Cefizox

Cef·i·zox (sf-zks)

A trademark for the drug ceftizoxime sodium.

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ceftizoxime sodium

Cefizox

Pharmacologic class: Third-generation cephalosporin

Therapeutic class: Anti-infective

Pregnancy risk category B

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

➣ Skin infections; bone and joint infections; urinary tract and gynecologic infections; respiratory tract infections; intra-abdominal infections; septicemia

Adults: For mild or moderate infections, 1g I.V. or I.M. q 8 to 12 hours. For uncomplicated urinary tract infections, 500 mg I.V. or I.M. q 12 hours. For severe infections, 2 g I.V. q 8 to 12 hours. For life-threatening infections, 4 g I.V. q 8 hours.

Children age 6 months and older: 50 mg/kg I.M. or I.V. q 6 to 8 hours

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:
• renal impairment, hepatic disease, biliary obstruction, 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 with sterile water, following manufacturer's guidelines for amount of diluent to use.
• For single I.V. injection, give in at least 10 ml of solution per gram; inject over 3 to 5 minutes. Use large vein, and rotate injection sites.
• For intermittent, piggyback, or continuous I.V. administration, dilute reconstituted drug in compatible solution, such as normal saline solution, dextrose 5% in water (D₅W), dextrose 10% in water, D₅W and normal saline solution, half-normal saline solution, or lactated Ringer's injection. Infuse over at least 30 minutes.
• Divide large I.M. doses equally and administer in two separate sites. Inject deep into large muscle mass.

Route	Onset	Peak	Duration
I.V.	Rapid	End of infusion	6-12 hr
I.M.	Rapid	0.5-1.5 hr	6-12 hr

Adverse reactions

CNS: headache, confusion, hemiparesis, 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 ceftizoxime

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 for extreme confusion, tonic-clonic seizures, and mild hemiparesis when giving high doses.
• Assess 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 urine 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.