CEFAMANDOLE NAFATE
(sef-a-man'dole)
Mandol
Classifications: antiinfective; antibiotic; second-generation cephalosporin
Prototype: Cefonicid sodium
Pregnancy Category: B

Availability

1 g, 2 g injection

Actions

Semisynthetic, second-generation cephalosporin antibiotic similar to other drugs of this class. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial wall synthesis, thus killing the bacterium.

Therapeutic Effects

Usually active against organisms susceptible to first generation cephalosporins. In addition, it is active against the anaerobes Clostridium sp, Peptococcus sp, Fusobacterium sp; and against some strains of Providencia sp, Enterobacter, Serratia, Proteus, Escherichia coli, and Klebsiella resistant to first generation cephalosporins. Inactive against Enterococci, methicillin-resistant Staphylococci (MRSA), Listeria monocytogenes and Pseudomonas. Partial cross-allergenicity between penicillins and cephalosporins has been reported. Effective treatment for bone and joint infections, lower respiratory tract infections, peritonitis, urinary tract infections and surgical prophylaxis.

Uses

Serious infections of respiratory, genitourinary, and biliary tracts, skin and soft tissue, bones and joints, and in septicemia and peritonitis (caused by E. coli and other coliform microbes); also perioperative prophylaxis to reduce infections in patient undergoing potentially contaminated procedure.

Contraindications

Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation. Safe use in children between 1 and 6 mo not established.

Cautious Use

History of sensitivity to penicillins or other drug allergies; renal function impairment; history of GI disease, particularly colitis.

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 500 mg–1 g q4–8h, up to 2 g q4h
Child: IV/IM 50–100 mg/kg/d in 3–6 divided doses, up to 150 mg/kg/d (not to exceed adult doses)

Surgical Prophylaxis
Adult: IV/IM 1–2 g 30–60 min before surgery, then q6h for 24 h
Child: IV/IM 50–100 mg/kg 30–60 min before surgery, then q6h for 24 h

Administration

Intramuscular

To each gram of cefamandole add 3 mL of sterile water for injection or bacteriostatic water for injection, or NS, or D5W. Resulting solution contains 285 mg/mL. Administer IM deep into a large muscle mass such as gluteus maximus or lateral thigh.

Intravenous

PREPARE: Direct: Reconstitute each gram with 10 mL sterile water for injection, D5W, or NS. Intermittent/Continuous: May be further diluted in 100–1000 mL of D5W or NS.

ADMINISTER: Direct: Give slowly over 3–5 min. Intermittent/Continuous: The rate of infusion is determined by the amount of solution and status of patient.

INCOMPATIBILITIES Solution/additive: Ringer's lactate, calcium gluconate, calcium gluceptate, cimetidine, aminoglycosides, metronidazole, magnesium, ranitidine. Y-site: aminoglycosides, amiodarone, hetastarch.

Prolonged exposure to light causes cefamandole powder to discolor. Once reconstituted, cefamandole is no longer light sensitive. Solutions appear light yellow to amber. Do not use if otherwise colored or if a precipitate is present.
After reconstitution, cefamandole may liberate CO₂. Do not store medication in syringes, as pressure build-up from CO₂ may force plunger out of barrel.

Protect from light. Reconstituted drug remains stable at room temperature for 24 h and when refrigerated at 5° C (41° F), for 96 h.

Adverse Effects (1%)

Body as a Whole: Drug fever, eosinophilia, pain, redness and induration, sterile abscess at injection site, superinfections. GI: Abdominal cramps, diarrhea, pseudomembranous colitis. Hematologic: Hypoprothrombinemia (vitamin K deficiency). Skin: Rash, urticaria.

Diagnostic Test Interference

False-positive urine glucose determinations using copper sulfate reduction methods, e.g., Clinitest or Benedict's reagent, but not with glucose oxidase (enzymatic) tests such as Clinistix, Diastix, TesTape. Cefamandole-induced positive direct Coombs' test may interfere with cross-matching procedures and hematologic studies.

Interactions

Drug: Probenecid decreases renal elimination of cefamandole; alcohol causes disulfiram reaction.

Pharmacokinetics

Peak: 0.5–2 h after IM; 10 min after IV. Distribution: Poor CNS penetration even with inflamed meninges; extensive enterohepatic circulation; high concentrations in bile. Metabolism: Rapidly hydrolyzed in plasma to active metabolite. Elimination: 68–85% excreted unchanged in urine in 6–8 h. Half-Life: 30–120 min.

Nursing Implications

Assessment & Drug Effects

Determine previous hypersensitivity to cephalosporins, penicillins, and other drugs prior to initiating therapy.
Lab tests: Perform culture and sensitivity testing prior to and periodically during therapy. Cefamandole therapy may be instituted pending test results. Baseline and periodic studies of renal function and PT determinations should be performed.
Monitor I&O rates and pattern: Particularly important in patients with impaired renal function, patients >50 y, or patients who are receiving high doses.
Antibiotic-associated pseudomembranous enterocolitis (life-threatening) is a superinfection caused by Clostridia difficile and may occur in 4–9 d or as long as 6 wk after cefamandole is discontinued (see Signs & Symptoms, Appendix F). Most likely to occur in the chronically ill or debilitated older adult patient, especially if undergoing abdominal surgery or if in an ICU.

Patient & Family Education

Check for fever if you have diarrhea and report fever and diarrhea to your physician.
If you experience any signs or symptoms of hypersensitivity (see Appendix F), discontinue your drug and consult with your physician.
Avoid use of alcohol during and for 48–72 h after taking cefamandole. A drug-induced disulfiram-like reaction (see Appendix F) may follow alcohol intake.
Report promptly any signs or symptoms of superinfection (see Appendix F). Superinfections may occur, particularly during prolonged use of cephalosporins.
Yogurt or buttermilk, 120 mL (4 oz) of either (if allowed), may serve as a prophylactic against intestinal superinfection by helping to maintain normal intestinal flora.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug