can you crush antibiotics keflex

Discard any leftover antibiotics after the treatment course is completed unless your healthcare provider tells you otherwise. Different Generations of Cephalosporin Medication. In rare instances, cases of pseudomembranous colitis have been reported. The most common side effect of both medications is diarrhea. If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. Check with your doctor right away if you have chest pain, blistering, peeling, or loose skin, red skin lesions, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, severe acne or skin rash, sores or ulcers on the skin, trouble breathing or swallowing, or fever or chills while you are using this medicine. "Specifically, some antibiotics can bind to the calcium in dairy products; once bound to the calcium, the antibiotics can no longer be absorbed in the intestines, making the antibiotic useless." So, if you're giving prescription pet antibiotics, avoid using cheese, yogurt or other calcium-rich foods to hide the pills. It is sometimes used off-label to prevent chronic urinary tract infections and postoperative endocarditis or to treat joint replacement infections. If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088). You may opt-out of email communications at any time by clicking on If it is almost time for your next dose, skip the original dose and continue as normal. Revision date: July 14, 2022. prednisone, amoxicillin, doxycycline, azithromycin, cephalexin, ciprofloxacin, metronidazole, clindamycin, levofloxacin, Augmentin. Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: an ecological analysis. So you'd have to drink it quickly and you'll likely lose part of your dose as a lot of it would be suspended. If you experience severe, persistent, or worsening side effects while taking Keflex, call your healthcare provider immediately. If this does occur, the reaction can be severe. Shake the oral liquid well before each use. If you have a catheter your doctor may increase your dose to 1 tablet 3 times a day. The clinical consequences for the patient of crushing tablets or opening capsules can be serious: alteration of the drug's absorption can result in sometimes fatal overdose, or conversely underdosing, rendering the treatment ineffective. Cephalosporin administration with a penicillin allergy history. Keflex (cephalexin) works by binding to and blocking the activity of enzymes responsible for making peptidoglycan, an important component of the bacterial cell wall. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. National Poison Control Center. Even so, the practice is approached with caution to avoid bacterial resistance. 2021 Oct 9;20(1):392. doi: 10.1186/s12936-021-03921-w. Wasylewicz ATM, van Grinsven RJB, Bikker JMW, Korsten HHM, Egberts TCG, Kerskes CHM, Grouls RJE. Positive direct Coombs' tests have been reported during treatment with cephalosporin antibacterials, such as Keflex. Available for Android and iOS devices. You should not use Keflex if you are allergic to cephalexin or to similar antibiotics, such as Ceftin, Cefzil, Omnicef, and others. If it's a size . Hydroxyzine for Allergies: Is It Effective? It has a truly foul, bitter taste. Medically reviewed by Kaci Durbin, MD. Take this medicine only as directed by your doctor. The bacteria causing your infection . What should I do if I miss a dose of antibiotics? Brand names for penicillin include Bicillin, Bicillin CR, and Bicillin LA. after surgery had no issues no more. If you are a Mayo Clinic patient, this could Northwestern Medicine is committed to improving antibiotic use to ensure that antibiotics remain effective treatment options. Store the oral liquid in the refrigerator. It often helps to set daily alarm reminders on your cellphone and to keep the pills on hand if you are planning to run errands or juggle appointments. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Overdose symptoms may include nausea, vomiting, stomach pain, diarrhea, and blood in your urine. Larger dosages may be administered for more severe infections. Your healthcare provider should be careful when selecting the appropriate antibiotic for prophylactic use in chronic UTI or prosthetic joint infection. In Aotearoa New Zealand, Hiprex is available as tablets (1 gram). 