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Correlation between fluorimetric and microbiological methods for determination of cephalexin in urine and serum.

The fluorimetric and microbiological methods for the determination of serum and urine cephalexin were compared with the aid of coded samples in two different laboratories. The coefficient of correlation between the two methods for serum cephalexin was 0.94. At urine cephalexin concentrations above 0.5 g/l, the coefficient of correlations between two methods was 0.83. At lower concentrations (0.5 g/l), the coefficient of correlation was 0.72. It was concluded that the tested methods are comparable, equally sensitive and precise.

Biological Assay↗

[Cephalexin pharmacokinetics].

The pharmacokinetics of cephalexin monohydrate after its oral administration in a single dose was studied on rats and dogs. The analysis of the pharmacokinetic data obtained with the one-compartmental model showed that the rate of the antibiotic absorption in the rats was higher than that in the dogs. The periods of the cephalexin half-absorption and maximum concentration were 0.2 and 1.1 hour in the rats and 0.64 and 1.9 hours in the dogs respectively. The period of the antibiotic half-life was almost the same in both animal species. Selective localization of cephalexin in the kidney and liver tissues was noted. The antibiotic was mainly excreted by the kidneys (98.8 per cent for 24 hours).

Animals↗

The efficacy of twice daily cephalexin.

A multi-centre study in general practice was carried out to compare the efficacy of two doses of cephalexin-500 mg or 1 g - given in a twice daily dosage regimen to 752 patients with respiratory or soft tissue infections. After 5-days' treatment, over 80% of the patients were cured or considerably improved, with no differences between the two treatment groups. Considering the lower respiratory and soft tissue infections together, 1 g cephalexin twice daily produced a better clinical response after 48-hours' treatment, suggesting a more rapid response with the higher dosage, but this trend did not reach statistical significance. Twice daily cephalexin therapy was also effective in patients with concurrent illness, and in those patients who had been treated unsuccessfully with other antibacterial therapy in the week prior to trial entry. No drug interactions were reported and the incidence of side-effects was low.

Adolescent↗

A large population-based follow-up study of trimethoprim-sulfamethoxazole, trimethoprim, and cephalexin for uncommon serious drug toxicity.

We conducted a population-based 45-day follow-up study of 232,390 people who were prescribed trimethoprim-sulfamethoxazole (TMP-SMZ), 266,951 prescribed trimethoprim alone, and 196,397 prescribed cephalexin, to estimate the risk of serious liver, blood, skin, and renal disorders resulting in referral or hospitalization associated with these drugs. The results were based on information recorded on office computers by selected general practitioners in the United Kingdom, together with a review of clinical records. The risk of clinically important idiopathic liver disease was similar for persons prescribed TMP-SMZ (5.2/100,000) and those prescribed trimethoprim alone (3.8/100,000). The risk for those prescribed cephalexin was somewhat lower (2.0/100,000). Only five patients experienced blood disorders, one of whom was exposed to TMP-SMZ; of seven with erythema multiforme and Stevens-Johnson syndrome, four were exposed to TMP-SMZ. The one case of toxic epidermal necrolysis occurred in a patient who took cephalexin. Finally, only five cases of acute parenchymal renal disease occurred, none likely to be caused by a study drug. We conclude that the risk of the serious diseases studied is small for the three agents, and compares reasonably with the risk for many other antibiotics.

Adult↗

Cephalexin: clinical effectiveness in geriatric patients.

A clinical and bacteriologic study was done in 298 elderly patients who had infections that were treated with cephalexin. Satisfactory clinical responses occurred in 93% of the 44 patients with respiratory tract infections, 96% of the 27 patients with skin and soft tissue infections, and 87% of the 227 patients with urinary tract infections (15 had asymptomatic bacteriurial); bacteriologic responses were satisfacoty in 80, 74, and 72 percent, respectively. The clinical response to cephalexin treatment was the same in 283 patients over age 65 as in 902 patients 16 to 64 years of age. Only 7% of 934 elderly patients had adverse reactions, which were generally mild. The BUN, SGOT, and hematopoietic values showed no change. Thus, cephalexin can be recommended for the oral treatment of many common infections in the elderly.

Adolescent↗

Pharmacokinetics of cephalexin in calves after intravenous and subcutaneous administration.

