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Related to cefoxitin: ceftriaxone
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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
Pregnancy Category: B
Pharmacologic: second generation cephalosporins
ClassificationTherapeutic: anti infectives
Pharmacologic: second generation cephalosporins
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,
Binds to bacterial cell wall membrane, causing cell death.
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),
- Moraxella catarrhalis.
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.
|IM||rapid||30 min||4–8 hr|
|IV||rapid||end of infusion||4–8 hr|
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)
- pseudomembranous colitis (life-threatening)
- diarrhea (most frequent)
- rashes (most frequent)
- hemolytic anemia
- pain at IM site (most frequent)
- phlebitis at IV site (most frequent)
- allergic reactions including anaphylaxis (life-threatening)
Drug-Drug interactionProbenecid ↓ excretion and ↑ blood levels.Concurrent use of aminoglycosides may ↑ risk of nephrotoxicity.May enhance the anticoagulant effect of warfarin.
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 ImpairmentIntramuscular 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
- 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 DiagnosesRisk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- 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.
- 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:
- 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
- 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.
- 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.
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