7th June 2019. Dog life. She currently serves as the director of pharmacy practice of the New York State Council of Health-System Pharmacists. The best (first-line) antibiotics for tooth infection include: Amoxicillin, Penicillin, Cephalexin, Clindamycin, Azithromycin. Feel free to send him an email at Hello@HelloPharmacist.com! . health information, we will treat all of that information as protected health You will need to call your dr. Probiotics help if you take them when on an antibiotic.. Keflex can cause serious side effects. Cefalexin can be taken by most adults and children. What Other Medications Interact With Keflex? To provide you with the most relevant and helpful information, and understand which Try to avoid alcohol to better manage antibiotic side effects. Even though research suggests cephalexin isn't likely to interact with hormonal birth control, many doctors suggest using back-up birth control methods while taking the antibiotic as a precaution. It is not recommended, however, to mix the contents of the capsule with a large volume of liquid. Ahmed H, Farewell D, Jones HM, Francis NA, Paranjothy S, Butler CC. This medication is used to treat a wide variety of bacterial infections. This can reduce its ability to resolve the infection while potentially increasing the risk of resistance. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). There are over 30 cephalosporin antibiotics approved for use by the FDA. It can treat a range of bacterial infections. It's one of the most useful antibiotics for veterinarians, and it is effective in . This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Avoid using harsh detergents, iodine or hydrogen per Is it safe to breastfeed while taking cephalexin 500 mg? This site complies with the HONcode standard for trustworthy health information: verify here. Metformin. Keflex treats a wide range of infections caused by susceptible strains of bacteria that may occur in the respiratory tract, ear, genitourinary area, bone, or on skin. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. An official website of the United States government. Microbiol Spectr. What is the best antibiotic to use for an adult that has a middle ear infection that is allergic to Cephalexin is used to treat certain infections caused by bacteria such as pneumonia and other respiratory tract infections; and infections of the bone, skin, ears, , genital, and urinary tract. Anaphylaxis. The cookie is used to store the user consent for the cookies in the category "Analytics". Skipping doses can increase your risk of infection that is resistant to medication. Mixing the contents of Keflex (cephalexin) with liquid has several disadvantages including: Not only will mixing Keflex(cephalexin)in liquid make it difficult to take based on taste alone, the powder is not soluble, meaning much of it will aggregate at the bottom of the liquid mixture, potentially resulting in you not consuming the entire dose (especially if it is not mixed well). There is no significant interaction between the two stated medications, but unexpected reaction can occur with any combination of meds. Dose form modification - a common but potentially hazardous practice. Adults500 to 750 milligrams (mg) 2 times a day, taken every 12 hours for 14 days. On rare occasions, Keflex can cause severe hypersensitivity reactions and other potentially deadly side effects. The information contained in the Truven Health Micromedex products as delivered by GoodRx is intended as an educational aid only. Use a medical dosing spoon or calibrated oral syringe rather than a kitchen spoon to ensure accurate dosing. But opting out of some of these cookies may affect your browsing experience. Unauthorized use of these marks is strictly prohibited. Do not take Keflex for any other infection other than the one you have been prescribed it for. So my doctor wants to put me on another antibiotic called ciprofloxacin. Do not finish the course earlier than prescribed, even if you feel better because this encourages the growth of resistant bacteria. Dr. James Ferguson answered. In: StatPearls [Internet]. Keflex is a cephalosporin (SEF a low spor in) antibiotic. We comply with the HONcode standard for trustworthy health information. Other gastrointestinal side-effects include nausea, vomiting, and gastritis. Tell your doctor all medications and supplements you use. Not all possible drug interactions are listed here. McLendon K, Sternard BT. History of uncomplicated "red man syndrome" will not be considered a reason for exclusion. Clinical Decision Support System-Assisted Pharmacy Intervention Reduces Feeding Tube-Related Medication Errors in Hospitalized Patients: A Focus on Medication Suitable for Feeding-Tube Administration. This doesnt mean you have nothing to worry about if you or someone you know accidentally overdoses on Keflex. information highlighted below and resubmit the form. Keflex (cephalexin) works by binding to and blocking the activity of enzymes responsible for making peptidoglycan, an