Name /bks_53161_deglins_md_disk/cefoperazone

02/19/2014 01:03PM

cefoperazone (sef-oh-per-a-zone)

to penicillins.

Use Cautiously in: Hepatic/biliary impairment or combined hepatic/biliary/renal

Classification
Therapeutic: anti-infectives
Pharmacologic: third-generation cephalosporins
Pregnancy Category B

impairment (dosep/qdosing interval recommended); Patients with poor nutritional

status, malabsorption states, or alcoholism (may be atqrisk of bleeding); History of
GI disease, especially colitis; OB, Lactation: Has been used safely.

Indications
Treatment of the following infections caused by susceptible organisms: Skin and skin
structure infections, Urinary tract infections, Gynecological infections including gonorrhea, Respiratory tract infections, Intra-abdominal infections, Septicemia.

Action
Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of
second-generation cephalosporins, but activity against staphylococci is less, while
activity against gram-negative pathogens is greater, even for organisms resistant to
first- and second-generation agents. Notable is increased action against: Citrobacter,
Enterobacter, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae,
Morganella morganii, Neisseria gonorrhoeae, Proteus, Providencia, Pseudomonas aeruginosa, Serratia. Has some activity against enterococci. Has some activity against anaerobes, includingBacteroides fragilis.

Pharmacokinetics
Absorption: Well absorbed following IM administration; IV administration results
in complete bioavailability.

Distribution: Widely distributed. Crosses the placenta; enters breast milk in low
concentrations. CSF penetration better than with first- and second-generation agents.

Protein Binding: 90%.

Metabolism and Excretion: Excreted in bile.
Half-life: 2 hr.

Adverse Reactions/Side Effects

CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,
vomiting. Derm: rashes, urticaria. Hemat: bleeding, eosinophilia, neutropenia.
Local: pain at IM site, phlebitis at IV site. Misc: allergic reactions including ANAPHYLAXIS, superinfection.

Interactions
Drug-Drug: Ingestion of alcohol within 48 72 hr of cefoperazone may result in a
disulfiram-like reaction. May potentiate the effects of anticoagulants andqrisk of
bleeding. Concurrent use of loop diuretics or aminoglycosides mayqrisk of
nephrotoxicity.

Route/Dosage
IM, IV (Adults): Mild to moderate infections 1 2 g every 12 hr. Severe infections 2 4 g q 8 hr or 1.5 3 g every 6 hr.

Hepatic Impairment
IV (Adults): Impaired hepatic function/biliary obstruction daily dose should
not exceed 4 g; combined hepatic and renal impairment daily dose should not
exceed 1 2 g.

NURSING IMPLICATIONS
Assessment

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;

WBC) at beginning of and throughout therapy.

Before initiating therapy, obtain a history to determine previous use of and reac-

TIME/ACTION PROFILE (blood levels)

ROUTE

ONSET

PEAK

DURATION

IM
IV

rapid
rapid

12 hr
end of infusion

12 hr
12 hr

Genetic Implication.

pg 1 # 1

Contraindications/Precautions
Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity

Canadian drug name.

Plate # 0-Composite

tions to penicillins or cephalosporins. Persons with a negative history of penicillin

sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.

CAPITALS indicate life-threatening, underlines indicate most frequent.

Strikethrough Discontinued.

PDF Page #1

Name /bks_53161_deglins_md_disk/cefoperazone

02/19/2014 01:03PM

2
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus,

laryngeal edema, wheezing). Discontinue the drug and notify health

care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event
of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and
bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
Lab Test Considerations: May cause positive results for Coombs test.
Monitor prothrombin time and assess patient for bleeding (guaiac stools; check
for hematuria, bleeding gums, ecchymosis) daily in high-risk patients; may cause
hypoprothrombinemia.
May causeqserum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
May rarely cause neutropenia and eosinophilia.

Potential Nursing Diagnoses

Risk for infection (Indications) (Side Effects)
Diarrhea (Adverse Reactions)

Implementation

IM: Reconstitute IM doses with sterile or bacteriostatic water for injection or 0.9%

NaCl for injection. May be diluted with lidocaine to minimize injection discomfort.

Inject deep into a well-developed muscle mass; massage well.

IV Administration

pH: 4.5 6.5.

