cefoxitin sodium

ce·fox·i·tin sodium (s-fks-tn)

n.

A semisynthetic, broad-spectrum antibiotic that acts by inhibiting bacterial cell-wall synthesis; used for lower respiratory, genitourinary, intra-abdominal, gynecological, skin and joint infections, and septicemia.

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cefoxitin sodium

[sēfok′sitin]

a parenteral second-generation cephalosporin antibiotic with greater activity against anaerobes and gram-negative bacilli than first-generation cephalosporins.

indications It is prescribed for bacterial infections of the lower respiratory tract, urinary tract, skin, abdomen, bones or joints, or reproductive organs and for surgical prophlaxis.

contraindications Known hypersensitivity to cephalosporins prohibits its use. It is administered with caution to patients who are allergic to penicillin and related antibiotics or who have impaired renal function.

adverse effects Among the most serious adverse reactions are hypersensitivity reactions, phlebitis, superinfection, and pain on intramuscular injection.

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cefoxitin sodium

a second generation cephalosporin antibiotic, especially effective against gram-negative organisms, with strong resistance to degradation by β-lactamase.

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cefoxitin sodium

Mefoxin

Pharmacologic class: Second-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: 1 g, 2 g

Premixed containers: 1 g/50 ml in dextrose 5% in water (D₅W), 2 g/50 ml in D₅W

⊘Indications and dosages

➣ Respiratory tract infections, skin infections, bone and joint infections, urinary tract infections, gynecologic infections, septicemia

Adults: For most infections, 1 g I.M. or I.V. q 6 to 8 hours. For severe infections, 1 g I.M. or I.V. q 4 hours or 2 g I.M. or I.V. q 6 to 8 hours. For life-threatening infections, 2 g I.V. q 4 hours or 3 g I.V. q 6 hours.

Children ages 3 months and older: For most infections, 13.3 to 26.7 mg/kg I.M. or I.V. q 4 hours or 20 to 40 mg/kg q 6 hours.

➣ Preoperative prophylaxis

Adults: 1 to 2 g I.V. within 60 minutes of incision, then q 6 hours for up to 24 hours

Dosage adjustment

• Renal failure

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:
• renal impairment, hepatic disease, or biliary obstruction
• history of GI disease
• elderly patients
• children.

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Reconstitute 1-g dose with 10 ml of sterile water; reconstitute 2-g dose with 10 to 20 ml.
• For direct I.V. injection, give 10 ml of sterile water with each gram of cefoxitin over 3 to 5 minutes. Inject into large vein and rotate sites, or give through existing I.V. tubing.
• For intermittent or continuous I.V. infusion, add reconstituted drug to compatible solution, such as D₅W, normal saline solution, or D₅W and normal saline solution.
• For I.M. injection, reconstitute each gram with 2 ml of sterile water or 2 ml of 0.5% lidocaine hydrochloride (without epinephrine).
• Inject I.M. deep into large muscle mass; divide 2-g dose in half and inject into separate large muscle masses.
• Know that dry powder and solution may darken, but this does not alter drug efficacy.

Route	Onset	Peak	Duration
I.V.	Rapid	End of infusion	4-8 hr
I.M.	Rapid	30 min	4-8 hr

Adverse reactions

CNS: headache, lethargy, paresthesia, syncope, seizures

CV: hypotension, palpitations, chest pain, vasodilation, thrombophlebitis

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. site, anaphylaxis, serum sickness

Interactions

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

Probenecid: decreased excretion and increased blood level of cefoxitin

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

Patient monitoring

• Assess CBC and kidney and liver function test results.
• Monitor fluid intake and output. Report significant decrease in output.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Instruct 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 and tests mentioned above.