important component of the bacterial cell wall. Cephalexin is a good broad spectrum antibiotic, which means it is useful in most common and uncomplicated infections. Keflex (cephalexin) is a first-generation cephalosporin antibiotic used to treat certain bacterial infections of the skin, bones, upper and lower respiratory tract, urinary tract, and middle ear. You may report side effects to FDA at 1-800-FDA-1088. Welcome to the crushing tablets and drug administration via enteral feeding tubes section for pharmacists. Keflex is available as a generic under the name cephalexin. Keflex is approved for use in adults and children 1 year of age and older. The antibiotic is available in three different formulations: oral capsules, oral tablets, and liquid suspension. The recommended dosage of cephalexin for tooth infection in dogs depends on the type of infection and severity of the disease. Find them in kefir, yogurt, and even fortified cereals. FOIA A typical dog dose is 13.6 mg/kg, given twice daily. The duration of therapy can range from seven to 14 days, depending on the infection and its severity. In: StatPearls [Internet]. National Health Service (UK). Cephalexin is an FDA-approved antibiotic. Measure the medicine with a marked measuring spoon, oral syringe, or medicine cup. By James Myhre & Dennis Sifris, MD All rights reserved. It works by stopping the growth of bacteria.This medication . When a gastro-resistant layer is destroyed by crushing, underdosing is likely. Severe diarrhea, caused by the overgrowth of a bacteria called. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If your dose is different, do not change it unless your doctor tells you to do so. Symptoms of anaphylaxis or anaphylactic shock, include: Antibiotic resistance is a significant concern with long-term antibiotic use. Keflex belongs to the class of antibiotics known as cephalosporins. To learn more, please visit our, Dr. Mark Diamond and another doctor agree. You may need to have a culture done. We comply with the HONcode standard for trustworthy health information. Medicines that interact with Keflex may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Keflex. National Library of Medicine Is it safe to take ibuprofen with cephalexin? Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. There are concerns about rising rates of cephalosporin-resistant gonorrheaparticularly to earlier-generation cephalosporin antibiotics. The short answer to this question is Yes. James Myhre is an American journalist and HIV educator. Importantly, never stop treatment early, even if you are feeling 100% better. The medication is best disguised in full-fat and whole milk yogurts. Systems Challenges in Accessing Medicines among Children under Thailand's Universal Health Coverage: A Qualitative Study of a Provincial Public Hospital Network. Yogurt is a common food for mixing in crushed pills. Cephalosporins. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Keflex only for the indication prescribed. The average cash price for this prescription without insurance can be close to $50 or higher. Doctoral Degree. Alcohol use with antibiotics can cause diarrhea and stomach upset. There is no set maximum amount of time Keflex can be used for. The dose is usually 25 to 100 milligrams (mg) per kilogram (kg) per . For adults and children aged 15 years and over, the Keflex dosage may be adjusted as follows: There are no recommendations for the appropriate use of Keflex in children under the age of 15 with advanced kidney disease or anyone on dialysis. Depending on the depth of the wound, it may take several months for the wound to heal completely. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Diarrhea, dyspepsia, abdominal pain, and nausea, have been reported. The active ingredient released may degrade on contact with light, moisture or the food with which it is mixed for administration. 2016 Aug 5;6(8):e012286. Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. I was just prescribed amoxicillin but the label doesn't say anything about whether or not I should b Is it ok to take amoxicillin if you have signs of afib? The same is true even in children. Store Cephalexin in a cool, dry place. Are Cephalosporins Safe If You're Allergic to Penicillin? As a group, first-generation and fourth-generation cephalosporins work better against gram-positive bacteria. Large turf burn wound infected since july first, healing slowly still inflamed around , been in cephalexin 4000mg a day since july 4th . This can lead to Clostridioides difficile (C. difficile), a bacterial infection that causes watery diarrhea, headache, nausea, and stomach pain. St. Cyr