VA Class:AM116
Cefoxitin is a semisynthetic cephamycin β-lactam antibiotic.
Cefoxitin is used for treatment of serious infections of the lower respiratory tract, skin and skin structure, bone and joint, and urinary tract; septicemia; gynecologic infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease); and intra-abdominal infections (including peritonitis and intra-abdominal abscess) caused by susceptible bacteria.149, 150, 151, 156 Cefoxitin also is used for perioperative prophylaxis136, 149, 150, 151, 156, 360 and has been used for treatment of uncomplicated gonorrhea†.344
Prior to and during cefoxitin therapy, the causative organism should be cultured and in vitro susceptibility tests conducted.149, 150, 151 In serious infections, therapy may be initiated pending results of in vitro tests.149, 150, 151 Use of cefoxitin does not replace surgical procedures such as incision and drainage when indicated.
Gram-positive Aerobic Bacterial Infections
Cefoxitin is used for treatment of lower respiratory tract infections (including pneumonia and lung abscess) caused by susceptible Staphylococcus aureus , Streptococcus pneumoniae , or other streptococci (except Enterococcus faecalis [formerly S. faecalis ]); septicemia caused by susceptible S. aureus or S. pneumoniae ; skin and skin structure infections caused by susceptible S. aureus , S. epidermidis , or streptococci (except E. faecalis ); and bone and joint infections caused by susceptible S. aureus .149, 150, 151, 156
Cefoxitin generally is not a drug of choice for treatment of infections caused by gram-positive bacteria and should not be used for treatment of infections caused by these organisms when a penicillin or a first generation cephalosporin could be used.
Gram-negative Aerobic Bacterial Infections
Cefoxitin is used for treatment of lower respiratory tract infections (including pneumonia and lung abscess) caused by susceptible Haemophilus influenzae , Escherichia coli , or Klebsiella ; urinary tract infections caused by susceptible E. coli , Klebsiella , Morganella morganii , Proteus mirabilis , P. vulgaris , or Providencia rettgeri ; septicemia or intra-abdominal infections (including peritonitis and intra-abdominal abscess) caused by susceptible E. coli or Klebsiella ; gynecologic infections (including endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by susceptible E. coli or Neisseria gonorrhoeae ; and skin or skin structure infections caused by susceptible E. coli , Klebsiella , or P. mirabilis .149, 150, 151, 156
Mixed Aerobic-Anaerobic Bacterial Infections
Cefoxitin is used for treatment of lower respiratory tract infections or septicemia caused by susceptible Bacteroides (including B. fragilis ); intra-abdominal infections (including peritonitis and intra-abdominal abscess) caused by susceptible Bacteroides or Clostridium ; or gynecologic infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease) and skin and skin structure infections caused by susceptible Bacteroides (including B. fragilis ), Clostridium , Peptococcus niger , Peptostreptococcus , or S. agalactiae (group B streptococci).149, 150, 151, 156
Cefoxitin has been effective for treatment of mixed aerobic-anaerobic infections which failed to respond to an aminoglycoside and clindamycin. In clinical studies in patients with intra-abdominal infections caused by Bacteroides (i.e., B. distasonis , B. fragilis , B. ovatus , B. thetaiotaomicron ), eradication rates 1-2 weeks after cefoxitin therapy were 70-80%. However, cefoxitin may no longer provide reliable coverage against B. fragilis , and many clinicians recommend that metronidazole be included in the regimen to provide coverage against B. fragilis for empiric treatment of intra-abdominal infections.123
For initial empiric treatment of mild to moderate community-acquired, extrabiliary, complicated intra-abdominal infections in adults (e.g., perforated or abscessed appendicitis), the Infectious Diseases Society of America (IDSA) recommends either monotherapy with cefoxitin, ertapenem, moxifloxacin, tigecycline, or the fixed combination of ticarcillin and clavulanic acid, or a combination regimen that includes either a cephalosporin (cefazolin, cefotaxime, ceftriaxone, cefuroxime) or fluoroquinolone (ciprofloxacin, levofloxacin) in conjunction with metronidazole.161
Gonorrhea and Associated Infections
Cefoxitin has been used for treatment of uncomplicated gonorrhea† in adults and adolescents.344
For treatment of uncomplicated urogenital, anorectal, or pharyngeal gonorrhea, CDC states that a combination regimen that includes a single 250-mg IM dose of ceftriaxone and either oral azithromycin (single 1-g dose) or oral doxycycline (100 mg twice daily for 7 days) is the regimen of choice.344 Although a single 2-g dose of IM cefoxitin (with a single 1-g dose of oral probenecid) may be effective for treatment of uncomplicated urogenital and anorectal gonorrhea, CDC states that the drug does not offer any advantages over IM ceftriaxone for urogenital infections and its efficacy for pharyngeal infections is less certain.344
Cefoxitin is used for treatment of pelvic inflammatory disease (PID).156, 344, 346 Because cefoxitin, like cephalosporins, is inactive against Chlamydia , the drug should not be used alone for treatment of PID.156, 344
PID is an acute or chronic inflammatory disorder in the upper female genital tract and can include any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.344, 417 PID generally is a polymicrobial infection most frequently caused by N. gonorrhoeae and/or Chlamydia trachomatis ; however, organisms that can be part of the normal vaginal flora (e.g., anaerobic bacteria, Gardnerella vaginalis , H. influenzae , enteric gram-negative bacilli, S. agalactiae ) or mycoplasma (e.g., Mycoplasma hominis , Ureaplasma urealyticum ) also may be involved.344, 346, 417, 418 PID is treated with an empiric regimen provides broad-spectrum coverage.344, 346, 417, 418 The regimen should be effective against N. gonorrhoeae and C. trachomatis and also probably should be effective against anaerobes, gram-negative facultative bacteria, and streptococci.344, 417, 418 The optimum empiric regimen for treatment of PID has not been identified.344 A wide variety of parenteral and oral regimens have been shown to achieve clinical and microbiologic cure in randomized studies with short-term follow-up;344, 417, 419 however, only limited data are available regarding elimination of infection in the endometrium and fallopian tubes or intermediate or long-term outcomes, including the impact of these regimens on the incidence of long-term sequelae of PID (e.g., tubal infertility, ectopic pregnancy, pain).344, 419
