cefotaxime sodium

Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Powder for injection: 500 mg, 1 g, 2 g, 10 g

Premixed containers: 1 g/50 ml, 2 g/50 ml

Indications and dosages

➣ Perioperative prophylaxis
Adults and children weighing more than 50 kg (110 lb): 1 g I.V. or I.M. 30 to 90 minutes before surgery

➣ Prophylaxis in patients undergoing cesarean delivery
Adults: 1 g I.V. or I.M. as soon as umbilical cord is clamped

➣ Gonococcal urethritis and cervicitis
Adults weighing more than 50 kg (110 lb): 500 mg I.M. as a single dose

➣ Rectal gonorrhea (females)
Adults weighing more than 50 kg (110 lb): 500 mg I.M. as a single dose

➣ Rectal gonorrhea (males)
Adults weighing more than 50 kg (110 lb): 1 g I.M. as a single dose

➣ Disseminated gonorrhea
Adults and children weighing 50 kg (110 lb) or more: 1 g by I.V. infusion q 8 hours

➣ Uncomplicated infections caused by susceptible organisms
Adults and children weighing 50 kg (110 lb) or more: 1 g I.V. or I.M. q 12 hours
Children ages 1 month to 12 years weighing less than 50 kg (110 lb): 50 to 180 mg/kg/day I.V. or I.M. in four to six divided doses

➣ Moderate to severe infections caused by susceptible organisms
Adults and children weighing 50 kg (110 lb) or more: 1 to 2 g I.V. or I.M. q 8 hours

➣ Life-threatening infections caused by susceptible organisms
Adults and children weighing 50 kg (110 lb) or more: 2 g by I.V. infusion q 4 hours. Maximum dosage is 12 g/day.

➣ Septicemia and other infections that commonly require antibiotics in higher doses
Adults and children weighing 50 kg (110 lb) or more: 2 g by I.V. infusion q 6 to 8 hours

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:

• renal impairment, phenylketonuria

• history of GI disease

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.

• Reconstitute powder for I.V. injection with at least 10 ml of sterile water, and give over 3 to 5 minutes. For intermittent infusion, drug may be diluted further with 50 or 100 ml of normal saline solution or dextrose 5% in water (D₅W) and given over 30 minutes.

• Reconstituted drug may be diluted further for a continuous I.V. infusion of up to 1,000 ml with a compatible solution, such as normal saline solution, dextrose 5% or 10% in water, or D₅W and normal saline solution. Give over 6 to 24 hours, depending on concentration.

• Don't use diluents with pH above 7.5 (such as sodium bicarbonate).

• Rotate infusion sites.

• Inject I.M. deep into large muscle mass. Divide 2-g dose in half and inject into separate large muscle masses.

Adverse reactions

CNS: headache, lethargy, paresthesia, syncope, seizures

CV: hypotension, palpitations, chest pain, vasodilation

EENT: hearing loss

GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis

GU: vaginal candidiasis, nephrotoxicity

Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression

Hepatic: hepatic failure, hepatomegaly

Musculoskeletal: arthralgia

Respiratory: dyspnea

Skin: urticaria, maculopapular or erythematous rash

Other: chills, fever, superinfection, pain at I.M. injection site, anaphylaxis, serum sickness

Interactions

Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

Probenecid: decreased excretion and increased blood level of cefotaxime

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results Hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding

Patient monitoring

• Monitor CBC and kidney and liver function test results.

• Monitor for signs and symptoms of superinfection and other serious adverse reactions.

• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Advise patient to report reduced urinary output, persistent diarrhea, bruising, and bleeding.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.