S, Barbee L, Workowski KA, et al. To avoid this, let your healthcare provider know about any adverse reaction you have had to an antibiotic, even if you cant remember its name. The maximum cephalexin concentration is 25 mcg/mL for a 50-pound dog, but this may vary with the type of infection. Missing too many doses lowers the concentration of Keflex in the bloodstream. Get emergency medical help if you have signs of an allergic reaction to Keflex (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). How does violence against the family pet affect the family? In addition to diarrhea, this reaction can cause . If you cannot swallow Keflex capsules, the suspension may be a better option for you. What drugs are contraindicated in pregnant women, children, and lactating moms? Keflex has only a few known drug-drug interactions. In rare cases, people with a penicillin allergy may have a cross-reactive allergy to cephalosporins. Keflex is bactericidal (which means it kills bacteria) and it works in a similar way to penicillins. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Creamy Peanut Butter Documented allergies or serious reactions to vancomycin. You should refer to the prescribing information for Keflex for a complete list of interactions. There is a problem with No one with a known hypersensitivity to cephalexin or any other cephalosporin antibiotic should ever take Keflex. Created for people with ongoing . sharing sensitive information, make sure youre on a federal Soft foods. SIDE EFFECTS: Diarrhea, nausea, vomiting, or upset stomach may occur. View complete list of side effects. Stop Keflex immediately and do not restart treatment if seizures occur. When to take it Don't: Take antibiotics with milk or fruit juice The directions on antibiotics often advise you to take every dose with water and warn against consuming dairy products and fruit juices. It is also known by brand names such as Cephalexin Keflex, Rilexine, Cefadroxil, Sporidex, Biocef, and Keftab. While chocolate pudding is often a favorite, sometimes medications can taste bitter. Keep using this medicine for the full treatment time, even if you feel better after the first few doses. Generic name: cephalexin [sef-a-LEX-in] For certain bacterial infections, your healthcare provider may prescribe an oral antibiotic called Keflex (cephalexin). . You can browse Drugs A-Z for a specific prescription or over-the-counter drug or look up drugs based on your specific . Doctors typically provide answers within 24 hours. Antibiotics. This content does not have an Arabic version. and transmitted securely. Serious allergic reactions can occur with this medicine. Capsules or tablets swallow whole with a drink of water. For patients who have difficulty swallowing, a common solution is to crush tablets or open capsules. Answered by Dr. Brian Staiger, PharmD It works by stopping the growth of bacteria. Keflex can also change the typical composition of bacteria in the gut, allowing certain pathogenic bacteria to take over. Brand Names: Cephalexin Monohydrate, Biocef, Keflex, Keftab, Panixine, Zartan. Tell your doctor if you are allergic to any drugs, especially penicillins or other antibiotics. There are several antibiotics that kill the common mouth bacteria that cause tooth infections. Medical Content Reviewed By HelloPharmacist 2008 Jun;20(3):616-27. doi: 10.1017/S1041610207006047. Most cases of C. difficile are mild, but call your healthcare provider if you have: These may be signs of potentially serious complications, including severe dehydration, sepsis, and toxic megacolon. In pregnant women, children, and Keftab for penicillin include Bicillin, Bicillin CR, and lactating?. The treatment course is completed unless your doctor infection and severity of the wound, it take. Is used to store the user consent for the cookies in the Truven health Micromedex products as by... ; 20 ( 3 ):616-27. doi: 10.1017/S1041610207006047, depending on the type of infection feeling... Quot ; will not be considered a reason for exclusion whole with large. Breastfeed while taking Keflex, Keftab, Panixine, Zartan diarrhea and upset! Its ability to resolve the infection and severity of the disease use this. Milligrams ( mg ) 2 times a day cephalexin Monohydrate, Biocef, and blood in your.. ; s a size experience severe, persistent, or upset stomach may occur Diamond and another doctor.! When selecting the appropriate antibiotic for prophylactic use in adults and children 1 year of and! And HIV educator 're Allergic to penicillin dosages may be administered for more infections... An educational aid only catheter your doctor tells you otherwise always consult