When a parenteral regimen is indicated for treatment of PID, CDC and other clinicians generally recommend a 2-drug regimen of cefoxitin (2 g IV every 6 hours) or cefotetan (2 g IV every 12 hours) given in conjunction with doxycycline (100 mg IV or orally every 12 hours) or a 2-drug regimen of clindamycin (900 mg IV every 8 hours) and gentamicin (usually a 2-mg/kg IV or IM loading dose followed by 1.5 mg/kg every 8 hours).344, 346, 419 While certain parenteral cephalosporins (e.g., cefotaxime, ceftriaxone) also have been used and may be effective for treatment of PID,344, 417, 418 CDC states that there is less experience with use of these cephalosporins in patients with PID and these drugs may be less active than cefoxitin or cefotetan against anaerobic bacteria.344 CDC states that only limited data are available to support the use of other parenteral regimens for treatment of acute PID, although a regimen of IV ampicillin and sulbactam given with oral or IV doxycycline may be effective against C. trachomatis , N. gonorrhoeae , and anaerobes in women with tubo-ovarian abscess.344
CDC states that a transition to oral therapy usually can be initiated within 24-48 hours after the patient demonstrates clinical improvement and decisions regarding such a transition should be guided by clinical experience.344 At least 24 hours of direct inpatient observation is recommended for patients with tubo-ovarian abscess.344
When acute PID that is mild to moderately severe is treated with an oral regimen, CDC recommends a regimen that consists of a single dose of IM ceftriaxone, IM cefoxitin (with oral probenecid), or IM cefotaxime given in conjunction with a 14-day regimen of oral doxycycline (100 mg twice daily) with or without oral metronidazole (500 mg twice daily).344 The optimal parenteral cephalosporin or cephamycin for this outpatient regimen is unclear; although cefoxitin has better anaerobic coverage, ceftriaxone has better coverage against N. gonorrhoeae .344 A single dose of cefoxitin effectively produces a short-term clinical response in women with PID; however, the theoretical limitations in anaerobic coverage might require that metronidazole be included in the regimen.344 With the addition of metronidazole, the regimen should be effective for treatment of bacterial vaginosis, which is frequently associated with PID.344
For additional information regarding treatment of PID, the current CDC sexually transmitted diseases treatment guidelines available at [Web] should be consulted.344
Cefoxitin has been used in conjunction with other antimycobacterial anti-infectives for treatment of infections caused by Mycobacterium abscessus †157 or M. fortuitum †.157
For serious skin, soft tissue, and bone infections caused by M. abscessus †, the American Thoracic Society (ATS) and IDSA recommend a multiple-drug regimen of oral clarithromycin (or azithromycin) used in conjunction with parenteral anti-infectives (e.g., amikacin, cefoxitin, imipenem).157 This multiple-drug regimen also has been used for treatment of M. abscessus lung disease.157 However, although periodic administration of multiple-drug regimens that include a macrolide and at least one parenteral agent (amikacin, cefoxitin, imipenem) or a multiple-drug regimen of several parenteral agents continued for several months may help control symptoms and disease progression in patients with lung infections, long-term sputum conversion is unlikely.157 In patients with focal infections and limited lung disease, curative therapy may be possible if surgical resection is used in conjunction with a multiple-drug treatment regimen.157
Cefoxitin is one of several anti-infectives recommended for use in multiple-drug regimens used for treatment of infections caused by M. fortuitum .157 Although optimum regimens have not been identified, the ATS and IDSA recommend that M. fortuitum pulmonary infections be treated with a regimen consisting of at least 2 anti-infectives selected based on results of in vitro susceptibility testing and tolerability (e.g., amikacin, clarithromycin, cefoxitin, ciprofloxacin or ofloxacin, a sulfonamide, imipenem, doxycycline).157 At least 4 months of treatment with at least 2 anti-infectives active against the clinical isolate is necessary to provide a high likelihood of cure in patients with serious skin, bone, and soft tissue infections;157 6 months of treatment is recommended for bone infections.157 Surgery usually is indicated for extensive disease, abscess formation, or when drug therapy is difficult.157
Cefoxitin is used perioperatively to reduce the incidence of infections in patients undergoing GI surgery (e.g., colorectal surgery, nonperforated appendectomy) or gynecologic and obstetric surgery (e.g., vaginal, abdominal, or laparoscopic hysterectomy, cesarean section).136, 149, 150, 151, 156, 360 Perioperative prophylaxis with an appropriate anti-infective agent can decrease the incidence of infection, particularly surgical site infection, after certain procedures.360, 374
Perioperative prophylaxis is recommended for patients undergoing biliary tract surgery who are at high risk of infection (e.g., those older than 70 years of age or those with acute cholecystitis, a nonfunctioning gallbladder, obstructive jaundice, or common duct stones).360 In high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), perioperative prophylaxis is recommended only if complete biliary drainage is unlikely to be achieved.360 Perioperative prophylaxis is not considered necessary for low-risk patients undergoing elective laparoscopic cholecystectomy.360, 374
For perioperative prophylaxis in high-risk patients undergoing open biliary tract surgery, many clinicians recommend IV cefazolin as the drug of choice.360, 374 Alternatives include IV cefotetan, IV cefoxitin, or IV ampicillin and sulbactam.360, 374 In patients allergic to penicillins and cephalosporins, a reasonable alternative is clindamycin or vancomycin used in conjunction with an aminoglycoside (gentamicin or tobramycin), a fluoroquinolone (ciprofloxacin or levofloxacin), or aztreonam;360, 374 some clinicians suggest metronidazole and an aminoglycoside (gentamicin or tobramycin) or fluoroquinolone (ciprofloxacin or levofloxacin) as another alternative.374
There is evidence that perioperative prophylaxis can decrease the incidence of infection after colorectal surgery, and such prophylaxis is recommended.360, 374
For perioperative prophylaxis in patients undergoing colorectal surgery, many clinicians recommend a parenteral regimen of IV cefoxitin, IV cefotetan, IV cefazolin (used in conjunction with IV metronidazole), IV ampicillin and sulbactam, or IV ertapenem.127, 360, 374 In patients allergic to penicillins and cephalosporins, a reasonable alternative is clindamycin or vancomycin used in conjunction with an aminoglycoside (gentamicin or tobramycin), a fluoroquinolone (ciprofloxacin or levofloxacin), or aztreonam;360, 374 some clinicians suggest metronidazole and an aminoglycoside (gentamicin or tobramycin) or fluoroquinolone (ciprofloxacin or levofloxacin) as another alternative.374
Alternatively, an oral regimen of oral neomycin with either oral erythromycin or oral metronidazole can be used in conjunction with mechanical bowel preparation for perioperative prophylaxis in patients undergoing colorectal surgery.360, 374 Many clinicians recommend using both an oral and a parenteral regimen for perioperative prophylaxis in patients undergoing colorectal surgery,124, 152, 360, 374 and there is some evidence that use of an oral regimen (with mechanical bowel preparation) in conjunction with a parenteral regimen is more effective than use of a parenteral regimen alone.125, 152, 360, 374