The pharmacokinetics of cephalexin was investigated in male calves following a single intravenous (i.v.) and subcutaneous (s.c.) administration (10 mg/kg). The distribution rate constant and distribution half-life were 3.34 +/- 1.22 h-1 and 0.32 +/- 0.08 h, respectively. The values of elimination half-lives following i.v. and s.c. administration were 3.17 +/- 1.30 and 2.56 +/- 0.24 h, respectively. The absorption half-life following s.c. administration was 0.09 +/- 0.01 h. The apparent volume of distribution was 0.65 +/- 0.16 and 0.46 +/- 0.07 L/kg and total body clearance was 2.96 +/- 0.46 and 1.66 +/- 0.31 ml/kg/min, respectively, following i.v. and s.c. administration. Systemic availability following subcutaneous administration was found to be almost complete (103.08%). The satisfactory intravenous dosage regimen of cephalexin for calves would be 11.3 mg/kg as the priming dose followed by 10.0 mg/kg as the maintenance dose to be repeated at 6-h intervals. However, the subcutaneous dosage regimen of cephalexin in calves would be 8.0 mg/kg followed by 7.05 mg/kg at 8-h intervals.

Animals↗

Comparative double-blind trial of cephalexin and ampicillin in treatment of urinary infections.

Cephalexin was compared with ampicillin in the treatment of urinary tract infections by a random double-blind technique. Both drugs were found to be equally effective. In 21 out of 31 patients treated with cephalexin and in 20 out of 31 treated with ampicillin the urine was sterile three weeks after starting therapy. The bacteriological findings at one and eight weeks were also similar in both groups. No serious adverse reactions were attributable to cephalexin, which seemed to be tolerated rather better than ampicillin.

Adult↗

Modelling of the enzymatic kinetically controlled synthesis of cephalexin: influence of diffusion limitation.

In this study the influence of diffusion limitation on enzymatic kinetically controlled cephalexin synthesis from phenylglycine amide and 7-aminodeacetoxycephalosporinic acid (7-ADCA) was investigated systematically. It was found that if diffusion limitation occurred, both the synthesis/hydrolysis ratio (S/H ratio) and the yield decreased, resulting in lower product and higher by-product concentrations. The effect of pH, enzyme loading, and temperature was investigated, their influence on the course of the reaction was evaluated, and eventually diffusion limitation was minimised. It was found that at pH >or=7 the effect of diffusion limitation was eminent; the difference in S/H ratio and yield between free and immobilised enzyme was considerable. At lower pH, the influence of diffusion limitation was minimal. At low temperature, high yields and S/H ratios were found for all enzymes tested because the hydrolysis reactions were suppressed and the synthesis reaction was hardly influenced by temperature. The enzyme loading influenced the S/H ratio and yield, as expected for diffusion-limited particles. For Assemblase 3750 (the number refers to the degree of enzyme loading), it was proven that both cephalexin synthesis and hydrolysis were diffusion limited. For Assemblase 7500, which carries double the enzyme load of Assemblase 3750, these reactions were also proven to be diffusion limited, together with the binding-step of the substrate phenylglycine amide to the enzyme. For an actual process, the effects of diffusion limitation should preferably be minimised. This can be achieved at low temperature, low pH, and high substrate concentrations. An optimum in S/H ratio and yield was found at pH 7.5 and low temperature, where a relatively low reaction pH can be combined with a relatively high solubility of 7-ADCA. When comparing the different enzymes at these conditions, the free enzyme gave slightly better results than both immobilised biocatalysts, but the effect of diffusion limitation was minimal.

Catalysis↗

Drug release from a novel self-setting bioactive glass bone cement containing cephalexin and its physicochemical properties.

A novel device containing cephalexin as a model drug using a self-setting bioactive cement based on CaO-SiO2-P2O5 glass was investigated. The device consisted of 95 wt/wt% glass powders and 5 wt/wt% cephalexin powder hardened within 5 min after mixing with a phosphate buffer. After setting, in vitro drug release from homogeneous or heterogeneous drug-loaded cement pellets in a simulated body fluid (SBF) at pH 7.25 and 37 degrees C continued for over 4 weeks. The hardened cement gradually formed low-crystallinity hydroxyapatite with high bioactivity in hard bone tissue and reduced in volume by about 5% during dissolution testing in SBF. Consequently, 30% of the loaded drug was squeezed from the cement system at the initial stage of the drug release, and the remainder released more slowly. Because the heterogeneous system consisting of the cement and drug-loaded pellet avoided the drug-squeezing effect, it showed a longer drug release term than the homogeneous drug-loaded cement. The heterogeneous system using the hardened cement after soaking in SBF at 37 degrees C for 10 days showed very slow drug release at the initial stage because it completely avoided the drug-squeezing effect, and the release was a zero-order pattern.

