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Acquired and native resistance of Staphylococcus aureus to cephalexin and other beta-lactam antibiotics.

Staphylococcus aureus cells that are initially susceptible to cephalexin can be induced to acquire intrinsic resistance to cephalexin in comparatively few steps. Concomitantly, resistance to cephalothin, oxacillin, and dicloxacillin increases. By population analysis, there is heteroresistance to cephalexin in some strains of S. aureus. Heterogeneity in colonial morphology on prolonged incubation in the presence of subinhibitory concentrations of cephalexin may constitute an expression of such heteroresistance.

Cephalothin↗

Cephalexin: absorption and excretion as related to renal function and hemodialysis.

Cephalexin is a new semisynthetic cephalosporin C derivative, which is well absorbed from the gastrointestinal tract and excreted in high concentration in the urine. Even in patients with impaired renal function, the concentrations of cephalexin present in the urine are adequate for the treatment of most urinary tract infections produced by Escherichia coli, Klebsiella, and Proteus mirabilis. In anephric patients, single doses of 250 or 500 mg of cephalexin resulted in high, prolonged serum concentrations. Peak levels were usually observed within 1 hr. However, in two of six anephric patients, peak levels were reached after 6 and 12 hr due to delayed absorption. Hemodialysis for 6 hr reduced the serum concentration of cephalexin by 58%.

Journal Article↗

Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies.

We attempted to determine the causative bacterial pathogens of impetigo in children in our area, to compare the effectiveness of three frequently used oral antimicrobial treatment regimens, and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment. Seventy-three children with impetigo were randomly assigned to receive penicillin V potassium or cephalexin monohydrate, both administered in dosages of 40 to 50 mg/kg per day, or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day. All drugs were given in three divided doses for 10 days. Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies. Forty-five (62%) cultures showed Staphylococcus aureus only, 14 (19%) showed S aureus and group A beta-hemolytic streptococci, six (8%) showed group A beta-hemolytic streptococci only, and eight (11%) showed no growth or other organisms. Treatment failure occurred in six (24%) of 25 patients treated with penicillin V, one (4%) of 25 patients treated with erythromycin estolate, and no patients treated with cephalexin. We conclude that S aureus is the most common cause of impetigo in children in our study population, that cephalexin is the most effective treatment, that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis, and that penicillin V is inadequate for treatment of this infection.

Adolescent↗

HPTLC assay of cephalexin and cefaclor in pharmaceuticals.

A simple and reliable HPTLC method for the simultaneous determination of cephalexin and cefaclor is developed and validated. The methanol-ethyl acetate-acetone-water (5:2.5:2.5:1.5 v/v/v/v) solvent system is used for the quantitative evaluation of chromatograms. The chromatographic zones, corresponding to the spots of cephalexin and cefaclor on the silica gel plates, are scanned in the reflectance/absorbance mode at 265 nm. The method is found to be reproducible and convenient for the quantitative analysis of cephalexin and cefaclor in its dosage forms.

Cefaclor↗

Pharmacokinetics of oral cephalosporins: cephradine cephalexin.

A crossover experiment was utilized to compare the pharmacokinetics of a 1-g dose of cephalexin tablets, cephalexin capsules, or cephradine capsules in nine normal human volunteers. These antibiotics were administered as three formulations: two 500-mg capsulin every 6 hr for five doses, and one 1000-mg tablet of cephalexin every 6 hr for five doses. Pharmacokinetic parameters in the experimental groups showed no statistical differences (p greater than 0.1), indicating that these drugs are equivalent pharmacokinetically.

Administration, Oral↗

A randomized double-blind investigation of cefroxadine (CGP 9000) versus cephalexin in urinary tract infection.

