Adult Dosing
Bacterial infections caused by susceptible organisms
- Uncomplicated infections: 1 g IM/IV q12 hrs; Max: 12 g/day
- Moderate to severe infections: 1-2 g IM/IV q8 hrs; Max: 12 g/day
- Infections requiring high-dose antibiotics (septicemia): 2 g IV q6-8 hrs; Max: 12 g/day
- Life-threatening infections: 2 g IV q4 hrs; Max: 12 g/day
Uncomplicated urethral or cervical gonorrhea
- 500 mg IM as a single dose
Rectal gonorrhea
- Females: 500 mg IM as a single dose
- Males: 1 g IM as a single dose
Disseminated gonorrhea (Not FDA approved)
- 1 g IV q8 hrs x 24-48 hrs; may switch to oral cefixime/cefpodoxime to complete at least 1 wk of therapy
- Give with antibiotics for chlamydial infection X 7 days if indicated
Lyme disease (Not FDA approved)
- 2 g IV q8 hrs x 10-28 days
Perioperative prophylaxis
- 1 g IM/IV 30-90 min prior to surgery
Infection prophylaxis, post-cesarean section
- 1 g IV soon after the umbilical cord is clamped, then 1 g IM/IV at 6 and 12 hours after first dose
Notes:- May be administered IM/IV after reconstitution; premixed cefotaxime injection is intended for IV administration after thawing
Pediatric Dosing
Bacterial infections caused by susceptible organisms
Except for meningitis [Max 12 g/day]
- Neonates (0-1 wk): 100 mg/kg/day IV div q12 hrs
- Neonate (1-4 wks): 150 mg/kg IV div q8 hrs
- Infants and children (<50 kg): 50-180 mg/kg/day IM/IV div q4-6 hrs
- Infants and children (>50 kg): Use usual adult dose; Max 12 g/day
For meningitis [Max 12 g/day] [Not FDA approved]
- <12 yrs or <50 kg: 200 mg/kg/day IV div q6 hrs. However, if meningitis is known or suspected to be caused by S.pneumoniae, administer 225-300 mg/kg/day IV div q6-8 hrs (usually in combination with vancomycin IV)
Disseminated gonorrhea [Not FDA approved]
- Neonates: 50 mg/kg/day IV/IM div q12 hrs x 7 days
- Infants and children: 1 g IV q8 hrs x 7 days [Max: 3 g/day]
Lyme disease [Not FDA approved]
- 150-200 mg/kg/day IV div q6-8 hrs x 10-28 days [Max: 6 g/day]
Notes:- May be administered IM/IV after reconstitution; premixed cefotaxime injection is intended for IV administration after thawing
Orbital cellulitis [Non-FDA Approved]
- 150-200 mg/kg/day IV divided q6-8h
Pediatrics Pneumonia [Non-FDA Approved]
- 200 mg/kg/24 hrs divided q8 hrs IV; Max: 2 g q8 hrs
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <20 mL/min: Reduce dose by 50%
- Hemodialysis: Administer 0.5-2 g qd; give a supplemental dose after each dialysis period
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
See Supplemental Patient Information
- Carefully inquire regarding previous hypersensitivity reactions to cefotaxime, penicillins, cephalosporins, or other drugs prior to initiating therapy. Suspend therapy on occurrence of any allergic reactions and initiate appropriate medical therapy. Manage serious anaphylactic reactions with immediate treatment using epinephrine, oxygen, intravenous fluids and antihistamine, and airway management, including intubation, as indicated
- Administer therapy with extreme caution in penicillin sensitive patients, as cross reactivity among beta-lactam antibiotics may occur
- Clostridium difficile associated diarrhea (CDAD), which may vary in severity from mild diarrhea to fatal colitis, has been reported with cefotaxime use. Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridium. Consider this diagnosis in patients presenting with diarrhea following administration of antibiotics and initiate therapeutic measures on confirmation of diagnosis
- C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains cause increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy
- Discontinue therapy if CDAD is suspected or confirmed; in moderate to severe cases, consider management of fluids and electrolytes, protein supplementation, antibiotic treatment clinically effective against C. difficile, and institute surgical evaluation as indicated
- Careful clinical observation and appropriate laboratory studies should be made prior to and during therapy in patients with known or suspected renal impairment
- Total daily dose of cefotaxime should be reduced in patients with renal impairment because high and prolonged serum antibiotic concentrations may occur in such patients following usual doses
- Use of therapy in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication may increase the risk of the development of drug-resistant bacteria
- Prolonged use may result in overgrowth of nonsusceptible organisms; monitor continuously. Discontinue therapy on occurrence of superinfection due to bacteria or fungi and institute appropriate measures
- Monitor blood counts if courses of treatment last longer than 10 days because granulocytopenia and agranulocytosis may develop during long-term treatment with cefotaxime
- Therapy may be locally irritating to tissues. Occasionally, extensive perivascular extravasation of cefotaxime may cause tissue damage and require surgical treatment. Regularly monitor infusion sites and consider changing when appropriate in order to minimize the potential for tissue inflammation
- Increased nephrotoxicity may occur following concomitant administration of cephalosporins and aminoglycoside antibiotics
Cautions: Use cautiously in
- Renal impairment
- Hypersensitivity to penicillin
- Hx of gastrointestinal disease
- Hx of recent antibiotic-associated colitis
- Seizure disorder
- Concurrent nephrotoxic agents
- Geriatric patients
Supplemental Patient Information
- Advise patients to contact their physicians if severe watery or bloody diarrhea develops during therapy or even as late as two or more months after having taken the last dose of antibiotic
Pregnancy Category:B
Breastfeeding: Cefotaxime is acceptable to use during nursing. Limited information indicates that maternal doses of cefotaxime up to 4 g/day produce low levels in milk that are not expected to cause adverse effects in breastfed infants. This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 ) and based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 3 January 2011). Manufacturer advises caution.
