CEFALEXIN

Cefalexin (INN) or more commonly cephalexin is a first-generation cephalosporin antibiotic introduced in 1967 by Eli Lilly and Company. It is an orally administered agent with a similar antimicrobial spectrum to the intravenous agents cefalotin and cefazolin. It was first marketed as Keflex (Lilly), and is marketed under several other trade names. As of 2008, cefalexin was the most popular cephalosporin antibiotic in the United States, with more than 25 million prescriptions of its generic versions alone, for US$255 million in sales (though less popular than two other antibiotics, amoxicillin and azithromycin, each with 50 million prescriptions per year).

MEDICAL USES

Cefalexin is used to treat a number of infections including: otitis media, streptococcal pharyngitis, bone and joint infections, pneumonia, cellulitis, and urinary tract infections. It may be used to prevent bacterial endocarditis.

INFECTIONS

In addition to being a rational first-line treatment for cellulitis, it is a useful alternative to penicillins in patients with penicillin hypersensitivity. In patients with mild or questionable history of penicillin allergy, cephalasporins are now thought to be relatively safe. Caution should always be taken when prescribing cephalosporins to those with strong history of true penicillin hypersensitivity, however, because cefalexin and other first-generation cephalosporins are known to have a modest cross-allergy in patients with penicillin hypersensitivity. Cefalexin may not be effective against bacteria that incorporate a gene for beta-lactamase on their R-plasmid as the beta-lactam ring is present in the chemical structure of cephalosporin derivatives.

FORMULATIONS

Cefalexin is marketed by generic pharmaceutical manufacturers under a wide range of brand names, including: Apo-Cephalex, Biocef, Cefanox, Ceforal, Cephabos, Cephalexin, Cephorum, Ceporex, Cilex, Ialex, Ibilex, Kefexin, Keflet, Keflex, Rekosporin, Keforal, Keftab, Keftal, Lopilexin, Larixin, Novo-Lexin, Ospexin, Tenkorex, Zephalexin, Panixine Disperdose, Sialexin, Sporidex and Ulexin. A version of Keflex 750 mg capsules is marketed for twice-daily dosage, to improve compliance. However, it is not a sustained release formulation, and since it is more expensive than the older strengths, some physicians prescribe three 250 mg capsules to be taken twice daily, as a less expensive alternative. In Finland, cefalexin is marketed under several names. Orion markets Kefexin.

ADVERSE EFFECTS

Common adverse effects include gastrointestinal upset such as diarrhea, nausea, vomiting, indigestion, and abdominal pain. Others may include dizziness, agitation, headache, joint pain, and tiredness. Symptoms of an allergic reaction include rash, itching, swelling, trouble breathing, or red, blistered, swollen or peeling skin. Overall, allergies occur in less than 0.1% of patients; they are seen in about 1% to 10% of patients with penicillin allergy.

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