A total of 64 out-patients with significant urinary tract infection were randomly allocated to treatment with cefroxadine 250 mg q.i.d. or cephalexin 500 mg q.i.d. for ten days. Urine cultures were performed before allocation to the treatment groups and on Days 0, 1, 3, 7 and 21. Twenty patients discontinued treatment prematurely because of insignificant bacteriuria on Day 0. Both drug regimes--the cefroxadine dose was half that of cephalexin--showed good activity during treatment, and no statistically significant differences were found between the two drugs. At follow-up, several relapses were found in both treatment groups. Adverse drug reactions were only reported by three patients in the cefroxadine group, and by none in the cephalexin group.

Adult↗

Azithromycin compared with cephalexin in the treatment of skin and skin structure infections.

This randomized, third-party-blinded study compared short-course therapy of once-daily azithromycin (500 mg on day 1, followed by 250 mg/day on days 2-5) with cephalexin (500 mg twice daily for 10 days) in the treatment of patients with skin and skin structure infections. At 25 centers, a total of 361 patients were entered into the study and 148 were evaluable for efficacy. The main causative pathogens, Staphylococcus aureus and Streptococcus pyogenes, were responsible for approximately two thirds of the infections in the two treatment groups. Clinical cure and improvement rates for the two treatments were comparable; 99% with azithromycin and 96% with cephalexin. On completion of therapy, both treatments had eradicated approximately 98% of pathogens. In general, both agents were well-tolerated. The results of this study show that a 5-day course of once-daily treatment with azithromycin is as effective as a 10-day course of twice-daily treatment with cephalexin in the management of skin and skin structure infections.

Adolescent↗

Clinical comparison of cefadroxil, new oral cephalosporin, and cephalexin in uncomplicated urinary tract infection.

Efficacy and safety of cefadroxil, a new oral cephalosporin, were compared with that of cephalexin in the treatment of 28 women with acute urinary tract infections. According to a randomized double-blind design, each patient received cefadroxil 1,000 mg. twice daily or cephalexin 500 mg. four times a day for ten days. Cures based on urine culture five to nine days post-treatment were obtained for all but 1 patient receiving cefadroxil; reinfection after eradication of the original pathogen was recorded for only 1 patient in each treatment group. No drug-related side effects or significant clinical laboratory abnormalities were observed during the study. Cefadroxil 1,000 mg. given twice daily was as effective and as well tolerated as cephalexin 500 mg. given four times daily. The significance of this dosage schedule advantage is discussed.

Administration, Oral↗

Enzymatic production of cephalexin.

Enzymatic production of cephalexin using immobilized penicillin G acylase was studied. The factors that affect the conversion of 7-amino-3-deacetoxycephalosporanic acid (7-ADCA) to cephalexin, such as pH; temperature; concentrations of 7-ADCA, D(-)-phenylglycine methyl ester (PGME), and immobilized penicillin G acylase (IMPGA); time; and molar ratios of 7-ADCA and PGME, were investigated. Under optimized conditions, 85% conversion of 7-ADCA to cephalexin was achieved. The IMPGA was used for 10 cycles.

Acylation↗

Cephalexin concentrations in human serum, gingiva, and mandibular bone following a single oral administration.

1. Cephalexin concentrations in human serum, gingiva, and mandibular bone after a single oral administration of cephalexin (500 mg) were measured by the paper disc method. 2. The peak times of serum, gingiva, and mandibular bone were approximately 90, 120 and 120 min, respectively. 3. The peak concentrations of serum, gingiva, and mandibular bone were 10.58 micrograms/ml, 5.57 micrograms/g and 2.12 micrograms/g, respectively. 4. The concentration ratio of gingiva/serum and mandibular bone/serum peak time of serum were 0.47 and 0.18, respectively. 5. Cephalexin concentrations in gingiva and mandibular bond did not exceed the MIC80s for clinically isolated strains of Staphylococcus aureus spp., alpha-Streptococci and Peptostreptococcus spp.

Adolescent↗

Residue determination of two co-administered antibacterial agents--cephalexin and colistin--in calf tissues using high-performance liquid chromatography and microbiological methods.