IV: Monitor injection site frequently for phlebitis (pain, redness, swelling).

Change sites every 48 72 hr to prevent phlebitis.

If aminoglycosides are administered concurrently, administer in separate sites, if

possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.
Intermittent Infusion: Reconstitute each gram with 5 mL of sterile or bacteriostatic water for injection, 0.9% NaCl, or D5W. Shake vigorously and allow to stand
for visualization and clarity. Solution may be colorless to straw-colored. Diluent:

Plate # 0-Composite

pg 2 # 2

Further dilute each gram in 50 100 mL of 0.9% NaCl, D5W, D10W, D5/0.25%
NaCl, D5/0.9% NaCl, D5/LR, or lactated Ringers solution. Solution is stable for 24
hr at room temperature and 5 days if refrigerated. Rate: Administer over 15 30
min.
Y-Site Compatibility: acyclovir, alfentanil, allopurinol, aminophylline, ascorbic
acid, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisplatin, clindamycin,
cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin,
dexamethasone, dexmedetomidine, digoxin, docetaxel, enalaprilat, epinephrine,
epoetin alfa, eptifibatide, etoposide, etoposide phosphate, fenoldopam, fentanyl,
fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, glycopyrrolate, granisetron, heparin, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, isoproterenol, ketorolac, lidocaine, linezolid, mannitol, mechlorethamine, melphalan, methotrexate, methylprednisolone, metoclopramide,
metoprolol, metronidazole, multivitamins, nafcillin, naloxone, nitroglycerin, nitroprusside, norepinephrine, oxacillin, oxytocin, paclitaxel, penicillin G, pentobarbital, phenobarbital, phenylephrine, phytonadione, potassium chloride, procainamide, propofol, propranolol, ranitidine, rituximab, sodium acetate, sodium
bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide,
theophylline, thiotepa, ticarcillin/clavulanate, vasopressin, vincristine.
Y-Site Incompatibility: amifostine, amikacin, amphotericin B cholesteryl, amphotericin B liposome, atracurium, azathioprine, benztropine, calcium chloride,
caspofungin, chlorpromazine, cimetidine, cisatracurium, codeine, dantrolene,
diazepam, diazoxide, diphenhydramine, dobutamine, dopamine, doxacurium,
doxorubicin(, doxorubicin liposome, doxycycline, epirubicin, filgrastim, ganciclovir, gemcitabine, gentamicin, haloperidol, hydralazine, hydroxyzine, idarubicin, indomethacin, insulin, labetalol, levofloxacin, meperidine, metaraminol, methoxamine, methyldopate, midazolam, mitoxantrone, nalbuphine, nesiritide,
nicardipine, ondansetron, oxaliplatin, pantoprazole, papaverine, pentamidine,
pentazocine, perphenazine, phentolamine, phenytoin, prochlorperazine, promethazine, protamine, pyridoxime, quinupristin/dalfopristin, rocuronium, sargramostim, thiamine, tobramycin, tolazoline, trastuzumab, trimetaphan, trimethoprim/sulfamethoxazole, vancomycin, verapamil, vinorelbine.

Patient/Family Teaching

Advise patient to report signs of superinfection (furry overgrowth on the tongue,

vaginal itching or discharge, loose or foul-smelling stools) and allergy.

2015 F.A. Davis Company

CONTINUED

PDF Page #2

Name /bks_53161_deglins_md_disk/cefoperazone

02/19/2014 01:03PM

Plate # 0-Composite

pg 3 # 3

3
PDF Page #3

CONTINUED
cefoperazone
Caution patients that concurrent use of alcohol with cefoperazone may cause a di-

sulfiram-like reaction (abdominal cramps, nausea, vomiting, headache, hypotension, palpitations, dyspnea, tachycardia, sweating, flushing). Alcohol and alcoholcontaining medications should be avoided during and for several days after
therapy.
Instruct patient to notify health care professional if fever and diarrhea
develop, especially if stool contains blood, pus, or mucus. Advise patient
not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

Resolution of the signs and symptoms of infection. Length of time for complete res-

olution depends on the organism and site of infection.

Why was this drug prescribed for your patient?

Canadian drug name.

Genetic Implication.

CAPITALS indicate life-threatening, underlines indicate most frequent.

Strikethrough Discontinued.