|Trade names||Keflex, Ceporex, others|
|Other names||cephalexin (BAN UK), cephalexin (USAN US)|
|Drug class||First-generation cephalosporin|
|Metabolism||80% excreted unchanged in urine within 6 hours of administration|
|Elimination half-life||For an adult with normal renal function, the serum half-life is 0.6–1.2 hours|
|CompTox Dashboard (EPA)|
|Chemical and physical data|
|Molar mass||347.39 g·mol−1|
|3D model (JSmol)|
|Melting point||326.8 °C (620.2 °F)|
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 beta-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.
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, 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 baby. It can be used in children and those over 65 years of age. Those with kidney problems may require a decrease in dose.
Cefalexin was developed in 1967. It was first marketed in 1969 and 1970 under the names Keflex and Ceporex, among others. Generic drug versions are available under other trade names and are inexpensive. It is on the World Health Organization's List of Essential Medicines. In 2018, it was the 85th most commonly prescribed medication in the United States, with more than 8 million prescriptions. In Canada, it was the fifth most common antibiotic used in 2013. In Australia, it is one of the top 15 most prescribed medications.
Cefalexin can treat a number of bacterial infections including otitis media, streptococcal pharyngitis, bone and joint infections, pneumonia, cellulitis, and urinary tract infections. It may be used to prevent bacterial endocarditis. It can also be used for the prevention of recurrent urinary-tract infections.
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. Caution must be exercised when administering cephalosporin antibiotics to penicillin-sensitive patients, because cross-sensitivity with beta-lactam antibiotics has been documented in up to 10% of patients with a documented penicillin allergy.
Pregnancy and breastfeeding
It is pregnancy category B in the United States and category A in Australia, meaning that no evidence of harm has been found after being taken by many pregnant women. Use during breast feeding is generally safe.
According to Plumb's Veterinary Medication Guides, cefalexin can be used in treating skin, respiratory tract, and urinary tract infections. The U.S. Food and Drug Administration (F.D.A.) 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.
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, diarrhea being most common. Hypersensitivity reactions include skin rashes, urticaria, fever, and anaphylaxis. Pseudomembranous colitis and Clostridium difficile have been reported with use of cefalexin.
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, but it is seen in 1% to 10% of patients with a penicillin allergy.
Like other β-lactam antibiotics, renal excretion of cefalexin is delayed by probenecid. Alcohol consumption reduces the rate at which it is absorbed. Cefalexin also interacts with metformin, an antidiabetic drug, and this can lead to higher concentrations of metformin in the body. Histamine H2 receptor antagonists like cimetidine and ranitidine may reduce the efficacy of cefalexin by delaying its absorption and altering its antimicrobial pharmacodynamics.
Mechanism of action
Cefalexin is a beta-lactam antibiotic of the cephalosporin family. It is bactericidal and acts by inhibiting synthesis of the peptidoglycan layer of the bacterial cell wall. 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. It is most active against gram-positive cocci, and has moderate activity against some gram-negative bacilli. However, some bacterial cells have the enzyme β-lactamase, which hydrolyzes the beta-lactam ring, rendering the drug inactive. This contributes to antibacterial resistance towards cefalexin.
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.
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. 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 safest and most effective medicines needed in a health system. The World Health Organization classifies cefalexin as highly important for human medicine.
Cefalexin is the International Nonproprietary Name (INN) and Australian Approved Name (AAN), while cephalexin is the British Approved Name (BAN) and United States Adopted Name (USAN). Brand names for cefalexin include Keflex, Acfex, Cephalex, Ceporex, L-Xahl, Medoxine, Ospexin, and Torlasporin.
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