There is evidence that perioperative prophylaxis can reduce the incidence of infection after surgery for acute appendicitis, and such prophylaxis is recommended.360, 374
For perioperative prophylaxis in patients undergoing uncomplicated (nonperforated) appendectomy, many clinicians recommend IV cefoxitin, IV cefotetan, or IV cefazolin (used in conjunction with IV metronidazole).360 In patients allergic to penicillins and cephalosporins, a reasonable alternative is clindamycin or vancomycin used in conjunction with an aminoglycoside (gentamicin or tobramycin), a fluoroquinolone (ciprofloxacin or levofloxacin), or aztreonam;360, 374 some clinicians suggest metronidazole and an aminoglycoside (gentamicin or tobramycin) or fluoroquinolone (ciprofloxacin or levofloxacin) as another alternative.374
If perforation has occurred, anti-infectives are continued postoperatively for about 5 days.360
Gynecologic and Obstetric Surgery
Perioperative prophylaxis decreases the incidence of infection after vaginal or abdominal hysterectomy and also is used for laparoscopic hysterectomies.360, 374 In addition, there is evidence that perioperative prophylaxis can prevent infection after elective and nonelective cesarean section,360, 374 and also can prevent infection after elective abortions.122, 360 A pooled analysis of results of randomized, placebo-controlled studies in women who underwent therapeutic abortion before 16 weeks' gestation indicates that perioperative prophylaxis can reduce the overall risk of postabortal infection in these women by 42% compared with placebo.122
Many clinicians suggest that the preferred agents for perioperative prophylaxis in women undergoing vaginal, abdominal, or laparoscopic hysterectomy are IV cefoxitin, IV cefotetan, IV cefazolin, or IV ampicillin and sulbactam.154, 360, 374 In patients allergic to penicillins and cephalosporins, a reasonable alternative is clindamycin or vancomycin used in conjunction with an aminoglycoside (gentamicin or tobramycin), a fluoroquinolone (ciprofloxacin or levofloxacin), or aztreonam;374 some clinicians suggest metronidazole and an aminoglycoside (gentamicin or tobramycin) or fluoroquinolone (ciprofloxacin or levofloxacin) as another alternative.374
IV cefazolin generally is the preferred agent for prophylaxis in women undergoing cesarean section;360, 374 oral doxycycline is recommended for prophylaxis in those undergoing abortion.360
When perioperative prophylaxis is indicated in patients undergoing surgery, administration of an appropriate anti-infective should be timed to ensure that bactericidal concentrations of the drug are established in serum and tissues by the time the initial surgical incision is made;360, 374 therapeutic concentrations of the drug should then be maintained in serum and tissues for the duration of the procedure.374
An IV dose of an appropriate anti-infective should be administered within 60 minutes before the initial incision.360, 374 If cefoxitin is used prophylactically, the manufacturers recommend that the drug be given 30-60 minutes before the initial incision to ensure adequate cefoxitin tissue concentrations at the time of surgery.149, 150, 151, 156
A single preoperative dose usually is sufficient for perioperative prophylaxis.374 However, if surgery is prolonged (more than 3-4 hours), major blood loss occurs, or other factors are present that shorten the half-life of the drug (e.g., extensive burns), additional doses should be administered during the procedure to ensure adequate serum and tissue concentrations of the anti-infective throughout the procedure.360, 374 For prolonged procedures in patients with normal renal function, some clinicians suggest that intraoperative doses be given during the procedure at intervals that correspond to 1-2 times the half-life of the drug (e.g., every 2 hours for cefoxitin, measured from the time the preoperative dose is initiated).360, 374 Intraoperative doses may not be warranted if there are factors that prolong the half-life of the drug (e.g., renal impairment).374
For most procedures, the duration of prophylaxis should be less than 24 hours.360, 374 There is no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.360, 374
Reconstitution and Administration
Cefoxitin sodium is administered by IV injection or infusion.149, 150, 151, 156 The drug also has been administered by IM injection†.344
Cefoxitin should be given IV in patients with septicemia or other severe or life-threatening infections, or in patients with lowered resistance resulting from debilitating conditions (e.g., malnutrition, trauma, surgery, diabetes, heart failure, malignancy), particularly with shock.149, 150, 156
For direct IV injection, the contents of a vial labeled as containing 1 or 2 g of cefoxitin should be reconstituted with 10 mL of sterile water for injection to provide a solution containing approximately 95 or 180 mg/mL, respectively.150 The vial should be shaken until the drug is dissolved, and then allowed to stand until the solution is clear.150
The appropriate dose of reconstituted solution may then be injected directly into a vein over a 3- to 5-minute period or slowly into the tubing of a compatible IV infusion solution.150
Intermittent or Continuous IV Infusion
For IV infusion, the contents of a vial labeled as containing 1 or 2 g of cefoxitin should be reconstituted with 10 or 10-20 mL, respectively, of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection to provide solutions containing approximately 95 or 95-180 mg/mL, respectively.150 The vial should be shaken until the drug is dissolved, and then allowed to stand until the solution is clear.150 The reconstituted solution should be further diluted in 50 mL to 1 L of a compatible IV solution.150
Commercially available pharmacy bulk packages containing 10 g of cefoxitin should be reconstituted with 43 or 93 mL of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection to provide solutions containing approximately 200 or 100 mg/mL, respectively.151 The vial should be shaken until the drug is dissolved, and then allowed to stand until the solution is clear.151 Reconstituted solutions in pharmacy bulk packages should not be used for direct IV infusion; the reconstituted solution must be further diluted in 50 mL to 1 L of a compatible IV infusion solution within 4 hours after reconstitution.151 (See Chemistry and Stability: Stability.) A suitable sterile transfer device or dispensing set should be used to transfer the contents of the reconstituted bulk package vial to a compatible IV solution;151 a syringe with a needle is not recommended since leakage could occur during transfer.151 The manufacturer's directions should be consulted for additional information.151
