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Generic Keflex ( Cephalexin )
Keflex (cephalexin monohydrate) is a first‑generation cephalosporin antibiotic indicated for the treatment of bacterial infections caused by susceptible gram‑positive and some gram‑negative organisms, including respiratory tract infections, otitis media, skin and skin structure infections, bone infections, and genitourinary tract infections. It works by binding to penicillin‑binding proteins and inhibiting bacterial cell wall synthesis, leading to cell lysis and death. Cephalexin is bactericidal and is not effective against methicillin‑resistant Staphylococcus aureus (MRSA) or Enterococcus species. It is available only by prescription in Canada.
Usual adult dose: The usual dose is 250 mg to 500 mg taken orally every 6 hours, or 500 mg to 1 g every 12 hours depending on the severity and site of infection. For mild skin and soft tissue infections, 500 mg every 12 hours may be sufficient. For more severe infections or those caused by less susceptible organisms, 500 mg every 6 hours is recommended. The maximum daily dose is 4 g per day. Cephalexin may be taken with or without food; taking it with food or milk may reduce gastrointestinal upset. The capsules or tablets should be swallowed whole with a full glass of water. In patients with renal impairment, the dose must be reduced based on creatinine clearance. If a dose is missed, it should be taken as soon as remembered, but two doses should not be taken at the same time. Treatment should be continued for the full prescribed duration, even if symptoms improve, to prevent bacterial resistance and recurrence.
Dosage form: Oral capsules: 250 mg (green/white, size 2) and 500 mg (green/white, size 0). Also available as film‑coated tablets in 250 mg and 500 mg strengths, and as an oral suspension (125 mg/5 mL and 250 mg/5 mL) for patients who cannot swallow capsules. The 250 mg and 500 mg capsules are the most commonly used strengths for adult therapy.
Onset of action: Peak plasma concentrations are reached approximately 1 hour after oral administration. Clinical improvement in susceptible infections is usually observed within 48 to 72 hours of starting therapy. For uncomplicated infections, symptoms such as fever and pain often begin to subside within the first 2 days.
Duration of action: The elimination half‑life of cephalexin is approximately 1 hour in patients with normal renal function, but the post‑antibiotic effect and tissue concentrations support dosing every 6 to 12 hours depending on the dose and indication. Treatment duration varies by infection type, typically 7 to 14 days for most uncomplicated infections.
Alcohol recommendation: No direct interaction between cephalexin and alcohol has been established. However, alcohol may increase the risk of gastrointestinal upset, nausea, and dehydration, and can impair the immune response. Patients with significant alcohol use or liver disease should exercise caution. Moderation is generally acceptable, but patients should follow the advice of their healthcare professional.
Most common side effects: Diarrhea, nausea, vomiting, dyspepsia, and abdominal pain. These effects are generally mild and resolve with continued use or after completion of therapy. Allergic reactions, including rash, pruritus, urticaria, and rarely anaphylaxis, may occur, particularly in patients with a history of penicillin allergy; cross‑reactivity is estimated at 1% to 10%. Clostridioides difficile‑associated diarrhea is a serious potential complication of any antibiotic therapy and should be suspected if severe or persistent diarrhea occurs. Other rare effects include serum sickness, Stevens‑Johnson syndrome, and reversible neutropenia. Cephalexin is contraindicated in patients with known hypersensitivity to cephalosporin antibiotics. It should be used with caution in patients with renal impairment, and dose adjustment is required for creatinine clearance below 60 mL/min. Keflex is available only by prescription in Canada and must be prescribed by a healthcare professional.
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