Cefoxitin Dosage

This dosage information may not include all the information needed to use Cefoxitin safely and effectively. See additional information for Cefoxitin.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Aspiration Pneumonia

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Intraabdominal Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Joint Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Osteomyelitis

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Peritonitis

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Pneumonia

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Bacterial Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Urinary Tract Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Skin and Structure Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Endometritis

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Pelvic Inflammatory Disease

Uncomplicated infections (bacteremia is absent or unlikely): 1 g IV every 6 to 8 hours
Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Centers for Disease Control and Prevention (CDC) recommendations:
Mild-to-moderately severe infections:
When parenteral regimen is used: 2 g IV every 6 hours plus oral or IV doxycycline
Parenteral therapy should be continued for at least 24 hours after clinical improvement is demonstrated. Oral therapy with doxycycline should then be continued to complete 14 days of treatment.

When oral regimen is used: 2 g IM as a single dose with probenecid 1 g orally as a single dose plus oral doxycycline (with or without oral metronidazole) for 14 days

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

Usual Adult Dose for Septicemia

Moderately severe or severe infections: 1 g IV every 4 hours or 2 g IV every 6 to 8 hours
Severe, life-threatening infections: 2 g IV every 4 hours or 3 g IV every 6 hours

Usual Adult Dose for Cesarean Section

1 to 2 g IV as soon as the umbilical cord is clamped and may be followed by 1 to 2 g IV 4 and 8 hours after the initial dose

Usual Adult Dose for Surgical Prophylaxis

For prophylactic use in uncontaminated gastrointestinal surgery, vaginal hysterectomy, or abdominal hysterectomy: 1 to 2 g IV 30 to 60 minutes prior to surgery followed by 1 to 2 g IV every 6 hours after the first dose for no more than 24 hours

Usual Adult Dose for Gonococcal Infection - Uncomplicated

(Not approved by FDA)

CDC recommendations:
Uncomplicated infections of the cervix, urethra, or rectum: 2 g IM as a single dose with probenecid 1 g orally as a single dose

This regimen with probenecid is recommended if ceftriaxone is not an option.

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.

Usual Pediatric Dose for Intraabdominal Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Joint Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Osteomyelitis

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Peritonitis

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Pneumonia

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Septicemia

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Bacterial Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Urinary Tract Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Skin and Structure Infection

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Endometritis

Lower respiratory tract infections (including pneumonia and lung abscess), urinary tract infections, intraabdominal infections (including peritonitis and intraabdominal abscess), gynecological infections (including endometritis, pelvic cellulitis, and pelvic inflammatory disease), septicemia, bone and joint infections, and skin and skin structure infections:
3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

Usual Pediatric Dose for Pelvic Inflammatory Disease

3 months or older: 80 to 160 mg/kg/day IV divided in 4 to 6 equal doses
Maximum dose: 12 g/day

CDC recommendations for adolescents:
Mild-to-moderately severe infections:
When parenteral regimen is used: 2 g IV every 6 hours plus oral or IV doxycycline

Parenteral therapy should be continued for at least 24 hours after clinical improvement is demonstrated. Oral therapy with doxycycline should then be continued to complete 14 days of treatment.

When oral regimen is used: 2 g IM as a single dose with probenecid 1 g orally as a single dose plus oral doxycycline (with or without oral metronidazole) for 14 days

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

Usual Pediatric Dose for Surgical Prophylaxis

For prophylactic use in uncontaminated gastrointestinal surgery, vaginal hysterectomy, or abdominal hysterectomy:
3 months or older: 30 to 40 mg/kg/dose IV 30 to 60 minutes prior to surgery followed by 30 to 40 mg/kg/dose IV every 6 hours after the first dose for no more than 24 hours
Maximum dose: 2 g/dose

Usual Pediatric Dose for Cesarean Section

1 to 2 g IV as soon as the umbilical cord is clamped and may be followed by 1 to 2 g IV 4 and 8 hours after the initial dose

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

(Not approved by FDA)

CDC recommendations:
Uncomplicated infections of the cervix, urethra, or rectum in adolescents: 2 g IM once with probenecid 1 g orally once

This regimen with probenecid is recommended if ceftriaxone is not an option.

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.

Renal Dose Adjustments

Adults:
CrCl 30 to 50 mL/min:
Loading dose: 1 to 2 g IV
Maintenance dose: 1 to 2 g IV every 8 to 12 hours

CrCl 10 to 29 mL/min:
Loading dose: 1 to 2 g IV
Maintenance dose: 1 to 2 g IV every 12 to 24 hours

CrCl 5 to 9 mL/min:
Loading dose: 1 to 2 g IV
Maintenance dose: 0.5 to 1 g IV every 12 to 24 hours

CrCl less than 5 mL/min:
Loading dose: 1 to 2 g IV
Maintenance dose: 0.5 to 1 g IV every 24 to 48 hours

Pediatric patients with renal insufficiency: The dosage and dosage frequency should be adjusted consistent with the recommendations for adults.

Liver Dose Adjustments

Data not available

Precautions

Prior to initiation of cefoxitin, it should be determined if the patient has had previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs. Caution is recommended if cefoxitin is given to penicillin-sensitive patients. If an allergic reaction to cefoxitin occurs, the drug should be discontinued. Serious hypersensitivity reactions may require epinephrine and other emergency measures.

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.

Appropriate measures should be taken if superinfection occurs.

Caution is recommended in patients with a history of gastrointestinal disorders, particularly colitis.

Some cephalosporins have been associated with seizures, particularly in renally impaired patients when the dosage was not reduced. The drug should be discontinued if seizures associated with drug therapy occur. Nephrotoxicity has occurred with concomitant cephalosporins and aminoglycosides or potent diuretics. Renal function should be monitored, especially in elderly patients.

Periodic assessment of organ system functions, including renal, hepatic, and hematopoietic, is recommended during prolonged therapy.

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 time should be monitored in patients at risk and vitamin K therapy initiated if indicated.

Benzyl alcohol preservative has been associated with toxicity in neonates. Small pediatric patients greater than 3 months of age may also be at risk for toxicity; therefore, diluents containing benzyl alcohol should not be used for pediatric patients in this age range.

Safety and effectiveness have not been established in pediatric patients less than 3 months of age.

Dialysis

Hemodialysis:
Adults:
Loading dose: 1 to 2 g IV after each hemodialysis

Maintenance dose:
CrCl 30 to 50 mL/min: 1 to 2 g IV every 8 to 12 hours
CrCl 10 to 29 mL/min: 1 to 2 g IV every 12 to 24 hours
CrCl 5 to 9 mL/min: 0.5 to 1 g IV every 12 to 24 hours
CrCl less than 5 mL/min: 0.5 to 1 g IV every 24 to 48 hours

Pediatric patients with renal insufficiency: The dosage and dosage frequency should be adjusted consistent with the recommendations for adults.

Other Comments

The duration of cefoxitin therapy depends on the type of infection. Antibiotic therapy for group A beta-hemolytic streptococcal infections should be continued for at least 10 days. In staphylococcal and other infections involving a collection of pus, surgical drainage is recommended where indicated.

If Chlamydia trachomatis is a suspected pathogen, appropriate antichlamydial coverage should be added, because cefoxitin has no activity against this organism.

To reduce the development of drug-resistant organisms, antibiotics should only be used for prophylaxis or treatment of infections that are proven or strongly suspected to be due to bacteria. Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy. Patients should be advised to avoid missing doses and to complete the entire course of therapy.

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