cefoxitin

REMS

Treatment of the following infections caused by susceptible organisms:
- Lower respiratory tract infections,
- Skin and skin structure infections,
- Bone and joint infections,
- Urinary tract infections,
- Gynecological infections,
- Intra-abdominal infections,
- Septicemia.
Perioperative prophylaxis.

Action ⬆ ⬇

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Similar to that of first-generation cephalosporins but has increased activity against several other gram-negative pathogens including: :
- Haemophilus influenzae,
- Escherichia coli,
- Klebsiella pneumoniae,
- Morganella morganii,
- Neisseria gonorrhoeae (including penicillinase-producing strains),
- Proteus,
- Providencia,
- Moraxella catarrhalis.
Also active against Bacteroides fragilis.
Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following IM administration; IV administration results in complete bioavailability.

Distribution: Widely distributed. Penetration into CSF is poor. Crosses the placenta and enters breast milk in low concentrations.

Protein Binding: 65–79%.

Metabolism/Excretion: Excreted primarily unchanged by the kidneys.

Half-Life: Adults–40–60 min (↑ in renal impairment); Infants: 1.4 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IM	rapid	30 min	4–8 hr
IV	rapid	end of infusion	4–8 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to cephalosporins;
Serious hypersensitivity to penicillins.

Use Cautiously in:

Renal impairment (dose ↓/↑ dosing interval recommended if CCr ≤50 mL/min;
History of GI disease, especially colitis;
Geri: Dose adjustment due to age-related in renal function may be necessary;
OB: Has been used safely.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rashes, urticaria

GI: diarrhea, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), nausea, vomiting

Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia, thrombocytopenia

Local: pain at IM site, phlebitis at IV site

Neuro: SEIZURES (HIGH DOSES)

Misc: ANAPHYLAXISALLERGIC REACTIONS INCLUDING , superinfection

Interactions ⬆ ⬇

Drug-drug:

Probenecid ↓excretion and ↑ blood levels.
Concurrent use of aminoglycosides may ↑ risk of nephrotoxicity.
May enhance the anticoagulant effect of warfarin.

Route/Dosage ⬆ ⬇

IM IV (Adults ): Most infections: 1 g every 6–8 hr. Severe infections: 1 g every 4 hr or 2 g every 6–8 hr. Life-threatening infections: 2 g every 4 hr or 3 g every 6 hr.Perioperative prophylaxis: 2 g 30–60 min before initial incision, then 2 g every 6 hr for up to 24 hr.
IM IV (Children and Infants >1 mo): Mild to moderate infections: 80 mg/kg/day divided every 6 hr (max = 4 g/day).Severe infections: 160 mg/kg/day divided every 6 hr (max = 12 g/day. Perioperative prophylaxis: 30–40 mg/kg within 60 min of incision, then 30–40 mg/kg every 6 hr for up to 24 hr.
IM IV (Neonates ): 90–100 mg/kg/day divided every 8 hr.

Renal Impairment

IM IV (Adults ): CCr 30–50 mL/min: Administer every 8–12 hr; CCr 10–29 mL/min: Administer every 12–24 hr; CCr <10 mL/min: Administer every 24–48 hr.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 1 g/vial; 2 g/vial; 10 g/vial

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.

Lab Test Considerations:

May cause positive results for Coombs' test, especially in patients with azotemia.
- May cause ↑ AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and serum creatinine.
- May cause falsely ↑ test results for serum and urine creatinine; do not obtain serum samples within 2 hr of administration.
- May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and eosinophilia.

Implementation ⬆ ⬇

Do not confuse cefoxitin with cefazolin, cefotetan, ceftazidime, or ceftriaxone.
IM: Reconstitute IM doses with sterile or bacteriostatic water for injection or 0.9% NaCl for injection. May be diluted with lidocaine to minimize injection discomfort.
- Inject deep into a well-developed muscle mass; massage well.

IV Administration:

IV: Change sites every 48–72 hr to prevent phlebitis. Monitor site frequently for thrombophlebitis (pain, redness, swelling).
- If aminoglycosides are administered concurrently, administer in separate sites if possible, at least 1 hr apart. If second site is unavailable, flush line between medications.
Reconstitution: Reconstitute each gram with at least 10 mL of sterile or bacteriostatic water for injection, 0.9% NaCl, or D5W. Do not use preparations containing benzyl alcohol for neonates.
Rate: Administer slowly over 3–5 min.
Intermittent Infusion: Diluent: Reconstituted solution may be further diluted in 50–100 mL of D5W, D10W, 0.9% NaCl, D5/0.45% NaCl, D5/0.25% NaCl, D5/0.9% NaCl, D5/LR, or Lactated Ringer's solution. Stable for 24 hr at room temperature and 1 wk if refrigerated. Darkening of powder does not alter potencyConcentration: 40 mg/mL.
Rate: Administer over 30–60 min.

Patient/Family Teaching ⬆ ⬇

Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