Chemical Properties
White cryst. powder
Originator
Ceporex,Glaxo,UK,1970
Definition
ChEBI: A semisynthetic first-generation cephalosporin antibiotic having methyl and beta-(2R)-2-amino-2-phenylacetamido groups at the 3- and 7- of the cephem skeleton, respectively. It is effective against both Gram-negative and G
am-positive organisms, and is used for treatment of infections of the skin, respiratory tract and urinary tract.
Manufacturing Process
To a 1 liter flask containing dimethylformamide at 0°C, was added 24.8 g
sodium N-(2-methoxycarbonyl-1-methylvinyl)-D-α-phenylglycine (prepared
from sodium D-α-phenylglycine and methyl acetoacetate). The mixture was
cooled to -40°C and methyl chloroformate (7.5 ml) and dimethylbenzylamine
(0.26 ml) added. After stirring for 25 minutes, p-nitrobenzyl 7-
aminodesacetoxycephalosporanate (32.8 g) in the form of its hydrochloride
salt was added, followed by triethylamine (12.1 ml) and dimethylformamide
(140 ml) over a period of 20 minutes. The reaction mixture was stirred for 2
hours at -25°C to -35°C, then warmed to 0°C and water (32 ml) added. To
the resultant solution, hydrochloric acid (54 ml) was added followed by zinc
(21.8 g) in portions over a period of 5 minutes, the temperature being
maintained at 5°C to 10°C. Further hydrochloric acid (35 ml) was added and
the solution stirred at 15°C to 20°C for 7 hours.
The pH was adjusted to 3.3 with triethylamine and
semicarbazidehydrochloride (9.5 g) added. The mixture was brought back to
pH 3 with further triethylamine, then stirred for 30 minutes at pH 3. The
resultant mixture was adjusted slowly over 4 hours to pH 6.8 by addition of
triethylamine, seeding being carried out when pH 4.5 was reached. The precipitated cephalexin was filtered off, washed with dimethylformamide (200
ml) and the cephalexin recovered, yield 75%.
Brand name
Keflex (Panixine (Ranbaxy).
Therapeutic Function
Antibiotic
Antimicrobial activity
It is resistant to staphylococcal β-lactamase. Gram-positive
rods and fastidious Gram-negative bacilli, such as Bordetella
spp. and H. influenzae, are relatively resistant. It is active
against a range of enterobacteria, but it is degraded by
many enterobacterial β-lactamases. Citrobacter, Edwardsiella,
Enterobacter, Hafnia, Providencia and Serratia spp. are all
resistant. Gram-negative anaerobes other than B. fragilis are
susceptible. Because of its mode of action it is only
slowly bactericidal to Gram-negative bacilli.
Pharmacokinetics
Oral absorption: >90%
Cmax 500 mg oral: c. 10–20 mg/L after 1 h
Plasma half-life: 0.5–1 h
Volume of distribution: 15 L
Plasma protein binding: 10–15%
Absorption and distribution
It is almost completely absorbed when given by mouth, the
peak concentration being delayed by food. Intramuscular
preparations are not available: injection is painful and produces
delayed peak plasma concentrations considerably lower
than those obtained by oral administration.
In synovial fluid, levels of 6–38 mg/L have been described
after a 4 g oral dose, but penetration into the CSF is poor.
Useful levels are achieved in bone (9–44 mg/kg after 1 g orally)
and in purulent sputum. Concentrations of 10–20 mg/L have
been found in breast milk. Concentrations in cord blood
following a maternal oral dose of 0.25 g were minimal.
Metabolism and excretion
It is not metabolized. Almost all the dose is recoverable from
the urine within the first 6 h, producing urinary concentrations
exceeding 1 g/L. The involvement of tubular secretion
is indicated by the increased plasma peak concentration and
reduced urinary excretion produced by probenecid. Renal
clearance is around 200 mL/min and is depressed in renal
failure, although a therapeutic concentration is still obtained
in the urine. It is removed by peritoneal and hemodialysis.
Some is excreted in the bile, in which therapeutic concentrations
may be achieved.
Clinical Use
As for group 2 cephalosporins . It should not be used
in infections in which H. influenzae is, or is likely to be, implicated.
It should not be used as an alternative to penicillin in
syphilis.
Clinical Use
Cephalexin, 7α-(D-amino-α-phenylacetamido)-3-methylcephemcarboxylicacid (Keflex, Keforal), was designed purposelyas an orally active, semisynthetic cephalosporin. Theoral inactivation of cephalosporins has been attributed to twocauses: instability of the β-lactam ring to acid hydrolysis(cephalothin and cephaloridine) and solvolysis or microbialtransformation of the 3-methylacetoxy group (cephalothin,cephaloglycin). The α-amino group of cephalexin renders itacid stable, and reduction of the 3-acetoxymethyl to a methylgroup circumvents reaction at that site.
Cephalexin occurs as a white crystalline monohydrate. Itis freely soluble in water, resistant to acid, and absorbed wellorally. Food does not interfere with its absorption. Becauseof minimal protein binding and nearly exclusive renal excretion,cephalexin is recommended particularly for the treatmentof urinary tract infections. It is also sometimes used forupper respiratory tract infections. Its spectrum of activity isvery similar to those of cephalothin and cephaloridine.Cephalexin is somewhat less potent than these two agentsafter parenteral administration and, therefore, is inferior tothem for the treatment of serious systemic infections.
Safety Profile
Poison by intraperitoneal route.Moderately toxic by ingestion and other routes. An experimental teratogen. Other experimental reproductiveeffects. Human systemic effects by ingestion: nausea,vomiting, and diarrhea. When heated to decomposition itemits
Synthesis
Cephalexin is synthesized from cephalophenylglycine (32.1.2.9),
which is synthesized by reacting 7-aminocephalosporanic acid with a mixed anhydride synthesized by reacting N-carbobenzoxyphenylglycine and isobutyl chloroformate in the presence of triethylamine. Removing the N-carbobenzoxy protective group from the resulting
product (32.1.2.8) using hydrogen and a palladium on carbon catalyst gives cephalophenylglycine (32.1.2.9) in the form of an internal salt. Reducing this product with hydrogen using
a palladium on barium sulfate catalyst results in the deacetoxylation at the third position of
7-aminocephalosporanic acid, making the desired cephalexin (32.1.2.10).
Veterinary Drugs and Treatments
There are no approved cephalexin products for veterinary use in the
USA. However, it has been used clinically in dogs, cats, horses, rabbits,
ferrets, and birds, particularly for susceptible Staphylococcal
infections.
Drug interactions
Potentially hazardous interactions with other drugs
Anticoagulants: effects of coumarins may be
enhanced.
Metabolism
Cefalexin is not metabolised. About 80% or more of a
dose is excreted unchanged in the urine in the first 6
hours by glomerular filtration and tubular secretion.
Probenecid delays urinary excretion. Therapeutically
effective concentrations may be found in the bile and
some may be excreted by this route.
