cefoxitin


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Related to cefoxitin: ceftriaxone

cefoxitin

 [sĕ-foks´ĭ-tin]
a semisynthetic second-generation cephalosporinantibiotic, especially effective against gram-negative organisms, with strong resistance to degradation by β-lactamase; administered intravenously as the sodium salt.

cefOXitin

(se-fox-i-tin) ,

Mefoxin

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: second generation cephalosporins
Pregnancy Category: B

Indications

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.
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 and Excretion: Excreted primarily unchanged by the kidneys.
Half-life: Adults–40–60 min (↑ in renal impairment); Infants—1.4 hr.

Time/action profile

ROUTEONSETPEAKDURATION
IMrapid30 min4–8 hr
IVrapidend of infusion4–8 hr

Contraindications/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; Geriatric: Dose adjustment due to age-related ↓ in renal function may be necessary; Obstetric / Lactation: Has been used safely.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (high doses) (life-threatening)

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • nausea
  • vomiting

Dermatologic

  • rashes (most frequent)
  • urticaria

Hematologic

  • bleeding
  • eosinophilia
  • hemolytic anemia
  • leukopenia
  • thrombocytopenia

Local

  • pain at IM site (most frequent)
  • phlebitis at IV site (most frequent)

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

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

Route/Dosage

Intramuscular Intravenous (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.
Intramuscular Intravenous (Children and Infants >1 mo) Mild to moderate infections—180–100 mg/kg/day divided every 6 hr.Severe infections—100–160 mg/kg/day divided every 4–6 hrs (maximum: 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.
Intramuscular Intravenous (Neonates) 90–100 mg/kg/day divided every 8 hr.

Renal Impairment

Intramuscular Intravenous (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
Premixed containers: 1 g/50 mL D5W, 2 g/50 mL D5W

Nursing implications

Nursing 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 pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: May cause positive results for Coombs' test, especially in patients with azotemia.
    • May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and 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.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Do not confuse cefoxitin with cefazolin, cefotetan, ceftazidime, or ceftriaxone.
  • Intramuscular: 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.
  • Intravenous Administration
  • pH: 4.2–8.0.
  • Intravenous: 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.
  • 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.
  • Concentration: 200 mg/mL
  • 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.
  • Syringe Compatibility:
    • heparin.
  • Y-Site Compatibility: acyclovir, alfentanil, amifostine, aminocaproic acid, aminophylline, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, cefazolin, cefoperazone, cefotaxime, cefotetan, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, docetaxel, dopamine, doxacurium, doxorubicin liposome, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, esmolol, etoposide, etoposide phosphate, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, granisetron, heparin, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, indomethacin, irinotecan, isoproterenol, ketorolac, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pantoprazole, penicillin G, perphenazine, phenylephrine, phytonadione, potassium acetate, potassium chloride, procainamide, propofol, propranolol, pyridoxime, ranitidine, remifentanil, rituximab, rocuronium, sodium acetate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolazoline, trimetaphan, vasopressin, vecuronium, verapamil, vincristine, voriconazole, zoledronic acid
  • Y-Site Incompatibility: alemtuzumab, ampicillin/sulbactam, azathioprine, caspofungin, chlorpromazine, dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, doxorubiucin hydrochloride, doxycycline, epirubicin, erythromycin, fenoldopam, fligrastim, ganciclovir, haloperidol, hydralazine, hydroxyzine, idarubicin, insulin, labetalol, levofloxacin, methylprednisolone, mitoxantrone, mycophenolate, papaverine, pemetrexed, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenytoin, prochlorperazine, promethazine, protamine, quinupristin/dalfopristin, sodium bicarbonate, trastuzumab, trimethoprim/sulfamethoxazole, vinorelbine

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.

Evaluation/Desired Outcomes

  • Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
  • Decreased incidence of infection when used for prophylaxis.

cefoxitin

/ce·fox·i·tin/ (sĕ-fok´sĭ-tin) a strongly &#x03B2;–resistant cephamycin antibiotic, classified as a second-generation cephalosporin and especially effective against gram-negative organisms; used as the sodium salt.
References in periodicals archive ?
Drugs with the best in vitro activity include clarithromycin, amikacin, cefoxitin, and possibly tigecycline.
103 28 4 16 ID AMP mecA PCG1 PCG MIC MIC SCL034 1 Neg 12 1 SCL041 1 Neg 12 1 SCL048 1 Neg 12 1 FOX30 = cefoxitin 30 [micro]g; FOXMIC = cefoxitin Etest; AMP2 = ampicillin 2 [micro]g; AMP MIC = ampicillin Etest; mecA = mecA status according to PCR; PCG1 = benzylpenicillin 1 unit; PCG MIC = benzylpenicillin Etest.
Antimicrobial resistance was assessed by disk diffusion and cutoffs defined by CLSI (2008) guidelines; resistance to cefoxitin was classified as either susceptible or resistant, based on CLSI (2008) guidelines.
MRSA strains are able to grow in the presence of the cefoxitin and produce mauve-colored colonies.
Blunting of zone of inhibition between cefotaxime and/ or ceftazidime and cefoxitin or reduced susceptibility to ceftazidime or cefotaxime and cefoxitin suggest production of AmpC [beta]-lactamase.
88 AMI: amikacin (30 [micro]g); AMP: ampicillin (10 [micro]g); CAR: carbenicillin (100 [micro]g); CPZ: cefoperazone (75 [micro]g); CTX: cefotaxime (30 [micro]g); CFO: cefoxitin (30 [micro]g); CLO: chloramphenicol (30 [micro]g); SUT: trimethoprim-sulfamethoxazole (25 [micro]g); GEN: gentamicin (10 [micro]g); NEO: neomycin (30 [micro]g); NET: netilmicin (30 [micro]g); POL: polymyxin B (300 [micro]g); TET: tetracycline (30 [micro]g); TOB: tobramycin (10 [micro]g).
All patients received prophylactic antibiotics (2 g intravenous cefoxitin preoperatively, followed by 1 g IV 12-hourly x 2).
Prophylactic antibiotics for various surgical procedures Type of surgery Consensus position Abdominal or vaginal Cefazolin or cefoxitin.
Prolonged treatment with antibiotics active against anaerobic organisms, such as clindamycin, metronidazole and cefoxitin is necessary.