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Keftab

What is Keftab?

Keftab is a branded medication that contains cephalexin as its active ingredient. Cephalexin belongs to the first-generation cephalosporin class of antibiotics and is used to treat a variety of bacterial infections. In the United Kingdom, Keftab is a prescription-only medicine (POM) regulated by the Medicines and Healthcare products Regulatory Agency (MHRA). It is supplied as an oral pill in strengths of 125 mg, 250 mg, 375 mg, 500 mg, and 750 mg.

How Keftab Works in the Body

Cephalexin interferes with bacterial cell wall synthesis. It binds to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, blocking the cross-linking of peptidoglycan strands. Without a sturdy cell wall, bacteria cannot maintain their shape and burst under osmotic pressure, leading to bacterial death. This bactericidal activity is rapid and is effective against many Gram-positive organisms (e.g., Staphylococcus aureus, Streptococcus pyogenes) and some Gram-negative species (e.g., Escherichia coli).

• Onset of action: Clinical improvement often begins within 48-72 hours.
• Peak plasma concentrations: Usually reached 1-2 hours after oral ingestion.
• Duration of effect: The drug’s half-life is approximately 1 hour; dosing is therefore typically every 6 hours to maintain therapeutic levels.

Conditions Treated by Keftab

Keftab is approved by the MHRA for the following adult indications:

• Skin and soft-tissue infections (e.g., cellulitis, impetigo, infected wounds)
• Bone and joint infections (osteomyelitis, septic arthritis)
• Upper respiratory tract infections caused by susceptible bacteria (e.g., acute bacterial sinusitis, tonsillitis)
• Ear infections (acute otitis media)
• Urinary tract infections (cystitis)

The medication is also indicated for pediatric patients when dosed by weight, but this article focuses on adult use.

Evidence-Based Off-Label Uses

Some clinicians prescribe cephalexin off-label for:

• Dental prophylaxis in patients at risk for infective endocarditis who cannot take the preferred agents.
• Pre-operative skin preparation to reduce bacterial load before minor surgical procedures.

These uses are not formally approved by the MHRA. Off-label prescribing should be guided by clinical judgment, relevant guidelines, and a thorough risk-benefit assessment.

Who Should (Not) Use Keftab?

Absolute Contra-indications

• Known hypersensitivity to cephalexin, any cephalosporin, or penicillin antibiotics.
• History of severe, immediate-type allergic reactions (e.g., anaphylaxis) to β-lactam antibiotics.

Relative Contra-indications

• Renal impairment: Dose adjustment required for patients with reduced creatinine clearance.
• Pregnancy and lactation: Cephalexin is classified as Category B (UK). It is generally considered safe, but it crosses into breast milk; benefits and risks should be evaluated.
• History of intestinal disease (e.g., colitis) that may be aggravated by broad-spectrum antibiotics.

Special Populations

• Elderly: May have reduced renal function; monitor renal parameters and adjust dose accordingly.
• Patients with a history of severe drug reactions (e.g., Stevens-Johnson syndrome) should avoid cephalexin.

Safety Profile: Side Effects and Interactions

Common Side Effects

• Gastro-intestinal: Diarrhoea, nausea, abdominal cramping (often mild and transient).
• Skin reactions: Rash, itching, or mild urticaria.
• Vaginal yeast infection in women due to alteration of normal flora.

Serious Adverse Events

• Severe allergic reactions: Anaphylaxis, angio-edema, or serum sickness-like syndrome. Seek immediate medical attention if symptoms such as difficulty breathing or swelling of the face develop.
• Clostridioides difficile-associated diarrhoea: Persistent watery stools, abdominal pain, or fever may indicate C. diff infection; medical evaluation is required.
• Blood dyscrasias: Rare cases of neutropenia, thrombocytopenia, or hemolytic anemia have been reported.

Drug Interactions

• Probenecid: Decreases renal excretion of cephalexin, leading to higher plasma concentrations; dose adjustment may be needed.
• Warfarin: May enhance anticoagulant effect; monitor INR more frequently when initiating or stopping Keftab.
• Oral contraceptives: No clinically significant interaction, but patients should be advised to use additional contraception if gastrointestinal upset occurs.
• Renal-clearance-dependent drugs (e.g., aminoglycosides): Co-administration may require renal function monitoring.

Food and Lifestyle Interactions

• Food: Can be taken with or without food; taking with meals may reduce mild stomach upset.
• Alcohol: No direct pharmacological interaction, but excessive alcohol can worsen gastrointestinal side effects.
• Driving: Cephalexin does not impair mental or motor skills; no restrictions required.

When uncertain about other medications, supplements, or herbal products, patients should inform their healthcare provider before starting Keftab.

How to Take Keftab

• Standard adult dosing:

• For most infections, 500 mg taken orally every 6 hours (four times daily).

• For mild infections, 250 mg every 6 hours may be sufficient.

• The available strengths (125 mg, 250 mg, 375 mg, 500 mg, 750 mg) allow flexibility to match the prescribed dose.

• Renal impairment:

• CrCl ≥ 50 mL/min: Standard dosing.

• CrCl 30-49 mL/min: Reduce dose by 50 % (e.g., 250 mg every 12 hours).

• CrCl < 30 mL/min: Use 250 mg every 12 hours or according to specialist guidance.

• Administration tips:

• Swallow the pill whole with a full glass of water.

• Do not crush or chew extended-release formulations (Keftab is immediate release).

• Complete the full prescribed course, even if symptoms improve, to prevent resistance.

• Missed dose:

• Take the missed tablet as soon as remembered unless the next scheduled dose is within 2 hours. In that case, skip the missed dose-do not double-dose.

• Overdose:

• Symptoms may include nausea, vomiting, diarrhoea, and abdominal pain. Seek emergency medical care; supportive treatment is the usual approach.

• Discontinuation:

• No tapering is required. If therapy is stopped early, ensure that the infection has resolved, or discuss alternative treatment with a prescriber.

Monitoring and Follow-Up

• Renal function: Check serum creatinine and estimated glomerular filtration rate (eGFR) before initiating therapy in patients with known kidney disease, and periodically thereafter if treatment exceeds 7-10 days.
• Hepatic function: Routine monitoring is not required for short-term use, but liver enzymes may be assessed in patients with pre-existing liver disease.
• Clinical response: Re-evaluate infection signs within 48-72 hours. Lack of improvement may necessitate culture-guided antimicrobial adjustment.

Storage and Handling

• Keep Keftab tablets in the original container, tightly closed, at room temperature (15-25 °C), protected from moisture and direct sunlight.
• Do not use tablets after the expiry date printed on the package.
• Dispose of unused medication safely, preferably through a local pharmacy take-back program, to prevent accidental ingestion by children.

Medication-Specific Glossary

Penicillin-Binding Proteins (PBPs)

Bacterial proteins that bind β-lactam antibiotics; inhibition of PBPs disrupts cell wall synthesis, leading to bacterial death.

Bactericidal

An agent that kills bacteria directly, as opposed to merely inhibiting their growth.

Cephalosporin

A class of β-lactam antibiotics structurally related to penicillins, divided into generations based on antimicrobial spectrum.

Renal Clearance

The volume of plasma cleared of a substance by the kidneys per unit time; drugs eliminated primarily by the kidneys require dose adjustments in renal impairment.

Medical Disclaimer

This article provides educational information about Keftab and is not a substitute for professional medical advice. Treatment decisions, including use for unapproved indications, must be made under the guidance of a qualified healthcare provider. The content is intended for informational purposes and does not constitute medical recommendations. Always consult a physician before starting, stopping, or changing any medication regimen.