Cefalexin

**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), *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, the safest and most effective medicines needed in a health system. In 2016, it was the 107th most prescribed medication in the United States with more than six 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.

## Medical uses

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 does not treat methicillin-resistant *Staphylococcus aureus* 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.

## Adverse effects

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.

## Interactions

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.

## Pharmacology

### 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.

### Pharmacokinetics

Like most other cephalosporins, cefalexin is not metabolized or otherwise inactivated in the body. The biological half-life of cefalexin is approximately 30 to 60 minutes.

## 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.

### Names

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.

### Cost

A seven-day course of cefalexin costs a consumer about CA$25 in Canada in 2014. The wholesale cost of this amount is about CA$4.76 as of 2019[update]. In the United States this amount costs a consumer about US$20.96 as of 2019[update]. In Australia a course of treatment costs from A$12 to A$26.77 as of 2019[update]. In the United Kingdom the costs to the consumer is generally £9. The wholesale price in the developing world is about US$2.18 as of 2015[update].