Alternatively, the commercially available Duplex® drug delivery system containing 1 or 2 g of cefoxitin powder and 50 mL of 4 or 2.2% dextrose injection, respectively, in separate chambers should be reconstituted (activated) according to the manufacturer's directions and administered by IV infusion.149 If stored in the refrigerator after reconstitution (see Chemistry and Stability: Stability), the solution should be allowed to reach room temperature prior to administration.149
Thawed solutions of the commercially available frozen premixed cefoxitin injection in dextrose should be given only by intermittent or continuous IV infusion.156 The frozen injection should be thawed at room temperature (25°C) or under refrigeration (5°C); the injection should not be thawed by warming in a water bath or by exposure to microwave radiation.156 Precipitates that may have formed in the frozen injection usually will dissolve with little or no agitation when the injection reaches room temperature; potency is not affected.156 After thawing to room temperature, the injection should be agitated and the container checked for minute leaks by firmly squeezing the bag.156 The injection should be discarded if container seals or outlet ports are not intact or leaks are found or if the solution is cloudy or contains an insoluble precipitate.156 Additives should not be introduced into the injection container.156 The injection should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.156
Other IV solutions flowing through a common administration tubing or site be discontinued while cefoxitin is being infused.150 If an aminoglycoside is administered concomitantly with cefoxitin, the drugs should be administered at separate sites.150
IM injections† of cefoxitin have been prepared by adding 2 mL of sterile water for injection or 0.5 or 1% lidocaine hydrochloride injection (without epinephrine) to each g of cefoxitin. IM injections of cefoxitin should be made deeply into a large muscle such as the upper outer quadrant of the gluteus maximus, using usual techniques and precautions. The plunger of the syringe should be drawn back before IM injection to ensure that the needle is not in a blood vessel.
Dosage of cefoxitin sodium is expressed in terms of cefoxitin.
The usual adult dosage of cefoxitin is 1-2 g every 6-8 hours, depending on the severity of the infection and the susceptibility of the causative organism.149, 150, 151, 156 In severe, life-threatening infections, up to 12 g daily may be required.149, 150, 151, 156
The manufacturers suggest that adults with uncomplicated infections (e.g., pneumonia, urinary tract infections, cutaneous infections) receive 1 g IV every 6-8 hours, those with moderately severe or severe infections receive 1 g IV every 4 hours or 2 g IV every 6-8 hours, and those with infections requiring higher dosage receive 2 g IV every 4 hours or 3 g IV every 6 hours.149, 150, 151, 156
The duration of cefoxitin therapy depends on the type of infection. In infections caused by group A β-hemolytic streptococci, therapy should be continued for at least 10 days.
Gonorrhea and Associated Infections
If cefoxitin is used for treatment of uncomplicated gonorrhea†, the US Centers for Disease Control and Prevention (CDC) recommends that adults and adolescents receive a single 2-g IM† dose of the drug (with a single 1-g oral dose of probenecid).344
For treatment of acute pelvic inflammatory disease (PID) when a parenteral regimen is used, CDC and others recommend that adults and adolescents receive an IV cefoxitin dosage of 2 g 4 times daily (every 6 hours) given in conjunction with IV or oral doxycycline (100 mg twice daily).344, 346 The initial parenteral regimen may be discontinued 24-48 hours after there is clinical improvement and oral doxycycline (100 mg twice daily) continued to complete 14 days of therapy.344, 346
For treatment of PID when an oral regimen is used, CDC recommends that adults and adolescents receive a single 2-g IM dose of cefoxitin and oral probenecid (1 g), followed by oral doxycycline (100 mg twice daily) with or without oral metronidazole (500 mg twice daily) given for 14 days.344
If cefoxitin is included in initial combination regimens used for treatment of serious skin, soft tissue, and bone infections caused by Mycobacterium abscessus † (see Uses: Mycobacterial Infections), the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) recommend an IV cefoxitin dosage up to 12 g daily given in divided doses for at least 2 weeks until clinical improvement.157 At least 4 months of antimycobacterial treatment is necessary for treatment of serious skin and soft tissue infections; 6 months of antimycobacterial treatment is recommended for bone infections.157
For perioperative prophylaxis in women undergoing abdominal, vaginal, or laparoscopic hysterectomy or undergoing cesarean section, 1 or 2 g of cefoxitin should be given IV within 30-60 minutes prior to incision.149, 150, 151, 156, 360, 374 For cesarean section, the manufacturers recommend giving the dose as soon as the umbilical cord is clamped;149, 150, 151, 156 however, there is some evidence that giving the dose prior to incision is more effective than giving it after clamping.360 Although the manufacturers state that additional 2-g doses should be given every 6 hours (for up to 24 hours) in hysterectomy patients or at 4 and 8 hours after the initial dose in cesarean section patients,149, 150, 151, 156 postoperative doses are usually unnecessary.360
For perioperative prophylaxis in patients undergoing colorectal surgery, appendectomy (nonperforated), or other uncontaminated GI surgery, 1 or 2 g of cefoxitin should be given IV within 30-60 minutes prior to incision.149, 150, 151, 156, 360, 374 Although the manufacturers state that additional 2-g doses should be given every 6 hours (for up to 24 hours) after the initial dose,149, 150, 151, 156 postoperative doses are usually unnecessary.360
During prolonged procedures (more than 3-4 hours), if major blood loss occurs, or if other factors are present that shorten the half-life of the drug, additional doses of cefoxitin should be given during the procedure (e.g., every 2 hours, measured from the time the preoperative dose is initiated).360, 374
The duration of prophylaxis should be less than 24 hours for most procedures;360, 374 there is no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.360, 374
The usual dosage of cefoxitin for pediatric patients 3 months of age or older is 80-160 mg/kg daily given in 4-6 equally divided doses.149, 150, 151, 156 The maximum dosage is 12 g daily.149, 150, 151, 156 Safe use of cefoxitin in infants younger than 3 months of age has not been established.149, 150, 151, 156
The American Academy of Pediatrics (AAP) recommends that pediatric patients beyond the neonatal period receive cefoxitin in a dosage of 80 mg/kg daily given in 3-4 divided doses for treatment of mild to moderate infections or 160 mg/kg daily given in 4 divided doses for treatment of severe infections.292
The duration of cefoxitin therapy depends on the type of infection. In infections caused by group A β-hemolytic streptococci, therapy should be continued for at least 10 days.
