ceftaroline

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Active against Staphylococcus aureus (including methicillin-susceptible and -resistant strains), Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Escherichia coli, Haemophilus influenzae,Haemophilus influenzae Klebsiella pneumoniae, and Klebsiella oxytoca.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability of parent drug.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Ceftaroline fosamil is rapidly converted by plasma phosphatases to ceftaroline, the active metabolite; 88% excreted in urine, 6% in feces.

Half-Life: 2.6 hr (after multiple doses).

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Known serious hypersensitivity to cephalosporins.

Use Cautiously in:

Known hypersensitivity to other beta-lactams;
Renal impairment (dosage ↓ required for CCr ≤50 mL/min in adults);
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Neonates 34 wk (gestational age) or 12 days (postnatal age) (acute bacterial skin/skin structure infections) and infants 2 mo (community-acquired pneumonia) (safety and effectiveness not established);
Geri: Dose adjustment may be necessary in older adults for age-related in renal function.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash

GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), diarrhea, nausea

Hemat: hemolytic anemia

Local: phlebitis at injection site

Neuro: ENCEPHALOPATHY, SEIZURES

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

Acute Bacterial Skin/Skin Structure Infections

IV (Adults ): 600 mg every 12 hr for 5–14 days.
IV (Children 2–17 yr and >33 kg): 400 mg every 8 hr for 5–14 days or 600 mg every 12 hr for 5–14 days.
IV (Children 2–17 yr and ≤33 kg): 12 mg/kg every 8 hr for 5–14 days.
IV (Children 2 mo–<2 yr): 8 mg/kg every 8 hr for 5–14 days.
IV (Neonates 0–<2 mo): 6 mg/kg every 8 hr for 5–14 days.

Renal Impairment

IV (Adults ): CCr >30 to ≤50 mL/min: 400 mg every 12 hr; CCr ≥15 to ≤30 mL/min: 300 mg every 12 hr; CCr <15 mL/min including hemodialysis: 200 mg every 12 hr.

Community-Acquired Pneumonia

IV (Adults ): 600 mg every 12 hr for 5–7 days.
IV (Children 2–17 yr and >33 kg): 400 mg every 8 hr for 5–14 days or 600 mg every 12 hr for 5–14 days.
IV (Children 2–17 yr and ≤33 kg): 12 mg/kg every 8 hr for 5–14 days.
IV (Children 2 mo–<2 yr): 8 mg/kg every 8 hr for 5–14 days.

Renal Impairment

IV (Adults ): CCr >30 to ≤50 mL/min: 400 mg every 12 hr; CCr ≥15 to ≤30 mL/min: 300 mg every 12 hr; CCr <15 mL/min including hemodialysis: 200 mg every 12 hr.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 400 mg/vial; 600 mg/vial

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins, cephalosporins, or carbapenems. Persons with a negative history of sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several mo following cessation of therapy.

Lab Test Considerations:

May cause seroconversion from a negative to a positive direct Coombs' test. If anemia develops during or after therapy, perform a direct Coombs' test. If drug-induced hemolytic anemia is suspected, discontinue ceftaroline and provide supportive care.

Implementation ⬆ ⬇

IV Administration:

Intermittent Infusion: Reconstitution: Reconstitute with 20 mL of sterile water for injection, 0.9% NaCl, D5W, or LR.Diluent: Dilute further with 50–250 mL of same diluent unless reconstituted with sterile water for injection, then use 0.9% NaCl, D5W, D2.5W, 0.45% NaCl, or LR. Mix gently to dissolve. Solution is clear to light or dark yellow; do not administer solutions that are discolored or contain particulate matter. Solution is stable for 6 hr at room temperature or 24 hr if refrigerated.
Rate: Infuse over 5–60 min.

Patient/Family Teaching ⬆ ⬇

Explain the purpose of ceftaroline to patient. Emphasize the importance of completing therapy, even if feeling better.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