hr for 20 days

Severe or Complicated Infections

1.5 g IV/IM q8hr; may be administered q6hr in life-threatening situations

Dosage Modifications

Renal impairment

  • CrCl >30 mL/min: No adjustment necessary
  • CrCl 10-30 mL/min: Administer dose q24hr
  • CrCl <10 mL/min: Administer dose q48hr

Dosing Considerations

Susceptible organisms

  • Borrelia burgdorferi, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Neisseria gonorrhoeae, Proteus mirabilis, Streptococcus pneumoniae, Streptococcus pyogenes

Dosage Forms & Strengths

oral suspension (discontinued; anticipated final availability early 2018)

  • 125mg/5mL
  • 250mg/5mL

powder for injection

  • 750mg
  • 1.5g
  • 7.5g
  • 75g
  • 225g

tablet

  • 250mg
  • 500mg

more...

Acute Bacterial Maxillary Sinusitis

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

>12 years: 250 mg tablet PO q12hr for 10 days

Acute Otitis Media

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

Alternativley: 125-250 mg PO q12hr for 10 days

>12 years: 250-500 mg tablet PO q12hr for 10 days

Impetigo

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day or 75-100mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

Alternativley: 125-250 mg PO q12hr for 10 days

>12 years: 250-500 mg tablet PO q12hr for 10 days

Pharyngitis/Tonsillitis

<3 months: Safety and efficacy not established

3 months-12 years: 20 mg/kg/day PO divided q12hr for 10 days; not to exceed 500 mg/day or 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

Alternativley: 125-250 mg PO q12hr for 10 days

>12 years: 250 mg PO q12hr for 10 days

Severe or Serious Infections (Off-label)

<6 days, <2 kg: 100 mg/kg/day IV/IM divided q12hr  

<6 days, >2 kg: 150 mg/kg/day IV/IM divided q8hr

>7 days: 150 mg/kg/day IV/IM divided q8hr

Interactions

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Adverse Effects

>10%

Diarrhea (4-11%; depends on duration)

1-10%

Decreased hemoglobin or hematocrit (10%)

Eosinophilia (7%)

Nausea or vomiting (3-7%)

Vaginitis (<5%)

Transient rise in hepatic transaminases (2-4%)

Diaper rash (3%)

Increase in alkaline phosphatase (2%)

Thrombophlebitis (2%)

Increase in lactate dehydrogenase (1%)

<1%

Anemia

Cholestasis

Colitis

Dyspnea

Epidermal necrolysis

Increase in blood urea nitrogen (BUN) and creatinine

Jaundice

Nephritis

Prolonged prothrombin time (PT)/international normalized ratio (INR)

Rash

Stevens-Johnson syndrome

Stomach cramps

Transient neutropenia and leukopenia

Urticaria

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Warnings

Contraindications

Documented hypersensitivity

Cautions

Do not crush tablet

Prolonged INR in nutritionally deficient patients, prolonged treatment, and hepatic and renal disease reported

Film-coated tablet and oral solution are not bioequivalent; tablets should not be crushed

Use caution in patients with history of colitis, renal impairment, or with a history of seizure disorders

Use with caution in patients with history of penicillin allergy

Reduce dosage by 50% if CrCl is 10-30 mL/min and by 75% if CrCl <10 mL/min (high doses may cause CNS toxicity)

Some products may contain phenylalanine

Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

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Pregnancy & Lactation

Pregnancy category: B

Lactation: Drug excreted in breast milk; use with caution

Pregnancy Categories

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Pharmacology

Mechanism of Action

Binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase; proper dosing and appropriate route of administration are determined by condition of patient, severity of infection, and susceptibility of microorganism

Absorption

Bioavailability: Fasting, 37%; postprandial, 52%

Peak serum time: 2-3 hr (PO); 15-60 min (IM); 2-3 min (IV)

Distribution

Widely distributed to body tissues and fluids, including cerebrospinal fluid (CSF)

Protein bound: 33-50%

Metabolism

Partially metabolized in liver

Elimination

Half-life: 1-2 hr (prolonged with renal impairment)

Excretion: Urine (66-100% as unchanged drug)

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Administration

IV Incompatibilities

Additive: Aminoglycosides, ciprofloxacin, ranitidine, sodium bicarbonate

Syringe: Doxapram

Y-site: Azithromycin, cisatracurium (potentially; compatible at low concentration [0.1 mg/mL]), clarithromycin, filgrastim, fluconazole, midazolam, vancomycin, vinorelbine

IV Compatibilities

Solution: D5W, NS

Additive: Clindamycin, floxacillin, furosemide, gentamicin (incompatible in total parenteral nutrition [TPN]), metronidazole, midazolam, netilmicin

Y-site (partial list): Acyclovir, allopurinol, amiodarone, diltiazem, linezolid, milrinone, morphine sulfate, ondansetron, propofol, tacrolimus

IV Preparation

Direct injection: reconstitute in 8 mL (for 750-mg vial) or 16 mL (for 1.5-g vial) to obtain 90 mg/mL solution

Infusion: Reconstitute in 100 mL SWI, D5W or NS to obtain 7.5 mg/mL (750-mg vial) or 15 mg/mL (1.5-g vial) solution

7.5 g bulk package not to be used for direct injection

IM Preparation

Reconstitute 750 mg in 3 mL SWI to obtain 220 mg/mL solution

IV Administration

Direct injection: Inject directly into vein over 3-5 minutes or slowly into tubing of free-flowing compatible IV solution

Infusion: Infuse intermittently over 15-60 minutes

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Patient Handout

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Formulary

FormularyPatient Discounts

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Create Your List of Plans

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
Plans
Non-Medicare Plans Medicare Plans

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