Cefalexin Explained

Cefalexin, also spelled cephalexin, is an antibiotic that can treat a number of bacterial infections. It kills gram-positive and some gram-negative bacteria by disrupting the growth of the bacterial cell wall. Cefalexin is a β-lactam antibiotic within the class of first-generation cephalosporins. It works similarly to other agents within this class, including intravenous cefazolin, but can be taken by mouth.[1]

Cefalexin can treat certain bacterial infections, including those of the middle ear, bone and joint, skin, and urinary tract. It may also be used for certain types of pneumonia and strep throat and to prevent bacterial endocarditis. Cefalexin is not effective against infections caused by methicillin-resistant Staphylococcus aureus (MRSA), most Enterococcus, or Pseudomonas. Like other antibiotics, cefalexin cannot treat viral infections, such as the flu, common cold or acute bronchitis. Cefalexin can be used in those who have mild or moderate allergies to penicillin. However, it is not recommended in those with severe penicillin allergies.

Common side effects include stomach upset and diarrhea. Allergic reactions or infections with Clostridium difficile, a cause of diarrhea, are also possible. Use during pregnancy or breast feeding does not appear to be harmful to the fetus.[2] [3] It can be used in children and those over 65 years of age. Those with kidney problems may require a decrease in dose.[4]

Cefalexin was developed in 1967.[5] [6] [7] It was first marketed in 1969 and 1970 under the names Keflex and Ceporex, among others.[8] [9] It is available as a generic medication.[4] [10] It is on the World Health Organization's List of Essential Medicines.[11] In 2021, it was the 96th most commonly prescribed medication in the United States, with more than 7million prescriptions.[12] [13] In Canada, it was the fifth most common antibiotic used in 2013.[14] In Australia, it is one of the top 15 most prescribed medications.[15]

Medical uses

Cefalexin can treat a number of bacterial infections including otitis media, streptococcal pharyngitis, bone and joint infections, pneumonia, cellulitis, and urinary tract infections.[4] It may be used to prevent bacterial endocarditis.[4] It can also be used for the prevention of recurrent urinary-tract infections.[4]

Cefalexin does not treat methicillin-resistant Staphylococcus aureus infections.[4]

Cefalexin is a useful alternative to penicillins in patients with penicillin intolerance. For example, penicillin is the treatment of choice for respiratory tract infections caused by Streptococcus, but cefalexin may be used as an alternative in penicillin-intolerant patients.[4] Caution must be exercised when administering cephalosporin antibiotics to penicillin-sensitive patients, because cross-sensitivity with β-lactam antibiotics has been documented in up to 10% of patients with a documented penicillin allergy.[16]

Pregnancy and breastfeeding

It is categorized in category A in Australia meaning that no evidence of harm has been found after being taken by many pregnant women.[4] [2] Use during breast feeding is generally safe.[3]

Adverse effects

The most common adverse effects of cefalexin, like other oral cephalosporins, are gastrointestinal (stomach area) disturbances and hypersensitivity reactions. Gastrointestinal disturbances include nausea, vomiting, and diarrhea, the latter being the most common.[17] Hypersensitivity reactions include skin rashes, urticaria, fever, and anaphylaxis.[4] Pseudomembranous colitis and Clostridium difficile have been reported with use of cefalexin.[4] Less common and more serious side effects include bruising of the skin and yellowing of the skin or eye whites.[18]

Signs and symptoms of an allergic reaction include rash, itching, swelling, trouble breathing, or red, blistered, swollen, or peeling skin. Overall, cefalexin allergy occurs in less than 0.1% of patients. Evidence suggests that it is seen in 1% to 10% of patients with a penicillin allergy.[19]

Interactions

Like other β-lactam antibiotics, renal excretion of cefalexin is delayed by probenecid.[4] It is also not recommended to take cefalexin with dofetilide, live Cholera vaccine, warfarin, and cholestyramine.[20] Alcohol consumption reduces the rate at which it is absorbed.[21] Cefalexin also interacts with metformin, an antidiabetic drug,[4] and this can lead to higher concentrations of metformin in the body.[4] [22] Histamine H2 receptor antagonists like cimetidine and ranitidine may reduce the efficacy of cefalexin by delaying its absorption and altering its antimicrobial pharmacodynamics. Zinc and zinc supplements also interact with cefalexin and may reduce the amount of cefalexin in the body.[18]

