Cefoperazone (Cefobid): Uses, Dosage Instructions & Side Effects

Cefoperazone is a third-generation cephalosporin antibiotic (Cefoperazone class) given as an injection or with sulbactam. It's used to treat serious infections like pneumonia, urinary tract infections and intra-abdominal sepsis.

Its rapid, broad-spectrum action and resistance to many β-lactamases make it highly effective.

What is Cefoperazone?

Cefoperazone is a semisynthetic broad-spectrum cephalosporin effective against pseudomonas infections.

Cephalosporins are third-generation antibiotic agents that treat various bacterial infections caused by susceptible organisms in the body.

The bacterial infections include:

• Respiratory tract infections
• Skin infections
• Endometritis
• Bacterial septicemia

What are the Uses of Cefoperazone?

Cefoperazone (Monotherapy) is a powerful antibiotic used to treat a variety of bacterial infections throughout the body. Its broad-spectrum activity makes it valuable for both community-acquired and hospital-acquired infections.

Conditions Cefoperazone Treats

Cefoperazone effectively treats numerous bacterial infections, including:

• Urinary tract infections (UTIs)
• Respiratory tract infections (e.g., pneumonia, bronchitis)
• Skin and soft tissue infections
• Intra-abdominal infections
• Septicemia (bloodstream infections)
• Biliary tract infections
• Gynecological infections

However, resistance due to β-lactamase-producing bacteria can limit its effectiveness when used alone.

Cefoperazone Sulbactam Injection Uses (Combination Therapy)

Cefoperazone + Sulbactam combines a cephalosporin (cefoperazone) with a β-lactamase inhibitor (sulbactam).

Why it's more effective:
Sulbactam inhibits β-lactamase enzymes that would otherwise destroy cefoperazone. This extends its spectrum to include β-lactamase-producing resistant bacteria (like ESBLs).

Common uses (same infections + resistant strains):

• Same conditions as cefoperazone alone
• Multidrug-resistant (MDR) bacterial infections
• Hospital-acquired pneumonia
• Intra-abdominal infections caused by resistant organisms
• Post-surgical infections
• Mixed aerobic/anaerobic infections

How Does Cefoperazone Work?

Cefoperazone works by interfering with bacterial cell wall synthesis. Like other beta-lactam antibiotics, it binds to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall.

Specifically, Cefoperazone prevents the cross-linking of peptidoglycan chains, which are essential components of bacterial cell walls. This interference weakens the cell wall structure, causing bacterial cells to become unstable and eventually rupture due to osmotic pressure, resulting in bacterial death.

This mechanism makes Cefoperazone bactericidal (killing bacteria) rather than bacteriostatic (preventing bacterial growth).

The addition of Sulbactam in Cefoperazone sulbactam formulations enhances its effectiveness by inhibiting beta-lactamase enzymes that some bacteria produce to resist beta-lactam antibiotics.

Available Forms of Cefoperazone

Cefoperazone is primarily available in the following forms:

1. Injectable Form (Most Common)

• Intravenous (IV) Injection/Infusion: Used for rapid and controlled delivery in hospitals.
• Intramuscular (IM) Injection: Used when IV access is not available or for outpatient care.

2. Combination Formulations

• Cefoperazone + Sulbactam: Most commonly available as an injectable. Sulbactam enhances the effectiveness of cefoperazone against resistant bacteria.

3. Dosage Strengths

• Common strengths include:
• Cefoperazone 1g/vial
• Cefoperazone 2g/vial
• Cefoperazone + Sulbactam 1g/0.5g per vial
• Cefoperazone + Sulbactam 2g/1g per vial

4. Oral Form

• Not available: Cefoperazone is not available as an oral tablet or syrup due to poor absorption from the gastrointestinal tract.

Cefoperazone Dosage

Cefoperazone dosage depends on the severity of infection, the patient's condition, and the specific bacteria causing the infection. It is typically administered as an intramuscular or intravenous injection.

Typical Dosage Instructions

For adults:

• General infections: 2 to 4 g daily, administered in equally divided doses every 12 hours
• Severe infections: Up to 6-8 g daily, divided into equal doses every 12 hours
• Extremely severe infections: Up to 12-16 g daily in divided doses has been reported without complications

For specific conditions:

• Endometritis: 1 to 2 g IV every 12 hours, continued for 48 hours until clinical improvement
• Febrile Neutropenia: 1 to 2 g IV every 12 hours for 14 days
• Joint infections: 1 to 2 g IV every 12 hours for 3 to 4 weeks
• Pelvic inflammatory disease: 1 to 2 g IV every 12 hours for 48 hours until improvement
• Pneumonia: 1 to 2 g IV every 12 hours for 7 to 21 days depending on the causative organisms.

What Should I Do If I Miss a Dose?

Missing one or two doses of Cefoperazone typically has minimal impact on treatment effectiveness. However, for optimal results, try to maintain a consistent dosing schedule.