For perioperative prophylaxis in pediatric patients 3 months of age or older, the manufacturers recommend that a cefoxitin dose of 30-40 mg/kg be given 30-60 minutes prior to incision.149, 150, 151, 156 Although the manufacturers state that additional doses of 30-40 mg/kg may be given every 6 hours (for up to 24 hours) after the initial dose,149, 150, 151, 156 postoperative doses are usually unnecessary.360
If cefoxitin is used for perioperative prophylaxis in children 1 year of age or older undergoing colorectal surgery or uncomplicated appendectomy, some clinicians recommend that 40 mg/kg of cefoxitin be given within 60 minutes prior to incision.374
During prolonged procedures (longer than 3-4 hours), if major blood loss occurs, or if other factors are present that shorten the half-life of the drug, additional doses should be given during the procedure.374
The duration of prophylaxis should be less than 24 hours for most procedures;360, 374 there is no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.360, 374
In patients with impaired renal function, doses and/or frequency of administration must be modified in response to the degree of impairment, severity of the infection, and susceptibility of the causative organism.149, 150, 151, 156 Dosage adjustments are not necessary in adults with creatinine clearances greater than 50 mL/minute.149, 150, 151, 156
In adults with creatinine clearances of 50 mL/minute or lower, the manufacturers recommend a loading dose of 1-2 g followed by a maintenance dosage based on the patient's creatinine clearance.149, 150, 151, 156 (See Table 1.)
Creatinine Clearance (mL/minute) | Dosage |
|---|---|
30-50 | 1-2 g every 8-12 h |
10-29 | 1-2 g every 12-24 h |
5-9 | 0.5-1 g every 12-24 h |
<5 | 0.5-1 g every 24-48 h |
In adults with renal impairment undergoing hemodialysis, a loading dose of 1-2 g should be given after each dialysis period followed by a maintenance dosage based on the patient's creatinine clearance.149, 150, 151, 156 (See Table 1.)
If cefoxitin is used in pediatric patients with renal impairment, dosage adjustments should be made similar to those recommended for adults.149, 150, 151, 156
Maculopapular or erythematous rash, exfoliative dermatitis, pruritus, urticaria, eosinophilia, fever, and other hypersensitivity reactions have occurred with cefoxitin. Anaphylaxis and angioedema have been reported rarely in patients who received cefoxitin. If a hypersensitivity reaction occurs during cefoxitin therapy, the drug should be discontinued and the patient given appropriate therapy (e.g., epinephrine, corticosteroids, maintenance of an adequate airway, oxygen) as indicated.
Local reactions are the most frequent adverse effects of cefoxitin. Pain, tenderness, and induration have been reported with IM† administration, and thrombophlebitis has occurred with IV administration. The discomfort of IM injections may be minimized by administering the drug in 0.5% or 1% lidocaine hydrochloride solution, and the use of butterfly or scalp vein type needles rather than indwelling polyethylene catheters may decrease the incidence of thrombophlebitis with IV administration.
Elevations in serum creatinine and/or BUN concentrations have been reported with cefoxitin. Rarely, renal toxicity and oliguria have occurred. These effects are most likely to occur in patients older than 50 years of age, patients with prior renal impairment, or patients who are receiving other nephrotoxic drugs. (See Drug Interactions: Nephrotoxic Drugs.)
Transient leukopenia, neutropenia, granulocytopenia, thrombocytopenia, and bone marrow depression have been reported rarely in patients receiving cefoxitin. Anemia, including hemolytic anemia, has also been reported. Although a definite causal relationship has not been established, bleeding from the GI tract, surgical wounds, or genitourinary tract, and prolonged prothrombin time (PT) and/or activated partial thromboplastin time (APTT) have been reported rarely in patients receiving cefoxitin.128 Positive direct antiglobulin (Coombs') test results have been reported during cefoxitin therapy, especially in patients with azotemia.
Rarely, adverse GI effects including nausea, vomiting, and diarrhea have been reported in patients receiving cefoxitin.
Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile .149, 150, 151, 156, 302, 303, 304 C. difficile infection (CDI) and C. difficile -associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) have been reported with nearly all anti-infectives, including cefoxitin, and may range in severity from mild diarrhea to fatal colitis.101, 102, 149, 150, 151, 156 C. difficile produces toxins A and B, which contribute to development of CDAD;149, 150, 151, 156, 302 hypertoxin producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.149, 150, 151, 156
CDAD should be considered in the differential diagnosis of patients who develop diarrhea during or after anti-infective therapy.149, 150, 151, 156, 149, 150, 151, 156, 302, 303, 304 Careful medical history is necessary since CDAD has been reported to occur as late as 2 months or longer after anti-infective therapy is discontinued.149, 150, 151, 156
If CDAD is suspected or confirmed, anti-infective therapy not directed against C. difficile should be discontinued whenever possible.149, 150, 151, 156, 302 Patients should be managed with appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.149, 150, 151, 156, 302, 303, 304
Transient increases in serum AST (SGOT), ALT (SGPT), LDH, and alkaline phosphatase concentrations and jaundice have occurred in patients receiving cefoxitin. Hypotension has also been reported.
