Cefpirome Sulfate

Cefpirome is indicated in:

• Severe infections, such as septicemia, bacteremia and infections in immunosuppressed neutropenic patients with hematological malignancies
• Lower respiratory infections including pneumonia
• Severe urinary tract infections including pyelonephritis
• Skin and soft tissue infections
• Bone and joint infections
• Infections in immunocompromised patients
• Other infections

Cefpirome binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

Adult: 1-2 gm every 12 hour via IV injection over 3-5 minutes or infuse over 20-30 minutes.

Elderly: There are no special precautions for its use in the elderly provided dosage is adjusted accordingly to renal function.

Cefpirome is administered only through the parenteral route. The dosage is dependent upon the severity and site of infection, the susceptibility of the infecting microorganisms and age, weight and renal function of the patient. The drug is administered through intravenous injection or infusion. The following dosages are recommended for moderate to severe infections in adult patients with normal renal function:

• Complicated upper & lower urinary tract infections: 1 gm 12 hourly. Total daily dose not more then 2 gm
• Skin & soft tissue infections: 1 gm 12 hourly. Total daily dose not more then 2 gm
• Lower respiratory tract infections: 1 to 2 gm 12 hourly. Total daily dose not more then 2 to 4 gm
• Bacteraemia or septicaemia and severe infections: 2 gm 12 hourly. Total daily dose not more then 4 gm
• Infections in neutropenic patients: 2 gm 12 hourly. Total daily dose not more then 4 gm

Dose reduction is necessary in patients with markedly reduced renal function. After an initial dose of 0.5 -2 gm to establish a high serum concentration, the dose should be reduced by 50% for clearances of 49-21 ml/min or 75% for clearances of 20 ml/min. In end-stage renal disease, a supplementary dose equal to 50% of the recommended daily dose should be administered after each hemodialysis
treatment.

Drug interactions have not been observed with Cefpirome.

Cefpirome is contraindicated in patients with known allergy to the cephalosporin group of antibiotics.

Cefpirome is generally well tolerated. There are no predictable life threatening effects of Cefpirome. Adverse gastrointestinal reactions include diarrhea, nausea, vomiting, pseudomembraneous colitis, abdominal pain and have been noted 3.86% of the patients. Superficial phlebitis, thrombophlebitis and infection site reaction have been reported in 2.31% of patients receiving intravenous Cefpirome.

The safety of Cefpirome has not been established in pregnancy and as with all agents it should be administered with caution, especially during the early months of pregnancy. As Cefpirome is excreted in human breast milk, either Cefpirome treatment should be discontinued or breast feeding ceased.

Allergy to penicillin or to cephalosporins; renal impairment, monitor renal and haematological status; pregnancy and lactation.

No cases of over dosage are known. However, general supportive care with monitoring of renal, hematological and hepatic function and coagulation status is recommended.

Fourth generation Cephalosporins

Cefpirome vial should be stored below 25° C, protected from light and moisture. Reconstituted solution can be stored for up to 6 hours at room temperature and 24 hours in refrigerator (at 2-8° C) when prepared in water for injection.