Residues of two antibacterial agents, cephalexin and colistin, co-administered by intramuscular injection to calves, were quantified in four different tissues (muscle, fat, liver and kidney) by column switching HPLC and by a microbiological method. For cephalexin assay, tissue samples with cephradin as internal standard were homogenized in a 5% trichloroacetic acid solution and filtrates were injected onto a concentration precolumn filled with LiChroprep RP-18 (25-40 microns). A clean-up step was incorporated by flowing a mobile phase (methanol-0.01 M phosphate buffer (pH 3.0); 15:85, v/v) through the enrichment column before elution on a LiChrospher RP-18e (5 microns) column with a methanol-phosphate buffer (30:70, v/v) at a flow rate of 1 ml min-1. Spectrometric detection was at 260 nm. An additional "off-line" washing step of extracts with methylene chloride was operated to achieve higher selectivity in the case of liver and kidney samples. The limit for quantitative assay was 0.045 micrograms g-1 with relative standard deviations in the range 5-8% and recoveries within 70%. For microbiological assay of colistin, samples were homogenized in 0.1 M hydrochloric acid-acetonitrile mixtures (3:1, v/v, for kidney and liver; 3:2, v/v, for fat and muscle). The supernatants were assayed by the cylinder plate method after evaporation to dryness under vacuum. Bordetella bronchiseptica ATCC 4617 was chosen as test organism. After a 3-h diffusion step at room temperature, the medium was incubated at 37 degrees C for 18 h and then the diameter of the growth inhibition zones was measured. Sensitivity reached 0.10-0.15 micrograms g-1. Results from the analysed samples over a 7-28 day period after drug administration show that no cephalexin was found at concentrations higher than the quantitation limit in the four test tissues and that colistin was found in muscle (injection site only) for 15 days and in kidney for 21 days.

Adipose Tissue↗

Calcium sulphate-based cements containing cephalexin.

Cephalexin containing gypsum and apatite/gypsum cements have been synthesised. The presence of cephalexin into the cements does not alter neither the physico-chemical behaviour of the cements nor produce structural changes on them. These cements behave as drug delivery systems when soaked in simulated body fluid. The release of the drug is different depending on the composition. For gypsum cements, the cephalexin is quickly released, helped by a dissolution process of the matrix, whereas the drug release is more controlled by the hydroxyapatite presence in hydroxyapatite/gypsum samples. Apatite containing cements do not only show a different drug release process, also the paste viscosity is lower and a faster formation "in vitro" of an apatite-type layer on their surface is observed.

Anti-Bacterial Agents↗

Simultaneous blood and brain sampling of cephalexin in the rat by microdialysis and microbore liquid chromatography: application to pharmacokinetics studies.

To circumvent the need for laborious sample clean-up and multiple blood sampling, a system was developed consisting of on-line microdialysis coupled to microbore liquid chromatography and ultraviolet detection. The system was designed for the simultaneous and continuous monitoring of unbound blood and brain cephalexin in the rat following single bolus intravenous administrations (10 mg/kg, n = 6). Microdialysis probes were inserted into the jugular vein and brain striatum, respectively, for blood and brain sampling. Chromatographic conditions consisted of a mobile phase of methanol-100 mM monosodium phosphoric acid (20:80, v/v, pH 5.0) pumped through a microbore reversed-phase column at a flow-rate of 0.05 ml/min. Detection wavelength was set at 260 nm. The method was validated for response linearity as well as intra- and inter-day variabilities. Rapid appearance of cephalexin in the striatal dialysate suggested good blood-brain barrier penetration. This study provided pharmacokinetics information for cephalexin as well as demonstrated the applicability of this continuous sampling method for pharmacokinetics studies.

Animals↗

Development of a densitometric method for the determination of cephalexin as an alternative to the standard HPLC procedure.

