Keflex Suspension 250mg/5ml
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Keflex Suspension 250mg/5ml
2. QUALITATIVE AND QUANTITATIVE COMPOSITIOn
Each bottle when prepared as directed, contains as the active ingredient, cefalexin monohydrate equivalent to 250mg/5ml of cefalexin base.
3. PHARMACEUTICAL FORM
Granules for oral suspension 250mg: White granules.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Cefalexin is a semisynthetic cephalosporin antibiotic for oral administration.
Cefalexin is indicated in the treatment of the following infections due to susceptible micro-organisms:
Respiratory tract infections
Otitis media
Skin and soft tissue infections Bone and joint infections
Genito-urinary tract infections, including acute prostatitis Dental infections
4.2. Posology and Method of Administration
Cefalexin is administered orally.
The bottle is first inverted and tapped to loosen the powder then a total of 60ml water in two portions is added, shaking after each addition until suspended. If dilution is unavoidable, Syrup BP should be used after the suspension has been prepared as described. Shake well before use.
Adults: The adult dosage ranges from 1-4g daily in divided doses; most infections will respond to a dosage of 500mg every 8 hours. For skin and soft tissue infections, streptococcal pharyngitis and mild, uncomplicated urinary tract infections, the usual dosage is 250mg every 6 hours, or 500mg every 12 hours.
For more severe infections or those caused by less susceptible organisms, larger doses may be needed. If daily doses of cefalexin greater than 4g are required, parenteral cephalosporins, in appropriate doses, should be considered.
The elderly and patients with impaired renalfunction: As for adults. Reduce dosage if renal function is markedly impaired (see ‘Special Warnings’).
Children. The usual recommended daily dosage for children is 25-50mg/kg (10-20mg/lb) in divided doses. For skin and soft tissue infections, streptococcal pharyngitis and mild, uncomplicated urinary tract infections, the total daily dose may be divided and administered every 12 hours. For most infections the following schedule is suggested:
Children under 5 years. 125mg every 8 hours.
Children 5 years and over: 250mg every 8 hours.
In severe infections, the dosage may be doubled. In the therapy of otitis media, clinical studies have shown that a dosage of 75 to 100mg/kg/day in 4 divided doses is required.
In the treatment of beta-haemolytic streptococcal infections, a therapeutic dose should be administered for at least 10 days.
4.3. Contra-indications
Cefalexin is contra-indicated in patients with known allergy to the cephalosporin group of antibiotics.
4.4. Special Warnings and Special Precautions for Use
Before instituting therapy with cefalexin, every effort should be made to determine whether the patient has had previous hypersensitivity reactions to the cephalosporins, penicillins or other drugs. Cefalexin should be given cautiously to penicillin-sensitive patients. There is some clinical and laboratory evidence of partial cross-allergenicity of the penicillins and cephalosporins. Patients have had severe reactions (including anaphylaxis) to both drugs.
Pseudomembranous colitis has been reported with virtually all broad-spectrum antibiotics, including macrolides, semisynthetic penicillins and cephalosporins. It is important, therefore, to consider its diagnosis in patients who develop diarrhoea in association with the use of antibiotics. Such colitis may range in severity from mild to life-threatening. Mild cases of pseudomembranous colitis usually respond to drug discontinuance alone. In moderate to severe cases, appropriate measures should be taken.
If an allergic reaction to cefalexin occurs, the drug should be discontinued and the patient treated with the appropriate agents.
Prolonged use of cefalexin may result in the overgrowth of non-susceptible organisms. Careful observation of the patient is essential. If superinfection occurs during therapy, appropriate measures should be taken.
Cefalexin should be administered with caution in the presence of markedly impaired renal function. Careful clinical and laboratory studies should be made because safe dosage may be lower than that usually recommended.
Positive direct Coombs’ tests have been reported during treatment with the cephalosporin antibiotics. In haematological studies, or in transfusion crossmatching procedures when antiglobulin tests are performed on the minor side, or in Coombs’ testing of newborns whose mothers have received cephalosporin antibiotics before parturition, it should be recognised that a positive Coombs’ test may be due to the drug.
A false positive reaction for glucose in the urine may occur with Benedict’s or Fehling’s solutions or with copper sulphate test tablets.
4.5 Interaction with other medicinal products and other forms of interaction
As with other beta-lactam drugs, renal excretion of cefalexin is inhibited by probenicid.
In a single study of 12 healthy subjects given single 500mg doses of cefalexin and metformin, plasma metformin Cmax and AUC increased by an average of 34% and 24%, respectively, and metformin renal clearance decreased by an average of 14%. No side-effects were reported in the 12 healthy subjects in this study. No information is available about the interaction of cefalexin and metformin following multiple dose administration. The clinical significance of this study is unclear, particularly as no cases of “lactic acidosis” have been reported in association with concomitant metformin and cefalexin treatment.
Hypokalaemia has been described in patients taking cytotoxic drugs for leukaemia when they were given gentamicin and cefalexin.
4.6. Pregnancy and Lactation
Usage in pregnancy. Although laboratory and clinical studies have shown no evidence of teratogenicity, caution should be exercised when prescribing for the pregnant patient.
Usage in nursing mothers: The excretion of cefalexin in human breast milk increased up to 4 hours following a 500mg dose. The drug reached a maximum level of 4 micrograms/ml, then decreased gradually and had disappeared 8 hours after administration. Caution should be exercised when cefalexin is administered to a nursing woman.
4.7. Effects on Ability to Drive and Use Machines
None known.
