Bromhexine + Cefalexin

Usage

This combination is prescribed for respiratory tract infections where both thinning mucus and antibacterial action are beneficial, such as pneumonia, bronchitis, and upper respiratory tract infections with excessive mucus production. It is also used in cases of abdominal surgery with risk of bronchopulmonary complications.

• Pharmacological Classification:

  • Bromhexine: Mucolytic, expectorant
  • Cefalexin: First-generation cephalosporin antibiotic

• Mechanism of Action:

  • Bromhexine breaks down mucopolysaccharides in the mucus, reducing its viscosity and making it easier to cough up. It also activates the ciliated epithelium, further aiding mucus clearance.
  • Cefalexin inhibits bacterial cell wall synthesis, leading to bacterial cell death.

Alternate Names

No widely recognized alternate names for the combination exist. It is commonly referred to as Bromhexine + Cefalexin or Cefalexin + Bromhexine.

• Brand Names: Resporidex, Stancare (These are regional and might not be available everywhere.)

How It Works

• Pharmacodynamics:

  • Bromhexine increases the volume of respiratory secretions and reduces their viscosity, thus facilitating expectoration.
  • Cefalexin exerts bactericidal activity against susceptible bacteria, primarily gram-positive organisms.

• Pharmacokinetics:

  • Bromhexine is rapidly absorbed orally and metabolized in the liver. It is highly protein-bound and excreted primarily in the urine.
  • Cefalexin is well-absorbed orally, minimally metabolized, and excreted mainly by the kidneys.

• Mode of Action:

  • Bromhexine: Depolymerizes mucopolysaccharide fibers in mucus.
  • Cefalexin: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.

• Elimination Pathways:

  • Bromhexine: Primarily renal excretion.
  • Cefalexin: Primarily renal excretion.

Dosage

Standard Dosage

Adults:

Cefalexin 500mg – 2g with Bromhexine 8mg-16mg three times a day.

Children:

Cephalexin 25-100 mg/kg/day (divided into multiple doses) with Bromhexine according to age: (<2 years: 1mg TID; 2-6 years: 2mg TID; 6-12 years: 4mg TID).

Special Cases:

• Elderly Patients: Start with lower doses of both drugs and monitor renal function.
• Patients with Renal Impairment: Reduce the dose of cefalexin based on creatinine clearance. Bromhexine should be used with caution.
• Patients with Hepatic Dysfunction: Use Bromhexine with caution. Cefalexin dose adjustment is usually not required.
• Patients with Comorbid Conditions: Adjust doses based on the specific comorbid condition and potential drug interactions.

Clinical Use Cases Dosage recommendations may vary; consultation with a pulmonologist or infectious disease specialist is essential. The information below is meant as general guidance.

• Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations: Dose adjustments are often necessary based on patient status and may involve intravenous administration of antibiotics.

Dosage Adjustments

Adjust doses based on renal/hepatic function, patient response, and other medications the patient may be taking.

Side Effects

Common Side Effects:

• Bromhexine: Nausea, vomiting, gastrointestinal upset, dizziness, headache.
• Cefalexin: Diarrhea, nausea, vomiting, abdominal pain, rash, allergic reactions.

Rare but Serious Side Effects:

• Bromhexine: Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis).
• Cefalexin: Severe allergic reactions (anaphylaxis), Clostridium difficile infection.

Long-Term Effects: Not typically associated with short-term use.

Adverse Drug Reactions (ADR): As listed above, plus any signs of a severe allergic reaction.

Contraindications

• Hypersensitivity to either bromhexine or cefalexin.
• History of severe penicillin allergy (for cefalexin).
• Active peptic ulcer disease (for bromhexine).

Drug Interactions

• Bromhexine may increase the concentration of certain antibiotics (e.g., erythromycin) in bronchial secretions.
• Cefalexin may interact with probenecid, metformin, and warfarin.
• Both drugs can interact with other medications metabolized by the liver or excreted by the kidneys.

Pregnancy and Breastfeeding

• Bromhexine: Use only if clearly needed and under medical supervision.
• Cefalexin: Generally considered safe but should be used cautiously and under medical advice.

Drug Profile Summary (This is a basic summary. Individual patient responses will vary.)

• Mechanism of Action: Bromhexine (mucolytic), Cefalexin (inhibits bacterial cell wall synthesis)
• Side Effects: GI upset, rash, allergic reactions (rarely severe).
• Contraindications: Hypersensitivity, penicillin allergy (cefalexin), peptic ulcer (bromhexine).
• Drug Interactions: See Drug Interactions section.
• Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
• Dosage: See Dosage section.
• Monitoring Parameters: Respiratory status, renal function (especially in special populations).

Popular Combinations This refers to other drugs that may be added to the Bromhexine + Cefalexin regimen, not Bromhexine + Cefalexin itself which is already a combination.

Other antibiotics or respiratory medications may be added depending on the specific infection and patient needs.

Precautions

Evaluate renal and hepatic function, allergies, and other medications. Monitor for adverse reactions. Exercise caution in patients with asthma or a history of peptic ulcer disease.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Bromhexine + Cefalexin?

A: See the Dosage section above for details based on age, condition, and special populations.

Q2: How does this combination treat respiratory infections?

A: It combines the mucus-thinning properties of bromhexine with the antibacterial action of cefalexin, addressing both mucus buildup and infection.

Q3: What are the most common side effects?

A: Nausea, vomiting, diarrhea, and skin rash are potential side effects.

Q4: Are there any serious side effects I should be aware of?

A: Rarely, severe skin reactions or allergic reactions can occur. Seek immediate medical attention if these develop.

Q5: Can this combination be used in pregnant or breastfeeding women?

A: It should be used cautiously and only if the potential benefits outweigh the risks. Consult with an obstetrician.

Q6: Are there any contraindications to using this combination?

A: Hypersensitivity to either drug, severe penicillin allergy (cefalexin), and active peptic ulcer (bromhexine) are contraindications.

Q7: How should I adjust the dosage for patients with renal impairment?

A: Cefalexin dosage needs to be reduced based on creatinine clearance. Bromhexine should be used cautiously.

Q8: What are the key drug interactions I should consider?

A: Consult the Drug Interactions section and consider interactions with other medications metabolized by the liver or excreted by the kidneys. Inform your patients to disclose all medications and supplements they are taking.

Q9: What are the monitoring parameters for patients on this combination?

A: Respiratory status and renal function should be monitored, particularly in elderly patients and those with renal impairment.