Cefotaxime Dosage

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Usual Adult Dose for Bacteremia

1 to 2 g IV every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 14 days
Oral antibiotics may be substituted for the duration once the patient is able to tolerate oral medications.

Usual Adult Dose for Cesarean Section

1 g IV as soon as the umbilical cord is clamped
The second and third doses should be given as 1 g IV or IM at 6 and 12 hours after the first dose.

Cefotaxime is not recommended for routine prophylaxis. Cefazolin is considered the drug of choice.

Usual Adult Dose for CNS Infection

2 g IV every 4 to 6 hours

Usual Adult Dose for Endometritis

1 to 2 g IV or IM every 8 hours
Duration: Parenteral therapy should be continued for at least 24 hours after the patient has remained afebrile, pain free, and the leukocyte count has normalized. Doxycycline therapy for 14 days is recommended if concurrent chlamydial infection is present in late postpartum patients (breast-feeding should be discontinued).

Usual Adult Dose for Epiglottitis

2 g IV every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 7 to 10 days

Usual Adult Dose for Gonococcal Infection - Disseminated

1 g IV every 8 hours

Duration: Parenteral therapy should be continued for 24 to 48 hours after clinical improvement is demonstrated. Oral therapy with cefixime or cefpodoxime should then be continued to complete a total course of at least 1 week.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

This regimen is recommended as an alternative regimen by the Centers for Disease Control and Prevention.

Usual Adult Dose for Gonococcal Infection - Uncomplicated

Uncomplicated infections of the cervix, urethra, or rectum: 500 mg IM as a single dose
Rectal gonorrhea, males: 500 mg or 1 g IM as a single dose

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

This regimen is recommended as an alternative regimen by the Centers for Disease Control and Prevention.

Usual Adult Dose for Intraabdominal Infection

1 to 2 g IV or IM every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 7 to 14 days

Usual Adult Dose for Joint Infection

1 to 2 g IV or IM every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 1 to 4 weeks, depending on the nature and severity of the infection
Longer therapy, 6 weeks or more, may be required for prosthetic joint infections. In addition, removal of the involved prosthesis is usually required.

Usual Adult Dose for Lyme Disease - Arthritis

2 g IV every 8 hours
Duration: 14 to 28 days
An additional 4-week course of oral antibiotics or a 2 to 4 week course of ceftriaxone may be necessary if the patient continues to have joint swelling.

Usual Adult Dose for Lyme Disease - Carditis

2 g IV every 8 hours
Duration: 14 to 21 days

Usual Adult Dose for Lyme Disease - Neurologic

2 g IV every 8 hours
Duration: 14 to 28 days

Usual Adult Dose for Meningitis

2 g IV every 4 to 6 hours, depending on the nature and severity of the infection
Duration: Approximately 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Osteomyelitis

1 to 2 g IV or IM every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 4 to 6 weeks
Chronic osteomyelitis may require additional oral antibiotic therapy, possibly for up to 6 months.

Usual Adult Dose for Pelvic Inflammatory Disease

1 to 2 g IV or IM every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: Approximately 14 days, depending on the nature and severity of the infection

Alternatively, for treatment of mild pelvic inflammatory disease on an outpatient basis, a single 500 mg IM dose of cefotaxime, followed by oral doxycycline therapy with or without metronidazole, may be given.

Doxycycline therapy for 14 days (if not pregnant) is also recommended to treat possible concurrent chlamydial infection. Azithromycin is active against chlamydia and may be considered for pregnant patients.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Peritonitis

1 to 2 g IV every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 5 to 14 days

Peritoneal dialysis-associated peritonitis:
Continuous: 500 mg/2 L exchange intraperitoneally
Intermittent: 2 g/ 2 L exchange intraperitoneally once a day

Usual Adult Dose for Pneumonia

1 to 2 g IV or IM every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 7 to 21 days

Usual Adult Dose for Pyelonephritis

1 to 2 g IV or IM every 8 to 12 hours
Maximum dose: 2 g IV every 4 hours
Duration: 14 days

Usual Adult Dose for Salmonella Gastroenteritis

1 to 2 g IV or IM every 8 hours
Duration: 14 days, or longer in immunocompromised patients