4.8. Undesirable Effects
Gastro-intestinal: Symptoms of pseudomembranous colitis may appear either during or after antibiotic treatment. Nausea and vomiting have been reported rarely. The most frequent side-effect has been diarrhoea. It was very rarely severe enough to warrant cessation of therapy. Dyspepsia and abdominal pain have also occurred. As with some penicillins and some other cephalosporins, transient hepatitis and cholestatic jaundice have been reported rarely.
Hypersensitivity: Allergic reactions have been observed in the form of rash, urticaria, angioedema, and rarely erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. These reactions usually subsided upon discontinuation of the drug, although in some cases supportive therapy may be necessary. Anaphylaxis has also been reported.
Haemic and Lymphatic System: Eosinophilia, neutropenia, thrombocytopenia and haemolytic anaemia have been reported.
Other: These have included genital and anal pruritus, genital candidiasis, vaginitis and vaginal discharge, dizziness, fatigue, headache, agitation, confusion, hallucinations, arthralgia, arthritis and joint disorder. Reversible interstitial nephritis has been reported rarely. Slight elevations in AST and ALT have been reported.
Overdose
4.9.
Symptoms of oral overdose may include nausea, vomiting, epigastric distress, diarrhoea and haematuria.
In the event of severe overdosage, general supportive care is recommended, including close clinical and laboratory monitoring of haematological, renal and hepatic functions, and coagulation status until the patient is stable. Forced diuresis, peritoneal dialysis, haemodialysis, or charcoal haemoperfusion have not been established as beneficial for an overdose of cefalexin. It would be extremely unlikely that one of these procedures would be indicated.
Unless 5 to 10 times the normal total daily dose has been ingested, gastrointestinal decontamination should not be necessary.
There have been reports of haematuria without impairment of renal function in children accidentally ingesting more than 3.5g of cefalexin in a day. Treatment has been supportive (fluids) and no sequelae have been reported.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
In vitro tests demonstrate that cephalosporins are bactericidal because of their inhibition of cell-wall synthesis.
Cefalexin is active against the following organisms in vitro.
Beta-haemolytic streptococci
Staphylococci, including coagulase-positive, coagulase-negative and penicillinase-producing strains.
Streptococcus pneumoniae
Escherichia coli
Proteus mirabilis
Klebsiella species
Haemophilus influenzae
Branhamella catarrhalis
Most strains of enterococci (Streptococcus faecalis) and a few strains of staphylococci are resistant to cefalexin. It is not active against most strains of Enterobacter species, Morganella morganii and Pr. vulgaris. It has no activity against Pseudomonas or Herellea species or Acinetobacter calcoaceticus. Penicillin-resistant Strptococcuspneumonia is usually cross-resistant to beta-lactam antibiotics . When tested by in-vitro methods, staphylococci exhibit cross-resistance between cefalexin and methicillin-type antibiotics.
5.2. Pharmacokinetic Properties
Cefalexin is acid stable and may be given without regard to meals.
Cefalexin is almost completely absorbed from the gastro-intestinal tract, and 75-100% is rapidly excreted in active form in the urine. Absorption is slightly reduced if the drug is administered with food. The half-life is approximately 60 minutes in patients with normal renal function. Haemodialysis and peritoneal dialysis will remove cefalexin from the blood.
Peak blood levels are achieved one hour after administration, and therapeutic levels are maintained for 6-8 hours. Approximately 80% of the active drug is excreted in the urine within 6 hours. No accumulation is seen with dosages above the therapeutic maximum of 4g/day.
The half-life may be increased in neonates due to their renal immaturity, but there is no accumulation when given at up to 50mg/kg/day.
5.3. Preclinical Safety Data
Daily oral administration of cefalexin to rats in doses of 250 or 500mg/kg prior to and during pregnancy, or to rats and mice during the period of organogenesis only, had no adverse effect on fertility, foetal viability, foetal weight, or litter size.
Cefalexin showed no enhanced toxicity in weanling and newborn rats as compared with adult animals.
The oral LD50 of cefalexin in rats is 5,000mg/kg.
6. PHARMACEUTICAL PARTICULARS 6.1. List of Excipients
The granules contain the following excipients:
Sucrose
Imitation Guarana Flavour
Allura red AC
Sodium Lauryl Sulphate
Methylcellulose 15
Dimeticone
Xanthan Gum
Pregelatininized Starch
6.2. Incompatibilities
None known.
6.3. Shelf-Life
When stored appropriately,
Unreconstituted product 3 years
Bottles of reconstituted product 10 days
6.4. Special Precautions for Storage
Do not store granules above 25°C.
After mixing, Keflex Suspensions should be stored in a cool place (6°C-15°C) or in a refrigerator (2°C-8°C) and be used within 10 days. Where dilution is unavoidable, Syrup BP should be used after the suspension has been prepared according to the manufacturer’s instructions.
6.5. Nature and Content of Container
The product is filled into 100ml HDPE bottles with screw caps.
6.6. Instructions for Use, Handling and Disposal
First invert the bottle and tap to loosen the powder then add a total of 60ml water in two portions, shaking after each addition until suspended. The solution is red. If dilution is unavoidable, Syrup BP should be used after the suspension has been prepared as described.
Shake well before use.
MARKETING AUTHORISATION HOLDER
7.
Flynn Pharma Limited Alton House 4 Herbert Street Dublin 2 Ireland
8. MARKETING AUTHORISATION NUMBER(S)
PL 13621/0024
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
30/09/2005
10 DATE OF REVISION OF THE TEXT
01/03/2011