Pharmacology

Mechanism of action

Cefalexin is a β-lactam antibiotic of the cephalosporin family.[23] It is bactericidal and acts by inhibiting synthesis of the peptidoglycan layer of the bacterial cell wall.[24] As cefalexin closely resembles d-alanyl-d-alanine, an amino acid ending on the peptidoglycan layer of the cell wall, it is able to irreversibly bind to the active site of PBP, which is essential for the synthesis of the cell wall.[24] It is most active against gram-positive cocci, and has moderate activity against some gram-negative bacilli.[4] However, some bacterial cells have the enzyme β-lactamase, which hydrolyzes the β-lactam ring, rendering the drug inactive. This contributes to antibacterial resistance towards cefalexin.[25]

Pharmacokinetics

Cefalexin is rapidly and almost completely absorbed from the gastrointestinal tract with oral administration. Absorption is slightly reduced when it is taken with food and the medication can be taken without regard for meals. Peak levels of cefalexin occur about 1 hour after administration. Maximal levels of cefalexin increase approximately linearly over a dose range of 250 to 1,000 mg.

Like most other cephalosporins, cefalexin is not metabolized or otherwise inactivated in the body.[26] [27]

The elimination half-life of cefalexin is approximately 30 to 60 minutes in people with normal renal function. Therapeutic levels of cefalexin with oral administration are maintained for 6 to 8 hours.[28] For this reason, cefalexin is typically administered once every 6 to 12 hours depending on the indication. More than 90% of cefalexin is excreted unchanged in the urine within 8 hours.

Society and culture

It is on the World Health Organization's List of Essential Medicines. The World Health Organization classifies cefalexin as highly important for human medicine.[29]

Names

Cefalexin is the International Nonproprietary Name (INN) and the Australian Approved Name (AAN), while cephalexin is the British Approved Name (BAN) and the United States Adopted Name (USAN).[30] Brand names for cefalexin include Keflex, Acfex, Cephalex, Ceporex, L-Xahl, Medoxine, Ospexin, Torlasporin, Bio-Cef, Panixine DisperDose, and Novo-Lexin.[31] [32]

Veterinary uses

Dogs

According to Plumb's Veterinary Medication Guides, cefalexin can be used in treating skin, respiratory tract, and urinary tract infections. Specifically, it can be used to treat pyoderma in dogs.[33] The U.S. Food and Drug Administration (FDA) has approved it for use in humans and dogs but not for other species. Like other drugs approved for human use, cefalexin may be prescribed by veterinarians for animals in certain situations.[34]

Cefalexin (Lexylan) is indicated for the treatment of cattle, dogs, and cats in the European Union.[35]