If you miss a dose, take it as soon as you remember, unless it's almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Never double up on doses to make up for a missed one.

What Happens If an Overdose Occurs?

Overdose of Cefoperazone can lead to medical emergencies and harmful effects on bodily functions. Symptoms may include:

• Seizures
• Neuromuscular hyperexcitability
• Encephalopathy
• Severe gastrointestinal symptoms

If an overdose is suspected, seek immediate medical attention. Treatment is typically supportive, focusing on managing symptoms and may include hemodialysis in severe cases.

What are the Side Effects of Cefoperazone?

Like all medications, Cefoperazone can cause side effects. Most are mild to moderate, but some can be serious and require medical attention.

Cefoperazone Side Effects

Common Side effects includes:

• Anemia
• GI bleeding
• Hemolytic anemia
• Leukopenia
• Bone marrow
• Depression
• Bleeding
• Dizziness
• Anorexia
• Dyspnea
• Abdominal pain
• Skin Rashes

Serious Side Effects:

• Hypersensitivity
• Hematology
• Hepatic
• Gastrointestinal
• Blood and lymphatic system disorders
• Immune system disorders
• Hepatobiliary disorders
• Skin tissue disorders
• Vascular Disorders

Precautions while taking Cefoperazone

Several precautions should be considered before and during treatment with Cefoperazone.

Who Should Avoid This Medicine

• Individuals with known hypersensitivity to cephalosporin antibiotics
• Those with severe allergic reactions to penicillins or other beta-lactam antibiotics
• Patients with a history of cephalosporin-associated hemolytic anemia

Conditions Where Caution is Needed

• Kidney disease (renal impairment)
• Liver disease (hepatic impairment)
• History of gastrointestinal disease, especially colitis
• Bleeding disorders or conditions that increase bleeding risk
• Malnutrition or poor nutritional status
• Alcoholism

People With Serious Health Conditions

• Pregnant women: The use of this medication during pregnancy hasn't been thoroughly studied, but it doesn't pose a significant risk of pregnancy loss or birth defects. However, it's advisable to consult your doctor before taking the medication to ensure safety.
• Breastfeeding: This medication passes into breast milk and can cause side effects in children who are breastfed. These can include diarrhea, vomiting, and rash. Before taking it while breastfeeding, consult your doctor.

Are There Any Age Restrictions for Using Cefoperazone?

While Cefoperazone has been used in pediatric patients, its safety and effectiveness in children have not been fully established. The half-life of Cefoperazone in serum is 6-10 hours in low birth-weight neonates, which may require dosage adjustments.

Alcohol or Food Interactions

Cefoperazone contains an N-methylthiotetrazole (NMTT) side chain that can cause a disulfiram-like reaction when alcohol is consumed. Patients should avoid alcohol for at least 72 hours after receiving Cefoperazone to prevent this reaction, which can include flushing, sweating, headache, and tachycardia.

Possible Interactions with Other Medications

Cefoperazone may interact with several other medications, potentially affecting their effectiveness or increasing the risk of side effects.

Drug Interactions

• Anticoagulants (e.g., warfarin): Cefoperazone may increase the anticoagulant effect, increasing bleeding risk
• Probenecid: May increase Cefoperazone levels in the blood
• Aminoglycosides: Potential for increased nephrotoxicity when used together
• Diuretics: May increase the risk of kidney problems
• Oral contraceptives: Cefoperazone may reduce contraceptive effectiveness
• Disulfiram: May enhance disulfiram-like reactions
• Vitamin K antagonists: Increased risk of bleeding

Supplement and Herbal Interactions

Always inform your healthcare provider about any supplements or herbal products you're taking, as they may interact with Cefoperazone.

Some supplements that affect blood clotting (like ginkgo biloba, garlic, or fish oil) may increase bleeding risk when combined with Cefoperazone.

How Should Cefoperazone Be Stored?

Proper storage of Cefoperazone is essential to maintain its effectiveness and safety. Following the manufacturer's guidelines will help ensure the medication remains stable until use.

Recommended Storage Temperature

Cefoperazone should be stored at or below 25°C (77°F) and protected from light prior to reconstitution. After reconstitution, protection from light is not necessary. Refrigeration of reconstituted solutions (2-8°C) can extend shelf life for up to 5 days.

What Happens If Cefoperazone Is Not Stored Properly?

Improper storage can lead to degradation of the active ingredient, potentially reducing the medication's effectiveness or causing harmful byproducts to form.

Signs of degradation may include color changes or visible particles in the solution. Never use Cefoperazone that shows signs of degradation or that has been stored improperly.

Always keep Cefoperazone away from children, direct sunlight, and moisture. Store in the original container and discard any unused portion according to healthcare provider instructions or local regulations for medication disposal.

Cefoperazone vs Ceftriaxone

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