cefoperazone + sulbactam

Action and Spectrum

Actions and Spectrum: 

• cefoperazone, as a cephalosporin antibiotic, inhibits bacterial cell wall synthesis. Bacterial cell walls are essential for maintaining the structural integrity of the cell. It achieves this by binding to penicillin-binding proteins (PBPs) in the bacterial cell wall. This binding interferes with the cross-linking of peptidoglycan chains in the cell wall. Disruption of peptidoglycan cross-linking leads to a weakened cell wall, making it susceptible to osmotic pressure. Ultimately, cell lysis (rupture) occurs, resulting in bacterial death. 
• sulbactam, a beta-lactamase inhibitor, is combined to counteract beta-lactamase enzymes some bacteria produce. Beta-lactamases are enzymes that can inactivate beta-lactam antibiotics like cephalosporins. It binds irreversibly to beta-lactamase enzymes, preventing them from breaking down cefoperazone and restoring the antibiotic’s activity. 

Combined cefoperazone and sulbactam have a broad spectrum of activity against various Gram-positive and Gram-negative bacteria, including but not limited to: 

Gram-Positive Bacteria: 

Streptococcus pneumoniae 

Streptococcus pyogenes 

Staphylococcus aureus  

Gram-Negative Bacteria: 

Escherichia coli 

Klebsiella pneumoniae 

Proteus mirabilis 

Enterobacter species 

Citrobacter species 

Drug Interaction

Adverse Reaction

Frequency not defined 

Decreased white blood cell count  

Decreased hematocrit level 

Coagulation disorder 

Decreased white blood cell count  

Decreased hemoglobin 

Low blood platelets 

Increased white blood cell count 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

• Hypersensitivity or Allergy: Patients with a known history of severe allergic reactions (including anaphylaxis) to cephalosporin antibiotics or beta-lactam antibiotics, such as penicillins, should generally avoid combined cefoperazone and sulbactam due to the risk of cross-reactivity. 
• Hypersensitivity to Any Component: If a patient is known to be hypersensitive to any component of the specific cefoperazone and sulbactam product, including cefoperazone, sulbactam, or any inactive ingredients, the use of that product should be avoided. 
• Previous Severe Allergic Reaction: Individuals who have experienced a severe allergic reaction to combined cefoperazone and sulbactam should not receive this antibiotic combination again. 
• Severe Hypersensitivity Reactions: Patients with a history of severe hypersensitivity reactions (e.g., severe skin rash, drug-induced liver injury, or blood disorders) to beta-lactam antibiotics should use combined cefoperazone and sulbactam with caution and under close medical supervision. 
• Hypersensitivity to Other Beta-Lactamase Inhibitors: Some patients may have hypersensitivity or allergy to beta-lactamase inhibitors, such as sulbactam. In such cases, the use of this combination should be avoided. 

Pregnancy / Lactation

Pregnancy consideration: N/A 

Lactation: N/A 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

cefoperazone  

• cefoperazone inhibits bacterial cell wall synthesis, which is essential for maintaining bacterial cells’ structural integrity. 
• It achieves this by binding to penicillin-binding proteins (PBPs) in the bacterial cell wall. This binding interferes with the cross-linking of peptidoglycan chains in the cell wall. 
• Disruption of peptidoglycan cross-linking leads to a weakened cell wall, making it susceptible to osmotic pressure. 
• Ultimately, cell lysis (rupture) occurs, resulting in bacterial death. 

sulbactam (Beta-Lactamase Inhibitor Component): 

• sulbactam is a beta-lactamase inhibitor included in the combination to counteract beta-lactamase enzymes produced by some bacteria. Beta-lactamases are enzymes that can inactivate beta-lactam antibiotics like cephalosporins. 
• sulbactam binds irreversibly to beta-lactamase enzymes, preventing them from breaking down cefoperazone and restoring the antibiotic’s activity. 

Pharmacokinetics: 

Absorption 

cefoperazone and sulbactam are administered parenterally (intravenously or intramuscularly). When given through these routes, they achieve high bioavailability and rapid onset of action. 

Distribution 

Both components distribute widely throughout body tissues and fluids, allowing them to reach various infection sites. 

Metabolism 

Neither cefoperazone nor sulbactam undergoes significant metabolism in the body. 

Elimination and Excretion 

Both components are primarily excreted unchanged in the urine. Renal clearance plays a significant role in their elimination. 

Adminstartion

Administration: 

Combined cefoperazone and sulbactam are administered through intravenous (IV) or intramuscular (IM) injection. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: cefoperazone and sulbactam 

Why do we use cefoperazone and sulbactam? 

Combined cefoperazone and sulbactam are antibiotics used to treat various bacterial infections. This combination therapy is effective against a wide range of Gram-positive and Gram-negative bacteria and is particularly valuable in situations where beta-lactamase-producing bacteria may be involved. Here are common uses of combined cefoperazone and sulbactam: 

• Lower Respiratory Tract Infections: This combination can treat lower respiratory tract infections, including pneumonia and bronchitis, caused by susceptible bacteria. 
• Skin and Soft Tissue Infections: Combined cefoperazone and sulbactam are effective against skin and soft tissue infections, such as cellulitis, skin abscesses, and wound infections, when susceptible bacteria are responsible. 
• Urinary Tract Infections (UTIs): It may be prescribed to treat uncomplicated UTIs, including cystitis, caused by susceptible bacteria. 
• Intra-abdominal Infections: This combination therapy can treat intra-abdominal infections, particularly in complex cases or when mixed infections are suspected. 
• Gynecological Infections: In some situations, it may treat gynecological infections, such as pelvic inflammatory disease (PID), when susceptible bacteria are identified. 
• Septicemia and Bloodstream Infections: Combined cefoperazone and sulbactam may be administered to patients with septicemia or bloodstream infections when the causative bacteria are susceptible. 
• Bone and Joint Infections: In certain cases, this combination may be considered for treating bone and joint infections, particularly when susceptible organisms are identified. 
• Meningitis: Although it has limited penetration of the blood-brain barrier, combined cefoperazone, and sulbactam may be considered part of the treatment for meningitis caused by susceptible bacteria in some situations.