Notes and References

  1. Book: Brunton LL . Goodman & Gilman's pharmacological basis of therapeutics.. 2011. McGraw-Hill. New York. 978-0071624428 . 12th . Chapter 53: Penicillins, Cephalosporins, and Other β-Lactam Antibiotics.
  2. Web site: Prescribing medicines in pregnancy database. Australian Government. 22 April 2014. 3 March 2014. live. https://web.archive.org/web/20140408040902/http://www.tga.gov.au/hp/medicines-pregnancy.htm#.U1Yw8Bc3tqw. 8 April 2014.
  3. Book: Breastfeeding and Medication. 2013. Routledge. 9781136178153. 227. Jones W . live. https://web.archive.org/web/20170908135050/https://books.google.com/books?id=0Y8lbCnF1mgC&pg=PA227. 8 September 2017.
  4. Web site: Cephalexin. The American Society of Health-System Pharmacists. 21 April 2014. live. https://web.archive.org/web/20140501202910/http://www.drugs.com/monograph/cephalexin.html. 1 May 2014.
  5. Book: Hey E . Neonatal formulary 5 drug use in pregnancy and the first year of life . 2007 . Blackwell . 9780470750353 . 67 . 5th . live . https://web.archive.org/web/20170908135050/https://books.google.com/books?id=aumIBqHmChwC&pg=PA67 . 8 September 2017 . >
  6. US . 3275626 . patent . Penicillin conversion via sulfoxide . 1966-09-27 . 1966-09-27 . 1962-07-31 . 1962-07-31 . Morin RB, Jackson BG . Eli Lilly and Co . Web site: Espacenet - Bibliographic data . 3 March 2020 . 25 September 2022 . https://web.archive.org/web/20220925035539/https://worldwide.espacenet.com/publicationDetails/biblio?CC=US&NR=3275626&KC=&FT=E&locale=en_EP .
  7. US . 3507861 . patent . Certain 3-methyl-cephalosporin compounds . 1970-04-21 . 1970-04-21 . 1966-09-14 . 1966-09-14 . Morin RB, Jackson BG . Eli Lilly and Co . Web site: Espacenet - Bibliographic data . 3 March 2020 . 25 September 2022 . https://web.archive.org/web/20220925035539/https://worldwide.espacenet.com/publicationDetails/biblio?CC=US&NR=3507861&KC=&FT=E&locale=en_EP .
  8. Book: McPherson EM . Cefalexin . Pharmaceutical Manufacturing Encyclopedia.. 2007. Elsevier. Burlington. 9780815518563. 915. https://books.google.com/books?id=_J2ti4EkYpkC&pg=PA915. 3rd. live. https://web.archive.org/web/20170908135051/https://books.google.com/books?id=_J2ti4EkYpkC&pg=PA915. 8 September 2017.
  9. Book: Ravina, Enrique. The evolution of drug discovery : from traditional medicines to modern drugs. 2011. Wiley-VCH. Weinheim. 9783527326693. 267. 1. Aufl.. live. https://web.archive.org/web/20170908135051/https://books.google.com/books?id=iDNy0XxGqT8C&pg=PA267. 8 September 2017.
  10. Book: Hanlon G, Hodges N . Essential Microbiology for Pharmacy and Pharmaceutical Science . 2012 . Wiley . Hoboken . 9781118432433 . 140 . live. https://web.archive.org/web/20170908135051/https://books.google.com/books?id=P4Ucifn76PUC&pg=PT140. 8 September 2017.
  11. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 22nd list (2021) . 2021 . 10665/345533 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.02 . free .
  12. Web site: The Top 300 of 2021 . ClinCalc . 14 January 2024 . 15 January 2024 . https://web.archive.org/web/20240115223848/https://clincalc.com/DrugStats/Top300Drugs.aspx . live .
  13. Web site: Cephalexin - Drug Usage Statistics . ClinCalc . 14 January 2024.
  14. Web site: Human Antimicrobial Drug Use Report 2012/2013. November 2014. 24 February 2015. Public Health Agency of Canada (PHAC). live. https://web.archive.org/web/20150321041930/http://publications.gc.ca/collections/collection_2014/aspc-phac/HP37-20-2013-eng.pdf. 21 March 2015.
  15. Book: Australia's Health 2012: The Thirteenth Biennial Health Report of the Australian Institute of Health and Welfare. 2012. Australian Institute of Health and Welfare. 9781742493053. 408. live. https://web.archive.org/web/20170908135051/https://books.google.com/books?id=1CazE2WqNBEC&pg=PT424. 8 September 2017.
  16. Web site: FDA Cephalexin drug label. 18 April 2014. live. https://web.archive.org/web/20140418220539/http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/063024s022lbl.pdf. 18 April 2014.