Precautions and Contraindications
Prior to initiation of cefoxitin therapy, careful inquiry should be made concerning previous hypersensitivity reactions to cefoxitin, cephalosporins, penicillins, or other drugs.149, 150, 151, 156 There is clinical and laboratory evidence of partial cross-allergenicity among cephamycins, cephalosporins, and penicillins.149, 150, 151, 156 Cefoxitin is contraindicated in patients who are hypersensitive to the drug or to cephalosporins and should be used with caution in patients hypersensitive to penicillins.149, 150, 151, 156 Although it has not been proven that allergic reactions to antibiotics are more frequent in atopic individuals, the manufacturers state that cefoxitin should be used with caution in individuals with a history of allergy, particularly to drugs.149, 150, 151, 156
As with other anti-infective agents, prolonged use of cefoxitin may result in overgrowth of nonsusceptible organisms.149, 150, 151, 156 If superinfection occurs, appropriate therapy should be instituted.149, 150, 151, 156
Patients should be advised that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued; however, they should contact a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.149, 150, 151, 156 Cefoxitin should be used with caution in patients with a history of GI disease, particularly colitis.149, 150, 151, 156 (See Cautions: GI Effects.)
As with any potent anti-infective agent, periodic assessment of organ system functions (including renal, hepatic, and hematopoietic) is advisable during prolonged cefoxitin therapy.149, 150, 151, 156
Like other dextrose-containing solutions, the commercially available Duplex® drug delivery system containing 1 or 2 g of cefoxitin powder and 50 mL of 4 or 2.2% dextrose injection, respectively, in separate chambers should be used with caution in patients with overt or known subclinical diabetes mellitus or in patients with carbohydrate intolerance for any reason.149
To reduce development of drug-resistant bacteria and maintain effectiveness of cefoxitin and other antibacterials, the drug should be used only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.149, 150, 151, 156 When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.149, 150, 151, 156 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.149, 150, 151, 156
Patients should be advised that antibacterials (including cefoxitin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).149, 150, 151, 156 Patients also should be advised about the importance of completing the full course of therapy, even if feeling better after a few days, and that skipping doses or not completing therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefoxitin or other antibacterials in the future.149, 150, 151, 156
Safety and efficacy of cefoxitin in infants younger than 3 months of age have not been established.149, 150, 151, 156 In pediatric patients 3 months of age and older, high doses of cefoxitin have been associated with an increased incidence of eosinophilia and elevation of serum AST concentration.149, 150, 151, 156
Cefoxitin that has been reconstituted with bacteriostatic water for injection containing benzyl alcohol should not be used in infants.150, 151 Although a causal relationship has not been established, administration of injections preserved with benzyl alcohol has been associated with toxicity in neonates.150, 151 Toxicity appears to have resulted from administration of large amounts (i.e., about 100-400 mg/kg daily) of benzyl alcohol in these neonates. The manufacturers of cefoxitin state that while this toxicity has not been demonstrated in infants older than 3 months of age, small infants in this age range may also be at risk for benzyl alcohol toxicity.150, 151
In clinical studies, safety and efficacy of cefoxitin in geriatric adults 65 years of age or older have been similar to those observed in younger adults.149, 150, 151, 156 Although other clinical experience has revealed no evidence of age-related differences, the possibility that some older patients may exhibit increased sensitivity to the drug cannot be ruled out.149, 150, 151, 156
Cefoxitin is substantially eliminated in urine and the risk of toxicity may be increased in patients with impaired renal function.149, 150, 151, 156 Because geriatric patients are more likely to have decreased renal function, use caution when selecting dosage for such patients and consider monitoring renal function.149, 150, 151, 156
Mutagenicity and Carcinogenicity
Long-term studies in animals have not been performed to date to evaluate the mutagenic or carcinogenic potential of cefoxitin.149, 150, 151, 156
Pregnancy, Fertility, and Lactation
Reproduction and teratologic studies in mice and rats using parenteral cefoxitin doses 1-7.5 times the maximum recommended human dose have not revealed evidence of impaired fertility or harm to the fetus, although a slight decrease in fetal weight was observed.149, 150, 151, 156 When used in rabbits, cefoxitin was associated with a high incidence of abortion and maternal death; however, this was considered to be an expected consequence of the rabbit's unusual sensitivity to antibiotic-induced changes in intestinal flora rather than a teratogenic effect.149, 150, 151, 156 There are no adequate and controlled studies to date using cefoxitin in pregnant women.149, 150, 151, 156 Because animal reproduction studies are not always predictive of human response, cefoxitin should be used during pregnancy only when clearly needed.149, 150, 151, 156
Because cefoxitin is distributed into milk in small amounts, the drug should be used with caution in nursing women.149, 150, 151, 156
Concomitant administration of oral probenecid competitively inhibits tubular secretion resulting in higher and more prolonged serum concentrations of cefoxitin. The clinical application of this effect is limited mainly to the treatment of gonorrhea.
Concurrent use of nephrotoxic agents such as aminoglycosides, colistin, polymyxin B, or vancomycin may increase the risk of nephrotoxicity with some cephalosporins. The possibility that this may occur with concurrent use of these nephrotoxic agents and cefoxitin should be considered.
Positive direct antiglobulin (Coombs') test results have been reported in patients receiving cefoxitin. This reaction may interfere with hematologic studies or transfusion cross-matching procedures.
Cefoxitin reportedly causes false-positive results in urine glucose determinations using cupric sulfate solution (Benedict's reagent, Clinitest®). Glucose oxidase methods (Clinistix®, Tes-Tape®) are unaffected.
At concentrations greater than 100 mcg/mL, cefoxitin may cause falsely elevated serum or urine creatinine values when the Jaffe reaction is used. Serum samples should not be tested for creatinine by the Jaffe reaction if drawn within 2 hours after drug administration.
Cefoxitin is usually bactericidal in action. Like other β-lactam antibiotics, the antibacterial activity of cefoxitin results from inhibition of mucopeptide synthesis in the bacterial cell wall.
Although cefoxitin is a cephamycin antibiotic, the spectrum of activity of the drug resembles that of the second generation cephalosporins. Therefore, based on its spectrum of activity, cefoxitin can be classified as a second generation cephalosporin. For information on the classification of cephalosporins and closely related β-lactam antibiotics based on spectra of activity, see Spectrum in the Cephalosporins General Statement 8:12.06.
Cefoxitin generally is less active in vitro on a weight basis against susceptible gram-positive cocci than first generation cephalosporins and some second generation cephalosporins; however, the drug may be active against strains of gram-negative bacteria, especially Escherichia coli, Klebsiella , and Proteus , that are resistant to first generation cephalosporins. Unlike other currently available second generation cephalosporins, cefoxitin is active in vitro against some strains of Bacteroides fragilis . Cefoxitin also is active against some Mycobacterium .
