cefotaxime sodium


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Related to cefotaxime sodium: ceftriaxone

cefotaxime sodium

Claforan

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

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.

cefotaxime sodium

[sēfōtak′zēm]
a third-generation cephalosporin antibiotic.
indications It is prescribed for lower respiratory tract, genitourinary, gynecological, skin, bone and joint, and central nervous system infections and for bacterial septicemia caused by strains of susceptible microorganisms.
contraindications Hypersensitivity to the cephalosporins or known hypersensitivity to this drug prohibits its use.
adverse effects The most serious adverse reactions are pruritus, colitis, fungal infections, and injection site reactions.
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