  17. Web site: Cephalexin Side Effects. Drugs.com. 9 February 2015. live. https://web.archive.org/web/20150208030513/http://www.drugs.com/sfx/cephalexin-side-effects.html. 8 February 2015.
  18. Web site: Cefalexin . NHS . 31 March 2020 . Crown . 14 November 2022.
  19. Book: Austria-Codex. Haberfeld, H. Österreichischer Apothekerverlag. Vienna. 2009. 2009/2010. 978-3-85200-196-8. de.
  20. Web site: Cephalexin (Oral Route) . Mayo Clinic . Mayo Foundation for Medical Education and Research . 14 November 2022.
  21. Barrio Lera JP, Alvarez AI, Prieto JG . Effects of ethanol on the pharmacokinetics of cephalexin and cefadroxil in the rat . Journal of Pharmaceutical Sciences . 80 . 6 . 511–516 . June 1991 . 1941538 . 10.1002/jps.2600800602 .
  22. Jayasagar G, Krishna Kumar M, Chandrasekhar K, Madhusudan Rao C, Madhusudan Rao Y . Effect of cephalexin on the pharmacokinetics of metformin in healthy human volunteers . Drug Metabolism and Drug Interactions . 19 . 1 . 41–48 . 2002 . 12222753 . 10.1515/dmdi.2002.19.1.41 . 26919498 .
  23. Book: Bothara SS, Kadam KR, Mahadik KG . Principles of Medicinal Chemistry . 1 . 2006 . Nirali Prakashan . Pune . 8185790043 . 81 . 14th . Antibiotics . https://books.google.com/books?id=b2KJZksQrzoC&q=antibiotics+cephalosporin+family+Cephalexin&pg=PA81 . 7 October 2020 . 25 September 2022 . https://web.archive.org/web/20220925035538/https://books.google.com/books?id=b2KJZksQrzoC&q=antibiotics+cephalosporin+family+Cephalexin&pg=PA81 . live .
  24. Fisher JF, Meroueh SO, Mobashery S . Bacterial resistance to beta-lactam antibiotics: compelling opportunism, compelling opportunity . Chemical Reviews . 105 . 2 . 395–424 . February 2005 . 15700950 . 10.1021/cr030102i .
  25. Drawz SM, Bonomo RA . Three decades of beta-lactamase inhibitors . Clinical Microbiology Reviews . 23 . 1 . 160–201 . January 2010 . 20065329 . 2806661 . 10.1128/CMR.00037-09 .
  26. Book: Rafiei N . Cephalexin. Grayson M . Kucers' The Use of Antibiotics: A Clinical Review of Antibacterial, Antifungal, Antiparasitic, and Antiviral Drugs . Seventh . https://books.google.com/books?id=3xE4DwAAQBAJ&pg=PA364. 2 October 2017. CRC Press. 978-1-4987-4796-7. 364–. 13 July 2018. 28 August 2021. https://web.archive.org/web/20210828023755/https://books.google.com/books?id=3xE4DwAAQBAJ&pg=PA364. live.
  27. Book: Skidmore-Roth L . Mosby's Drug Guide for Nursing Students, with 2016 Update. 16 July 2015. Elsevier Health Sciences. 978-0-323-17297-4. 181–. 13 July 2018. 28 August 2021. https://web.archive.org/web/20210828023811/https://books.google.com/books?id=g_BwCgAAQBAJ&pg=PA181. live.
  28. Web site: Cefalexin 500mg Tablets - Summary of Product Characteristics (SMPC) - (Emc). 5 March 2021. 19 April 2021. https://web.archive.org/web/20210419094953/https://www.medicines.org.uk/emc/product/9143/smpc. live.
  29. Book: ((World Health Organization)) . 2019 . Critically important antimicrobials for human medicine . 6th revision . World Health Organization . World Health Organization . Geneva . 10665/312266 . License: CC BY-NC-SA 3.0 IGO . 9789241515528 . free .
  30. Web site: Cephalexin [USAN:BAN] ]. ChemIDplus . 25 September 2022 . 29 January 2022 . https://web.archive.org/web/20220129041851/https://chem.nlm.nih.gov/chemidplus/rn/15686-71-2 . live .
  31. Web site: Cefalexin International . Drugs.com . 3 February 2020 . 8 February 2020 . 29 May 2016 . https://web.archive.org/web/20160529145832/http://www.drugs.com/international/cefalexin.html . live .
  32. Web site: Cephalexin (Oral Route) Description and Brand Names . May Clinic . Mayo Foundation for Medical Education and Research . 14 November 2022.
  33. Web site: Gollakner R . Cephalexin . VCA Animal Hospitals . Affiliate of Mars Inc. . 14 November 2022.
  34. Web site: Frequently Asked Questions about Animal Drugs . . 17 April 2024 . 9 June 2024.
  35. Web site: Lexylan PI . Union Register of medicinal products . 10 April 2024 . 17 June 2024.

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