Cephalexin↗

Polarographic analysis of cephalexin.

Cephalexin was found to be polarographically reducible after hydrolysis in an acidic medium, producing two polarographic waves. Both waves were diffusion controlled. The concentration-diffusion plot method was used for the analysis of cephalexin in capsules.

Cephalexin↗

Variability in the renal clearance of cephalexin in experimental renal failure.

This study forms a part of an investigation into the extent to which the type of renal damage influences the renal clearance of drugs. We have already demonstrated an effect of different types of experimental renal failure (ERF) on the renal clearance of two cations: cimetidine, a drug that is filtered and secreted by the nephron, and lithium, which is filtered and reabsorbed by more than one segment of the nephron. In this report the renal clearance of cephalexin (CLCEX) is investigated, a drug that has a different mode of renal elimination, since it is filtered, secreted, and reabsorbed by the proximal tubules. The aim was to extend our earlier studies to an organic anion, and to provide an opportunity to evaluate the feasibility of using the renal clearance of N-1-methylnicotinamide (NMN) to predict the renal clearance of anionic drugs in renal failure. Different models of site-specific ERF have been developed in the rat; proximal tubular necrosis (induced by cisplatin), papillary necrosis (induced by 2-bromoethylamine), and glomerulonephritis (induced by sodium aurothiomalate or by antiglomerular basement membrane antibodies). Glomerular function (GFR) was assessed by the clearance of inulin (CLNULIN), and tubular function was assessed by the clearance of endogenous NMN (CLNMN). OUr results show that even if the models of ERF used were not absolutely site-specific, glomerular function and tubular function did not decrease to the same extent in the different ERF. Therefore, glomerulo-tubular imbalance existed, which is incompatible with the "intact nephron hypothesis," i.e., the site of the damage along the nephron and not only the degree of renal dysfunction, is a potential source of variability in the clearance of certain drugs. The renal clearance of cephalexin was estimated more accurately by CLNMN than GFR (r = 0.90). We conclude that the clearance of the endogenous cation NMN can be used to predict the renal clearance of drugs that are not only filtered by the glomeruli but also secreted and/or reabsorbed by the proximal tubules, and in the limited examples investigated appears to apply to both anionic and cationic compounds. In this respect the GFR alone was not an adequate parameter for the prediction of the renal clearance of such drugs.

Animals↗

The extended microbiology of group A streptococcal pharyngitis. Observations during a double-blind controlled study of cephalexin twice versus four-times daily.

In a double-blind controlled study we compared the effectiveness of cephalexin b.i.d. versus q.i.d. in the treatment of group A streptococcal pharyngitis in 65 children. Clinical improvement was noted in 64 patients (98%) and bacteriologic cure in 60 (92%). Despite good compliance, three bacteriologic failures were noted in the q.i.d., and two in the b.i.d. treatment groups. Two of these five were carriers. Significant antibody responses were observed in 61% of the patients by at least one of three tests (ASO, anti-DNase B, Streptozyme). We also investigated the extended microbiology of streptococcal pharyngitis by looking for the presence of viruses, chlamydia and beta-lactamase producing organisms in the pharynx. Respiratory viruses were isolated concomitantly with Streptococcus pyogenes in six patients. Beta-lactamase producing bacteria were present in the pharynx of 98% of the patients at the initiation of treatment and comprised 1-98% of the total bacterial flora. The beta-lactamase producing flora did not significantly change with cephalexin therapy.

Bacteria↗

Activity of cefroxadine and cephalexin in urinary tract infections: a double-blind comparative study.

Cefroxadine and cephalexin were compared in a double-blind study in patients with established, complicated urinary tract infections. The patients were treated orally with 1 g t.i.d. for five days. Bacterial counts in the urine were determined one, three and eight hours after the first dose and on the second, third and fifth days of treatment. A significant reduction in the bacterial count was seen one and three hours after the first dose and to a much greater extent eight hours after the dose. Reductions in the bacterial count were more frequent in the group treated with cefroxadine. The results during the first eight hours indicate that cefroxadine kills more rapidly than cephalexin; this is in agreement with the experimental findings. It is still uncertain whether the transient differences observed in the rates of inhibition are of clinical relevance.

