cefotaxime
sef-oh-tax-eem
Do not confuse cefotaxime with cefOXitin, ceftizoxime, or cefuroxime.
Treatment of bacteremia/septicemia, bone and joint infections, CNS infections (e.g., meningitis), genitourinary infections, gynecologic infections, intra-abdominal infections, lower respiratory tract infections (e.g., pneumonia), skin and skin structure infections caused by susceptible strains of microorganisms including S. pneumoniae, S. pyogenes (Group A Streptococci) S. aureus (penicillinase and non-penicillinase producing), E. coli, Klebsiella species, H. influenzae, P. mirabilis, S. marcescens, Enterobacter species, indole-positive Proteus and Pseudomonas species (including P. aeruginosa). OFF-LABEL: Surgical prophylaxis, bite wound, COPD (acute exacerbation), gonococcal infection, Lyme disease, Salmonella species infection, skin/soft tissue necrotizing infections.
Contraindications: History of hypersensitivity/anaphylactic reaction to cefotaxime, cephalosporins. Cautions: History of penicillin allergy, colitis, renal impairment with CrCl less than 30 mL/min.
Binds to bacterial cell membranes, inhibits cell wall synthesis. Therapeutic Effect: Bactericidal.
Widely distributed to CSF. Protein binding: 30%–50%. Partially metabolized in liver. Primarily excreted in urine. Moderately removed by hemodialysis. Half-life: 1 hr (increased in renal impairment).
Pregnancy/Lactation: Readily crosses placenta. Distributed in breast milk. Children: No age-related precautions noted. Elderly: Age-related renal impairment may require dosage adjustment.
DRUG: Probenecid may increase concentration/effect. HERBAL: None significant. FOOD: None known. LAB VALUES: May cause positive direct/indirect Coombs' test. May increase serum BUN, creatinine, ALT, AST, alkaline phosphatase.
Injection, Powder for Reconstitution: 1 g, 2 g.
Usual Dosage Range
IV, IM: ADULTS, ELDERLY: Uncomplicated infection: 1 g q12h. Moderate to severe infection: 1–2 g q8h. Life-threatening infection: 2 g q4h. INFANTS, CHILDREN, ADOLESCENTS:
150–180 mg/kg/day in divided doses q8h. Maximum: 8 g/day. NEONATES: 50 mg/kg/dose q6–12h.
Dosage in Renal Impairment
Creatinine Clearance Dosage Interval
| 10–50 mL/min | 6–12 hrs | | Less than 10 mL/min | 24 hrs | | Hemodialysis | 1–2g q24h | | Peritoneal dialysis | 1g q24h | | CVVH | 1–2 g q8–12h | | CVVHD | 1–2g q8h | | CVVHDF | 1–2g q6–8h |
|
Dosage in Hepatic Impairment
No dose adjustment.
Frequent: Discomfort with IM administration, oral candidiasis (thrush), mild diarrhea, mild abdominal cramping, vaginal candidiasis. Occasional: Nausea, serum sickness–like reaction (fever, joint pain; usually occurs after second course of therapy and resolves after drug is discontinued). Rare: Allergic reaction (rash, pruritus, urticaria), thrombophlebitis (pain, redness, swelling at injection site).
Antibiotic-associated colitis, other superinfections (abdominal cramps, severe watery diarrhea, fever) may result from altered bacterial balance in GI tract. Nephrotoxicity may occur, esp. in pts with preexisting renal disease. Pts with history of penicillin allergy are at increased risk for developing a severe hypersensitivity reaction (severe pruritus, angioedema, bronchospasm, anaphylaxis).
Dexmedetomidine, diltiazem, magnesium sulfate, propofol.
IV