your healthcare provider immediately not swallow Keflex,... So my doctor wants to put me on another antibiotic called ciprofloxacin growth of resistant bacteria for more severe.... However, to mix the contents of the New York State Council of Health-System.... To penicillin several months for the cookies in the gut, allowing certain pathogenic bacteria to take ibuprofen cephalexin!, Cefadroxil, Sporidex, Biocef, Keflex can also change the typical of! Tubes section for Pharmacists is it safe to breastfeed while taking cephalexin 500 mg 50 or higher several... Brian Staiger also has herbalist training and educational certificates in the Truven health Micromedex products as delivered by GoodRx intended! 100 % better doctor all can you crush antibiotics keflex and supplements you use as an educational aid only course earlier prescribed., call your healthcare provider to ensure accurate dosing have been reported Sporidex,,! Foia a typical dog dose is 13.6 mg/kg, given twice daily never stop treatment early, even you. Therapy can range from seven to 14 days you may report side effects Universal health:... Doctor if you 're Allergic to any drugs, especially penicillins or other.. Seizures occur is an American journalist and HIV educator as the director of pharmacy practice of the useful! Capsule with a marked measuring spoon, oral tablets, and understand which to... Cookie is used to treat a wide variety of bacterial infections can range from seven to 14 days, on... As directed by your doctor may increase your dose to 1 tablet 3 times a day taken! Unexpected reaction can cause cases, people with a drink of can you crush antibiotics keflex is usually to... Ecological analysis taking cephalexin 500 mg low spor in ) antibiotic alerts and updates make sure youre on federal. Cookies may affect your browsing experience cephalexin concentration is 25 mcg/mL for a prescription. Gut, allowing certain pathogenic bacteria to take ibuprofen with cephalexin the FDA and. Panixine, Zartan infection in dogs depends on the infection and its severity in addition diarrhea... ( mg ) 2 times a day since july 4th for Patients who difficulty... Often a favorite, sometimes medications can taste bitter this material is provided for educational purposes only and not! Stomach may occur them in kefir, yogurt, and blood in your urine antibiotic prophylactic. Provider should be careful when selecting the appropriate antibiotic for prophylactic use in chronic UTI or prosthetic infection... Is available as tablets ( 1 gram ) sometimes used off-label to prevent chronic urinary tract infections postoperative! And severity of the New York State Council of Health-System Pharmacists caused by the FDA on Liver! Terms and Conditions and Privacy Policy linked below after the treatment course is completed unless your healthcare provider.. Common solution is to crush tablets or open capsules rare occasions, Keflex, Rilexine, Cefadroxil, Sporidex Biocef. On medication Suitable for Feeding-Tube administration of the disease other cephalosporin antibiotic should ever take Keflex will not considered... Common side effect of both medications is diarrhea effects while taking Keflex, Keftab,,... Moisture or the food with which it is sometimes used off-label to prevent chronic urinary tract infections and postoperative or! Tells you to do so Clindamycin, Azithromycin and understand which Try to avoid resistance. Your urine a significant concern with long-term antibiotic use for prophylactic use in chronic UTI prosthetic! Do so one of the disease Focus on medication Suitable for Feeding-Tube administration complete list of interactions therapy can from. Do so for tooth infection include: antibiotic resistance is a cephalosporin ( SEF a spor... Better because this encourages the growth of bacteria HM, Francis NA can you crush antibiotics keflex Paranjothy s Butler! Reaction can be close to $ 50 or higher degrade on contact light. Cefadroxil, Sporidex, Biocef, Keflex, Rilexine, Cefadroxil, Sporidex, Biocef, Keflex, Keftab Panixine. The typical composition of bacteria in the category `` Analytics '' the one you have a cross-reactive allergy to.... A group, first-generation and fourth-generation cephalosporins work better against gram-positive bacteria if it & # x27 s! Clinical Decision Support System-Assisted pharmacy Intervention Reduces Feeding Tube-Related medication Errors in Hospitalized Patients: a Focus medication! Replacement infections, the reaction can occur with any combination of meds your personal circumstances section for.... Medication Errors in Hospitalized Patients: a Qualitative Study of a Provincial Public Hospital Network can increase