A HPTLC-densitometric method was developed in order to obtain a reliable procedure for routine analysis of cephalexin in pharmaceutical formulations. Optimization of TLC conditions for the densitometric scanning was reached by eluting HPTLC silica gel plates in an horizontal developing chamber. Quantitation of cephalexin was performed in single beam reflectance mode by using a computer-controlled densitometric scanner and applying a five-point calibration. A linear regression has been found in the 200-1000 ng range. The setup method is precise, reproducible and accurate. Recovery was also assessed by comparison with the HPLC USP XXIII alternate method. In this case HPTLC-densitometry appears worth of consideration as being relatively inexpensive and time-saving (up to 12 samples can be determined simultaneously in less than 15 min with a solvent consumption of about 15 ml). The results suggest that the proposed method may be used in place of HPLC for the routine quantitation of cephalexin in both pure and dosage forms.

Calibration↗

A comparison of the efficacy of nalidixic acid and cephalexin in bacteriuric women and their effect on fecal and periurethral carriage of enterobacteriaceae.

Eighty-one women were randomly selected for treatment with nalidixic acid (1 g four times a day) or cephalexin (500 mg four times a day) as therapy for 131 episodes of bacteriuria localized using the antibody-coated bacteria (ACB) test. Bladder infections were treated for three days and renal infections for 14 days. Rates of cure were not significantly different between treatment groups in each drug regimen. However, significantly more relapses occurred in the patients with ACB-positive infections treated for 14 days with cephalexin than in those treated for 14 days with nalidixic acid. More early reinfections occurred in the cephalexin-treated group after both three and 14 days of therapy. Resistance to nalidixic acid developed in the infecting bacteria in the urine during therapy with nalidixic acid in 3% of women after three days and in 16% of women after 14 days. Simultaneous resistance appeared in the urine, periurethral area, and fecal flora of these patients.

Antibody-Coated Bacteria Test, Urinary↗

Determination of the spiral conformation of Aquaspirillum spp. by scanning electron microscopy of elongated cells induced by cephalexin treatment.

The effect of the beta-lactam antibiotic cephalexin on the spiral conformation of cells of Aquaspirillum spp. was examined by scanning electron microscopy. A. itersonii and A. peregrinum, which are known to have a left-handed spiral shape, elongated and still showed left-handed spirals in medium containing cephalexin. The spiral conformation of the elongated cells is therefore considered to represent the natural condition. The spiral conformations of A. metamorphum and A. psychrophilum grown in ordinary cultures were difficult to determine because they have short cells without a complete spiral. After cephalexin treatment, the cells of these species elongated and displayed spiral forms, right-handed in A. metamorphum and left-handed in A. psychrophilum. This elongation method may be useful for checking and determination of the spiral handedness of short spiral or curved bacteria such as vibrios.

Cephalexin↗

Cephalexin: a channel hydrate.

The antibiotic cephalexin [systematic name: D-7-(2-amino-2-phenylacetamido)-3-methyl-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid] forms a range of isomorphic solvates, with the maximum hydration state of two water molecules formed only at high relative humidities. The water content of the structure reported here (C(16)H(17)N(3)O(4)S.1.9H(2)O) falls just short of this configuration, having three independent cephalexin molecules, one of which is disordered, and 5.72 observed water molecules in the asymmetric unit. The facile nature of the cephalexin solvation/desolvation process is found to be facilitated by a complex channel structure, which allows free movement of solvent in the crystallographic a and b directions.

Anti-Bacterial Agents↗

A bioequivalence study of six brands of cephalexin.

The bioequivalence of six brands of cephalexin capsules or tablets was studied in six healthy volunteers in a crossover design. Single oral doses (1 X 500 mg) of each product were administered at intervals of 1 week. Bioequivalence was assessed by a urinary excretion method in which the drug was assayed by a sensitive and precise high pressure liquid chromatographic (HPLC) method. Statistical analysis of the cumulative urinary amounts of cephalexin excreted after 7 h indicated no significant differences between brand A and the other brands. However, brand C was significantly different from brands F and B. The various brands did not differ from each other with respect to urinary excretion rate, time to reach the urinary peak height, elimination rate constant and absorption rate constant. The study demonstrated that the six products of cephalexin were bioequivalent.

Adult↗