In Vitro Susceptibility Testing
Inoculum size, pH, and test media do not usually influence results of cefoxitin in vitro susceptibility tests.
Strains of staphylococci resistant to penicillinase-resistant penicillins (oxacillin-resistant [methicillin-resistant] staphylococci) should be considered resistant to cefoxitin, although results of in vitro susceptibility tests may indicate that the organisms are susceptible to the drug.105
For information on interpreting results of in vitro susceptibility testing (disk susceptibility tests, dilution susceptibility tests) when cefoxitin susceptibility testing is performed according to the standards of the Clinical and Laboratory Standards Institute (CLSI; formerly National Committee for Clinical Laboratory Standards [NCCLS]), see Spectrum: In Vitro Susceptibility Testing, in the Cephalosporins General Statement 8:12.06.
Gram-positive Aerobic Bacteria
In vitro, cefoxitin concentrations of 6.25 mcg/mL or less inhibit most strains of α- and β-hemolytic streptococci, Streptococcus pneumoniae , and staphylococci. The drug is active against most strains of penicillin G-resistant Staphylococcus aureus ; however, oxacillin-resistant (methicillin-resistant) staphylococci usually also are resistant to cefoxitin. Enterococcus faecalis (formerly S. faecalis ) is resistant to cefoxitin concentrations obtainable in serum.
Gram-negative Aerobic Bacteria
Cefoxitin is generally active in vitro against the following Enterobacteriaceae: Escherichia coli , Klebsiella (including K. pneumoniae ), Morganella morganii (formerly Proteus morganii ), Proteus mirabilis , P. vulgaris , Providencia rettgeri (formerly Proteus rettgeri ), Salmonella , and Shigella . The MIC90 (minimum inhibitory concentration of the drug at which 90% of strains tested are inhibited) of cefoxitin for most of these Enterobacteriaceae is 4-16 mcg/mL.
Cefoxitin is active in vitro against most strains of Haemophilus influenzae and is also active against many strains of N. gonorrhoeae , including both penicillinase- and nonpenicillinase-producing strains. However, antibiotic-resistant strains of N. gonorrhoeae are being reported with increasing frequency,131, 132, 133, 134 and decreased susceptibility to cefoxitin131, 132, 133, 134 has been reported in strains with chromosomally mediated resistance131, 132 and in those with plasmid-mediated resistance to tetracycline (TRNG).133
Pseudomonas aeruginosa is resistant to the drug.
Cefoxitin is active in vitro against β-lactamase-negative strains of Eikenella corrodens .149, 150, 151 In vitro, cefoxitin concentrations of 0.25 mcg/mL or less inhibit most strains of Legionella pneumophila ; however, in vivo activity has not been demonstrated to date.
Cefoxitin is active in vitro against certain gram-negative anaerobic bacteria, including some strains of Bacteroides , Fusobacterium , and Prevotella , and certain gram-positive anaerobic bacteria, including some strains of Clostridium , Peptococcus , Peptostreptococcus , and Propionibacterium .140, 141
The MIC50 of cefoxitin reported for B. fragilis , B. distasonis , B. ovatus , B. thetaiotamicron , B. uniformis , and B. vulgatus is 8-32 mcg/mL; however, the MIC90 of the drug reported for these Bacteroides is 16-64 mcg/mL or greater.140, 141, 142
The MIC90 of cefoxitin reported for Prevotella bivia , P. disiens , P. oralis , and P. melaninogenica (formerly B. bivius , B. disiens , B. oralis , and B. melaninogenicus ) is 2-16 mcg/mL.140
Fusobacterium nucleatum , F. necrophorum , F. varium , Peptostreptococcus , and Propionibacterium acnes generally are inhibited in vitro by cefoxitin concentrations of 1-16 mcg/mL.140
While the MIC90 of cefoxitin reported for C. perfringens is 1 mcg/mL, C. difficile is resistant to the drug.140
Cefoxitin is active in vitro against some mycobacteria, including Mycobacterium abscessus ,157 M. fortuitum ,157 and M. mucogenicum .157 Cefoxitin has variable activity against M. smegmatis ;157 however, M. chelonae 157 and M. immunogenum 157 are resistant to the drug.
For information on possible mechanisms of bacterial resistance to β-lactam antibiotics, see Resistance in the Cephalosporins General Statement 8:12.06.
Because of the 7α-methoxy group on the β-lactam ring, cefoxitin is generally more resistant than first generation cephalosporins to staphylococcal β-lactamases and most β-lactamases produced by gram-negative aerobic and anaerobic bacteria.
Cefoxitin sodium is not appreciably absorbed from the GI tract and must be given parenterally. Following a single 1-g IM dose of cefoxitin in healthy adults with normal renal function, peak serum cefoxitin concentrations are attained within 20-30 minutes and average 22-24 mcg/mL; serum concentrations of the drug average 6.4 mcg/mL at 2 hours. After a single 1-g IV dose of cefoxitin given over 3 minutes in adults with normal renal function, serum concentrations of the drug average 110-125 mcg/mL at 5 minutes and less than 1-2 mcg/mL at 4 hours. A single 2-g IV dose given over 3 minutes results in average serum cefoxitin concentrations of 221 mcg/mL at 5 minutes and 3.6 mcg/mL at 4 hours.
In a group of children 3 months to 6 years of age, 37.5 mg/kg of cefoxitin administered IV over 5 minutes every 6 hours resulted in average serum drug concentrations of 82 mcg/mL at 15 minutes, 27 mcg/mL at 1 hour, and 1.4 mcg/mL at 4 hours after each dose.
Cefoxitin is widely distributed into body tissues and fluids including ascitic, pleural, and synovial fluid. Therapeutic concentrations of the drug may be obtained in bile if biliary obstruction is not present. The drug diffuses poorly into CSF following IM or IV administration, even when meninges are inflamed. Cefoxitin is 50-80% bound to plasma proteins.
Cefoxitin readily crosses the placenta, and fetal serum concentrations may be equal to maternal serum concentrations. Small amounts of the drug are distributed into milk.
