Cephalexin

PD Dialyzability: Likely

Pharmacokinetic Parameters [1] [2]

  Cephalexin
Molecular Weight (Da) 347.39
Plasma Protein Binding (%) 20
Volume of Distribution (L/Kg) 0.35
Hepatic Metabolism No appreciable biotransformation in the liver
Excreted Unchanged (%) 98%
Half-Life; Normal Renal Function (hours) 0.7
Half-Life; ESRD (hours) 16

CAPD Dosing: [3] [4] [5] [6]

  • 200mg PO daily

CCPD Dosing:

  • No literature identified. Extrapolate dosing from CAPD dosing recommendations.

Indication Specific PD Dosing:

  • Peritonitis: Cephalexin 500mg PO QID [7] [8] (consider loading dose of 1000 mg PO) [9] [10]
  • Exit-Site and Tunnel Infections: Cephalexin 500mg PO BID-TID [7] [11] [12]
  • Dental, oral, or upper respiratory procedure prophylaxis: Cephalexin 500mg PO 1 hour preoperatively [13]

Literature Summary:

Title Patient Intervention Outcome Note
Exit-site infections by non-diphtheria corynebacteria in CAPD. [14]
  • CAPD
  • 8 patients.
  • Confirmed Corynebacterium SPP exit-site infections and early superficial tunnel infections
 Cephalexin PO 2g (loading dose) followed by 500mg Q12H (maintenance dose) x 4 weeks in combined exit-site + tunnel infections.
  • Normal exit-site appearance.
  • Ultrasound examination.
  • Follow up culture
 No ADR reported
Peritoneal dialysis associated peritonitis of zoonotic origin, when minor gets major. [15]
  • CAPD
  • 62 year old female patient.
  • Presenting with symptoms of abdominal discomfort and cloudy effluent.
  • Diagnosed with peritonitis due to Pastreurella multocida and Streptococcus minor
 Cephalexin 500mg PO TID
  • Clinical status (unspecified)
  • Cephalexin co-administered with cefalotin 250mg QID IP
  • Patient further deteriorated and antibiotic therapy was switched to ciprofloxacin.

References

[1]Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(suppl_1):D668–72.
[2]American Pharmacist Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals [Internet]. Hudson, Ohio: American Pharmacist association; 2012 [cited 2018 Jan 24]. Available from: http://online.lexi.com.login.ezproxy.library.ualberta.ca/lco/action/home?siteid=1
[3]Gilbert B, Robbins P, Livornese LL. Use of Antibacterial Agents in Renal Failure. Med Clin North Am. 2011;95(2):677–702.
[4]Aronoff GR. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
[5]Adjusting oral antibiotics to estimated creatinine clearance [Internet]. [cited 2018 Jan 24]. Available from: http://www.vhpharmsci.com/VHFormulary/Tools/ADJUSTING%20ORAL%20ANTIBIOTICS.pdf
[6]Piraino B, Bailie GR, Boeschoten E, Li PK, Szeto CC, Bernardini J, et al. Ispd Guidelines / Recommendations: Peritoneal dialysis-related infections recommendations: 2005 Update. Perit Dial Int. 2005;30:393–423.
[7](1, 2) Keane WF, Bailie GR, Boeschoten E, Gokal R, Golper T a, Holmes CJ, et al. ISPD Guidelines/Recommendations: Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 Update. Perit Dial Int. 2000;20(May):396–411.
[8]Murphy BF, Harris DC, Disney A, Ibels LS, Saltissi D, Rigby R, et al. Treatment of peritoneal dialysis related peritonitis–an Australian and New Zealand perspective. Aust N Z J Med. 1999;29(4):552–555.
[9]Williams JD, Coles GA. CAPD Peritonitis. Int J Antimicrob Agents. 1992;1:165–174.
[10]Drew PJT, Casewell MW, Desai N, Houang ET, Simpson CN, Marsh FP. Cephalexin for the oral treatment of CAPD peritonitis. J Antimicrob Chemother. 1984;13:153–159.
[11]Li PK-T, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. Peritoneal Dialysis-Related Infections Recommendations: 2010 Update. Perit Dial Int. 2010;30(4):393–423.
[12]Szeto C-C, Li PK-T, Johnson DW, Bernardini J, Dong J, Figueiredo AE, et al. ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int. 2017 Mar 1;37(2):141–54.
[13]Saxena R, West C. Peritoneal Dialysis: A Primary Care Perspective. J Am Board Fam Med. 2006;19(4):380–389.
[14]Schiffl H, Mücke C, Lang SM. Exit-site infections by non-diphtheria corynebacteria in CAPD. Perit Dial Int J Int Soc Perit Dial. 2004;24(5):454–9.
[15]Dresselaars HF, Zwart B, Pettersson AM, Rijnsburger MC. Peritoneal dialysis-associated peritonitis of zoonotic origin , when minor gets major. Neth J Med. 2014;(10):551–553.