Adolescent↗

In vitro transformation of ampicillin to cephalexin by free and immobilized cells of Streptomyces sp.

In vitro transformation of ampicillin to cephalexin was studied using calcium alginate-immobilized and free Streptomyces sp. strain DRS-1 packed in glass columns. Tris-HCl buffer containing ampicillin was continuously circulated through the columns for four cycles, each cycle (with fresh ampicillin) being continued for 5 h. The pattern of product formation was identical in both cases, i.e. in each cycle, after reaching a certain concentration, its formation did not increase. Product formation was always higher with immobilized cells. Conversion of ampicillin to cephalexin by the strain was affected by cell and substrate concentration.

Alginates↗

Carrier-mediated uptake of cephalexin in human intestinal cells.

A transport carrier for cephalexin, a cephalosporin antibiotic, was identified in a human intestinal cell line, HT-29. Uptake via the carrier was inhibited by dipeptides, phe-gly, gly-pro, carnosine, and cefaclor, a close drug analog. Uptake was unaffected by the presence of amino acids. The pH optimum for uptake was 6.2. Drug uptake was not dependent on the presence of sodium and was insensitive to metabolic inhibitors. The efflux of cephalexin was stimulated by extracellular carnosine, indicating counter-transport. Taken together, drug uptake is mediated by a dipeptide transport carrier and not by an amino acid transport carrier. This is the first demonstration of the carrier in an established cell line.

Carnosine↗

The development of an enzyme-linked immunosorbent assay (ELISA) for cephalexin.

Cephalexin was structurally modified by the attachment of a spacer at the carboxylic acid through which it was subsequently covalently attached to BSA. This method permitted the molecule to be attached without cleavage of the beta-lactam ring giving a conjugate distinct from previously described immunogenic preparations of penicillins and cephalosporins. This approach required the development of a novel spacer molecule, and its synthesis and characterisation are reported. Rabbits were used to raise antisera and the antibodies produced were characterised with respect to their reactivity with cephalexin and various analogues, other cephalosporins, and a number of penicillins.

Animals↗

Nitrofurantoin, sulfamethizole and cephalexin urinary concentration in unequally functioning pyelonephritic kidneys.

Nitrofurantoin, sulfamethizole and cephalexin peak urinary drug concentrations were studied in patients and non-human primates with unequally functioning pyelonephritic kidneys. The peak urinary drug concentration of the poorly functioning kidney in comparison to the better kidney was greater than its percentage relative blood flow or creatinine clearance but variable in its relationship to creatinine concentration, osmolality and sodium concentration. Although for each unit of creatinine clearance the poorly functioning kidney had a higher peak urinary drug concentration than the better functioning kidney, for each kidney the peak urinary drug concentration seemed to be directly proportional to the creatinine clearance, the drug dosage and the renal mechanisms of drug excretion. Nitrofurantoin in the usual recommended dosage did not reach minimal inhibitory urinary drug concentration below a unilateral creatinine clearance of 20 ml. per minute. Whereas, sulfamethizole and cephalexin reached peak urinary drug concentrations greater than the minimal inhibitory concentration at the lowest studied unilateral creatinine clearance of 4 and 11 ml. per minute, respectively.

Adolescent↗

Microbore liquid chromatographic determination of cadralazine and cephalexin in plasma with large-volume injection.

The application of microbore systems (15 cm X 1 mm I.D. columns filled with Nucleosil C18, 5 microns particle size) to the determination of cephalexin and cadralazine in plasma was investigated. Factors such as mobile phase flow-rate, detector flow-cell volume and injection volume were examined with regard to the needs of routine drug analysis. Mobile phase flow-rates of 50-60 microliters/min were used. A flow cell with an optical path length of 6 mm and an intermediary volume (2.4 microliters) was selected for UV detection in order to obtain sufficient sensitivity. Large volumes of non-eluting solvent containing the drug were injected on the column. The addition of an ion-pairing reagent to samples containing cephalexin and cefroxadin prior to the injection was found to improve the chromatographic performance. The blood sample size required for analysis with microbore columns was smaller than that with conventional columns. The analysis time was similar and the limit of quantitation was also similar, provided that large sample volumes were injected on the microbore column.

Animals↗