The serum half-life of cefoxitin is 0.7-1.1 hours in adults with normal renal function. In one study in geriatric patients 64-88 years of age with renal function normal for their age, the half-life of cefoxitin was 0.9-1.5 hours and plasma concentrations of the drug were higher than in younger adults.150, 156
Serum concentrations of the drug are higher and the serum half-life is prolonged in patients with renal impairment. Serum half-life is reported to average 6.3 hours and 21.5 hours in adults with creatinine clearances of about 18 mL/minute and 2 mL/minute, respectively.
Approximately 2% or less of a dose of cefoxitin is metabolized to descarbamylcefoxitin which is microbiologically inactive. Cefoxitin is rapidly excreted in urine by both glomerular filtration and tubular secretion. The same system of anion transport is responsible for the tubular secretion of cefoxitin as for other β-lactam antibiotics and probenecid. Oral probenecid administered shortly before, or with cefoxitin usually slows the rate of excretion of cefoxitin and produces higher and more prolonged serum concentrations. In adults with normal renal function, approximately 85% of a single IM or IV dose of cefoxitin is excreted unchanged in the urine within 6 hours. Peak urinary concentrations of the drug may be 3 mg/mL or greater following a single 1-g IM dose in adults.
Cefoxitin is removed by hemodialysis, but not by peritoneal dialysis.
Cefoxitin is a semisynthetic cephamycin antibiotic derived from cephamycin C, a substance produced by Streptomyces lactamdurans . The drug is a β-lactam antibiotic structurally and pharmacologically related to cephalosporins and penicillins. Cephamycins contain a methoxy group rather than a hydrogen at the 7α-position on the β-lactam ring of the cephalosporin nucleus.
Cefoxitin is commercially available as the sodium salt which occurs as a somewhat hygroscopic, white to off-white powder or granules having a slight characteristic odor. Cefoxitin sodium is very soluble in water and slightly soluble in alcohol. Each gram of cefoxitin as the sodium salt contains approximately 53.8 mg (2.3 mEq) of sodium.149, 150, 151
Following reconstitution of the commercially available powder for injection with sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection, cefoxitin sodium solutions have a pH of 4.2-7 and are colorless to light amber.150
When the commercially available Duplex® delivery system containing 1 or 2 g of cefoxitin powder and 50 mL of 4 or 2.2% dextrose injection, respectively, in separate chambers is reconstituted (activated) according to the manufacturer's directions, the resultant solution is iso-osmotic and has an osmolality of approximately 290 mOsm/kg.149
Commercially available frozen premixed injections of cefoxitin sodium in dextrose are sterile, nonpyrogenic, iso-osmotic solutions of the drug provided in a plastic container fabricated from specially formulated multilayered plastic PL 2040 (Galaxy®).156 The 1- or 2-g frozen injections of cefoxitin contain approximately 2 or 1.1 g of dextrose, respectively, to adjust osmolality.156 The 1- or 2-g frozen injections also contain sodium bicarbonate and may contain hydrochloric acid to adjust pH to approximately 6.5.156
Cefoxitin sodium powder for injection should be stored at 2-25°C and should not exposed to temperatures exceeding 50°C.150, 151
Following reconstitution with sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection, cefoxitin sodium IV solutions containing approximately 100 mg of cefoxitin per mL are stable for 6 hours at room temperature or 1 week when refrigerated at less than 5°C.150 Reconstituted IV solutions that have been further diluted in 50 mL to 1 L of a compatible IV infusion solution are stable for an additional 18 hours at room temperature or an additional 48 hours when refrigerated.150
The commercially available Duplex® drug delivery system containing 1 or 2 g of cefoxitin powder and 50 mL of dextrose injection in separate chambers should be stored at 20-25°C, but may be exposed to 15-30°C.149 Following reconstitution (activation), these IV infusions must be used within 12 hours if stored at room temperature or within 7 days if stored in a refrigerator and should not be frozen.149
The commercially available frozen premixed cefoxitin sodium injection in dextrose should be stored at -20°C or lower.156 The frozen injections should be thawed at room temperature (25°C) or under refrigeration (5°C) and, once thawed, should not be refrozen.156 Thawed solutions of the commercially available frozen injections are stable for 24 hours at room temperature (25°C) or 21 days under refrigeration (2-8°C);156 after these periods, any unused solution should be discarded.156 The commercially available frozen premixed injections of the drug are provided in plastic containers fabricated from specially formulated multilayered plastic PL 2040 (Galaxy® containers).156 Solutions in contact with PL 2040 can leach out some of its chemical components in very small amounts within the expiration period of the injection; however, safety of the plastic has been confirmed in tests in animals according to USP biological tests for plastic containers as well as by tissue culture toxicity studies.156
Cefoxitin sodium powder for injection and solutions of the drug may darken; however, this is not an indication of change in potency.150, 151, 156 Cefoxitin sodium is most stable at pH 4-8; the free acid may precipitate at pH less than 4, and hydrolysis of the β-lactam ring may occur at pH greater than 8.
Cefoxitin sodium is potentially physically and/or chemically incompatible with some drugs, including aminoglycosides, but the compatibility depends on several factors (e.g., concentrations of the drugs, specific diluents used, resulting pH, temperature). Specialized references should be consulted for specific compatibility information. Because of the potential for incompatibility, the manufacturer states that cefoxitin sodium and aminoglycosides should not be admixed.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | For injection | 1 g (of cefoxitin)* | Cefoxitin Sodium for Injection | |
2 g (of cefoxitin)* | Cefoxitin Sodium for Injection | |||
For injection, for IV infusion | 1 g (of cefoxitin)* | Cefoxitin Sodium for Injection (available in dual-chambered Duplex® drug delivery system with 4% dextrose injection) | ||
2 g (of cefoxitin)* | Cefoxitin Sodium for Injection (available in dual-chambered Duplex® drug delivery system with 2.2% dextrose injection) | B Braun | ||
10 g (of cefoxitin) pharmacy bulk package* | Cefoxitin Sodium for Injection |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | Injection (frozen), for IV infusion | 20 mg (of cefoxitin) per mL (1 g) in 4% Dextrose* | Mefoxin® in Dextrose Injection | |
40 mg (of cefoxitin) per mL (2 g) in 2.2% Dextrose* | Mefoxin® in Dextrose Injection | Bioniche |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Only references cited for selected revisions after 1984 are available electronically.
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