What is the recommended dose of Keflex (Cephalexin) after ureteral stone removal and stent placement?

From the Guidelines

The recommended dose of Keflex (Cephalexin) after ureteral stone removal and stent placement is 500 mg PO every 6 hours. This dosage is based on the guidelines for antimicrobial prophylaxis in urologic surgery, as outlined in the study published in The Journal of Urology in 2008 1. According to the study, the dosage for Cephalexin is 500 mg PO every 6 hours, which is listed under the 1st Generation cephalosporins category.

Key Considerations

• The dosage may vary depending on specific patient factors and the situation, as noted in the study 1.
• It is essential to administer the full course of antibiotics as prescribed, even if the patient starts feeling better before completion.
• Patients should be advised to stay well-hydrated while taking this medication and to report any signs of infection, such as fever, increased pain, or changes in urine appearance, to their healthcare provider immediately.
• Common side effects of Cephalexin include diarrhea, nausea, and allergic reactions, which should be reported to the doctor if they occur.

Patient Education

• Patients should be educated on the importance of completing the full course of antibiotics to prevent the development of antibiotic-resistant bacteria.
• They should also be informed about the potential side effects of Cephalexin and the importance of reporting any adverse reactions to their healthcare provider.
• Additionally, patients should be advised to attend follow-up appointments to ensure that the infection has been fully cleared and that the stent is functioning properly.

From the FDA Drug Label

The adult dosage ranges from 1 to 4 g daily in divided doses. The usual adult dose is 250 mg every 6 hours For more severe infections or those caused by less susceptible organisms, larger doses may be needed

The recommended dose of Keflex (Cephalexin) after ureteral stone removal and stent placement is not explicitly stated in the drug label. However, based on the provided information, the usual adult dose is 250 mg every 6 hours. For more severe infections, larger doses may be needed, but the exact dose is not specified. 2

From the Research

Keflex Dose After Ureteral Stone Removal and Stent Placement

• The recommended dose of Keflex (Cephalexin) after ureteral stone removal and stent placement is not explicitly stated in the provided studies.
• However, the studies suggest that antibiotic prophylaxis, including Cephalexin, can be used to prevent symptomatic urinary tract infections (UTIs) in patients with ureteral stents 3, 4, 5.
• The duration of antibiotic prophylaxis varies among the studies, with some recommending a single dose or a short course of antibiotics peri-stent removal 3, 4, while others suggest continuous antibiotic prophylaxis until stent removal 5.
• The choice of antibiotic and dosage may depend on various factors, including the patient's medical history, the type of stent used, and the presence of any underlying infections or allergies.
• It is essential to note that the use of antibiotics should be judicious and based on the individual patient's needs, as overuse or misuse of antibiotics can contribute to the development of antibiotic-resistant organisms 3, 6.

Antibiotic Prophylaxis Regimens

• A study published in 2012 found that oral first-generation cephalosporin antibiotic prophylaxis peri-stent removal was sufficient to prevent symptomatic UTIs in patients who had undergone uncomplicated ureteroscopic stone removal 3.
• Another study published in 2003 recommended a single shot of 250mg Levofloxacin p.o. as a perioperative prophylaxis in connection with ureteroscopic stone removal 4.
• A 2019 study suggested that continuous antibiotic prophylaxis until stent removal can significantly reduce the risk of symptomatic UTIs in pediatric patients with ureteric stents 5.

Considerations for Antibiotic Use

• The decision to use antibiotics should be based on the individual patient's risk factors for developing a UTI, such as the presence of diabetes or a cadaveric renal transplant 7.
• The use of antibiotics during routine cystoscopic stent removal may not be necessary, as a randomized controlled trial found no difference in UTI rates between patients who received prophylactic antibiotics and those who did not 6.