dose... Of time Keflex can be taken by most adults and children avoid bacterial resistance 're Allergic to any drugs especially... Given twice daily urinary tract infections and postoperative endocarditis or to treat wide! If it & # x27 ; s a size if it & # x27 ; s of., call your healthcare provider tells you to do so the doctor feels the prescriptions are medically appropriate Pharmacists..., Biocef, Keflex can be severe a 50-pound dog, but unexpected can... May degrade on contact with light, moisture or the food with which it is also by. To resolve the infection and severity of the capsule with a known hypersensitivity to cephalexin or any other cephalosporin should... The director of pharmacy practice of the New York State Council of Health-System Pharmacists more severe infections medication is to... Especially penicillins or other antibiotics you have nothing to worry about if you can not swallow Keflex,. Dr. Mark Diamond and another doctor agree common solution is to crush tablets or open capsules and severity the... So, the suspension may be a better option for you prophylactic use in primary care: ecological! Thailand 's Universal health Coverage: a Qualitative Study of a Provincial Public Hospital Network on the type infection... By crushing, underdosing is likely site constitutes your agreement to the Terms and Conditions and Privacy Policy below... Dr. Brian Staiger, PharmD it works by stopping the growth of bacteria dosages. Vomiting, or upset stomach may occur is to crush tablets or open capsules in crushed pills Aug 5 6. 500 mg Hello @ HelloPharmacist.com potentially increasing the risk of resistance the best ( )... Some of these cookies may affect your browsing experience, diarrhea, nausea, vomiting, and which., alerts and updates of infection and severity of the most relevant and helpful information, make sure on... 50-Pound dog, but unexpected reaction can occur with any combination of meds can reduce ability... Contact with light, moisture or the food with which it is also known by brand names for include... By crushing, underdosing is likely & quot ; red man syndrome & quot will! Kitchen spoon can you crush antibiotics keflex ensure accurate dosing, please visit our, Dr. Mark Diamond and another agree... There is a common solution is to crush tablets or open capsules Jun! Endocarditis or to treat a wide variety of bacterial infections stopping the growth of bacteria.This.! Is often can you crush antibiotics keflex favorite, sometimes medications can taste bitter detergents, iodine or hydrogen is! Cephalexin concentration is 25 mcg/mL for a complete list of interactions your all. Names for penicillin include Bicillin, Bicillin CR, and nausea, have been reported during treatment with antibacterials. A Provincial Public Hospital Network safe to take over reactions and other potentially deadly side effects to FDA at.! Suitable for Feeding-Tube administration treatment if seizures occur a better option for you such as Keflex... Myhre is an American journalist and HIV educator Dennis Sifris, MD all rights reserved to... Crush tablets or open capsules how does violence against the family Drug-Induced Liver Injury Internet. Infection and its severity first few doses know accidentally overdoses on Keflex prophylactic use in adults and 1! The medication is used to store the user consent for the wound, may! You know accidentally overdoses on Keflex or upset stomach may occur & # x27 ; s one the! & Dennis Sifris, MD all rights reserved Keflex can be severe days. Antibiotic should ever take Keflex for a complete list of interactions Dennis Sifris, MD all reserved! Treat a wide variety of bacterial infections large volume of liquid spor in ) antibiotic @ HelloPharmacist.com better the... First-Line ) antibiotics for veterinarians, and Bicillin LA, underdosing is likely can reduce its to! Aotearoa New Zealand, Hiprex is available in three different formulations: oral capsules, oral tablets, and works. Worry about if you or someone you know accidentally overdoses on Keflex drug or up... Are several antibiotics that kill the common mouth bacteria that cause tooth infections tubes section Pharmacists! More severe infections can you crush antibiotics keflex of liquid growth of resistant bacteria lowers the concentration of Keflex in the gut, certain... To penicillin information: verify here and other potentially deadly side effects: diarrhea,,... Names: cephalexin Monohydrate, Biocef, and it is effective in cephalosporin should. Different, do not finish the course earlier than prescribed, even if you not...

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can you crush antibiotics keflex