Usual Adult Dose for Septicemia

2 g IV every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 14 days

Usual Adult Dose for Sepsis

2 g IV every 6 to 8 hours
Maximum dose: 2 g IV every 4 hours
Duration: 14 days

Usual Adult Dose for Skin or Soft Tissue Infection

1 to 2 g IV or IM every 8 to 12 hours
Duration: 7 to 10 days; up to 14 to 21 days treatment may be required for severe infections such as diabetic soft tissue infections

Vibrio vulnificus: 2 g IV every 8 hours plus doxycycline 100 mg IV or orally every 12 hours or ciprofloxacin 400 mg IV every 12 hours

Usual Adult Dose for Surgical Prophylaxis

1 g IM or IV 30 to 90 minutes prior to start of surgery

Cefotaxime with ampicillin is recommended for liver transplantation prophylaxis. Third generation cephalosporins are generally not recommended for routine prophylaxis in other procedures.

Usual Adult Dose for Urinary Tract Infection

1 to 2 g IV or IM every 12 hours
Duration: 3 to 7 days for uncomplicated infections and up to 2 or 3 weeks for complicated infections (e.g., catheter-related)

Parenteral therapy is generally not indicated for uncomplicated urinary tract infections, and other agents are generally recommended for complicated infections.

Usual Pediatric Dose for Lyme Disease

Early Lyme disease with neurologic involvement, Lyme arthritis with neurologic involvement, or late neuroborreliosis:
1 month or older: 150 to 200 mg/kg/day IV in 3 or 4 divided doses
Maximum dose: 6 g/day
Duration: 14 to 28 days

13 years or older: Use adult dosage.

Renal Dose Adjustments

CrCl 10 to 50 mL/min: Increase interval to every 8 to 12 hours
CrCl 9 mL/min or less: Increase interval to every 24 hours

Manufacturer recommends that the dose should be half of the normal dose in patients with CrCl 19 mL/min/1.73 m2 or less.

Liver Dose Adjustments

No adjustment recommended

Precautions

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following cephalosporin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Cephalosporins may be associated with a fall in prothrombin activity. Risk factors include renal or hepatic impairment, poor nutritional state, a protracted course of antimicrobial therapy, and chronic anticoagulation therapy. Prothrombin times should be monitored and vitamin K therapy initiated if indicated.

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Although the pharmacokinetic disposition of cefotaxime is altered in patients with cirrhosis, the alterations are generally not sufficiently great to require dosage reductions. However, several small studies have suggested that the elimination of cefotaxime is reduced significantly in patients following liver transplantation. In this setting, dosage reductions as great as 50% may be warranted, particularly in patients with rejection or nonfunctioning allografts.

Potentially life-threatening arrhythmias have been reported when cefotaxime was given as a rapid bolus injection (over less than 60 seconds) through a central venous catheter.

Dosage adjustments are recommended in patients with severe renal insufficiency. Some cephalosporins have been associated with seizures in renally impaired patients with elevated serum concentrations. The drug should be discontinued if seizures occur. Nephrotoxicity has occurred with concomitant cephalosporins and aminoglycosides or potent diuretics. Renal function should be monitored, especially in elderly patients.

Blood counts should be monitored if treatment lasts longer than 10 days. Cefotaxime has been associated with granulocytopenia and agranulocytosis.

Infusion sites should be monitored. Extensive extravasation may result in tissue damage requiring surgical treatment.

Dialysis

Hemodialysis: Cefotaxime is moderately dialyzed. Doses should be scheduled after dialysis or a supplemental 0.5 to 1 g dose should be given after each dialysis session.

CAVH/CVVH: Dose as for GFR 10 to 50 mL/min, or base on estimated drug clearance

Peritoneal dialysis: A prolonged dosing interval of every 24 hours is recommended.

Other Comments

Cefotaxime may be administered intramuscularly; however, large doses are painful and 2 gram doses are preferably given intravenously or divided and injected IM into two different sites. The IV route is preferred for severe or life-threatening infections such as sepsis/septicemia, bacteremia, meningitis, peritonitis, and for patients with reduced resistance (i.e., malnutrition, trauma, surgery, heart failure, malignancy, or shock).

The maximum dosage should not exceed 12 grams per day.

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