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Mefoxin

Generic Name: Cefoxitin Sodium
Class: Cephamycins
CAS Number: 33564-30-6

Introduction

Antibacterial; β-lactam antibiotic; cephamycin.c

Uses for Mefoxin

Bone and Joint Infections

Treatment of bone and joint infections caused by susceptible S. aureus (including penicillinase-producing strains).149 150 151 156

Gynecologic Infections

Treatment of gynecologic infections (including endometritis, pelvic cellulitis, pelvic inflammatory disease [PID]) caused by susceptible S. agalactiae (group B streptococci), E. coli, Neisseria gonorrhoeae, Bacteroides (including B. fragilis), Clostridium, Peptococcus niger, or Peptostreptococcus.149 150 151 156

Cefoxitin (or cefotetan) in conjunction with doxycycline considered a regimen of choice by CDC and others when a parenteral regimen is indicated for treatment of PID.100 114 155

When an oral regimen is used for treatment of mild to moderately severe acute PID, CDC recommends a single IM dose of ceftriaxone, cefoxitin (with oral probenecid), or other parenteral third-generation cephalosporin (e.g., cefotaxime) given in conjunction with a 14-day regimen of oral doxycycline.100 155

Because cefoxitin (like cephalosporins) is not active against Chlamydia, concomitant use of a drug active against Chlamydia (e.g., doxycycline) is necessary when these organisms are suspected pathogens.100 114

Intra-abdominal Infections

Treatment of intra-abdominal infections (including peritonitis and intra-abdominal abscess) caused by susceptible E. coli, Klebsiella, Bacteroides (including B. fragilis), or Clostridium.149 150 151 156

Has been effective in mixed aerobic-anaerobic infections.c However, cefoxitin may no longer provide reliable coverage against B. fragilis, and metronidazole is recommended by many clinicians to provide coverage against B. fragilis in combination anti-infective regimens used for empiric treatment of intra-abdominal infections.123

Slideshow: The Shocking Truth About Antibiotic Resistance

Respiratory Tract Infections

Treatment of lower respiratory tract infections (including pneumonia and lung abscess) caused by susceptible Staphylococcus aureus (including penicillinase-producing strains), Streptococcus pneumoniae, or other streptococci (except enterococci), Haemophilus influenzae, Escherichia coli, Klebsiella, or Bacteroides.149 150 151 156

Septicemia

Treatment of septicemia caused by susceptible S. aureus (including penicillinase-producing strains), S. pneumoniae, E. coli, Klebsiella, or Bacteroides (including B. fragilis).149 150 151 156

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible S. aureus (including penicillinase-producing strains), S. epidermidis, S. pyogenes (group A β-hemolytic streptococci), or other streptococci (except enterococci), E. coli, Klebsiella, P. mirabilis, Bacteroides (including B. fragilis), Clostridium, P. niger, or Peptostreptococcus.149 150 151 156

Urinary Tract Infections (UTIs)

Treatment of UTIs caused by susceptible E. coli, Klebsiella, Morganella morganii, P. mirabilis, P. vulgaris, or Providencia (including P. rettgeri).149 150 151 156

Gonorrhea and Associated Infections

Treatment of uncomplicated cervical, urethral, or rectal gonorrhea caused by susceptible Neisseria gonorrhoeae in adults or adolescents.100 155 Drug of choice is IM ceftriaxone or oral cefixime.100 155 CDC considers IM cefoxitin an alternative;100 155 does not appear to offer any advantage over IM ceftriaxone.100

Mycobacterial Infections

Treatment of infections caused by Mycobacterium abscessus157 or M. fortuitum;157 used in conjunction with other antimycobacterial anti-infectives.157

For serious skin, soft tissue, and bone infections caused by M. abscessus, ATS and IDSA recommend a multiple-drug regimen of oral clarithromycin (or azithromycin) used in conjunction with parenteral anti-infectives (e.g., amikacin, cefoxitin, imipenem).157 This multiple-drug regimen also used in treatment of M. abscessus lung disease;157 however, anti-infectives may help control symptoms and disease progression, but long-term sputum conversion is unlikely.157 In patients with focal infections and limited lung disease, curative therapy may be possible if surgical resection is used in conjunction with a multiple-drug treatment regimen.157

Although optimum regimens not identified for treatment of M. fortuitum infections, ATS and IDSA recommend that pulmonary infections be treated with a regimen consisting of at least 2 anti-infectives selected based on results of in vitro susceptibility testing and tolerability (e.g., amikacin, clarithromycin, cefoxitin, ciprofloxacin or ofloxacin, a sulfonamide, imipenem, doxycycline).157 In serious skin, bone, and soft tissue infections, ≥4 months of treatment with ≥2 anti-infectives active against the clinical isolate is necessary to provide a high likelihood of cure;157 6 months of treatment recommended for bone infections.157 Surgery usually indicated for extensive disease, abscess formation, or when drug therapy is difficult.157

Perioperative Prophylaxis

Perioperative prophylaxis in women undergoing gynecologic and obstetric surgery (e.g., vaginal, abdominal, or laparoscopic hysterectomy, cesarean section).106 115 136 148 149 150 151 156 A preferred agent for vaginal, abdominal, or laparoscopic hysterectomy.106 Cefazolin generally preferred for perioperative prophylaxis in cesarean section;106 doxycycline recommended for perioperative prophylaxis in abortion.106

Perioperative prophylaxis in patients undergoing GI surgery (e.g., colorectal surgery, nonperforated appendectomy).106 115 127 148 149 150 151 156 A preferred agent for colorectal surgery and nonperforated appendectomy.106 115 127 148

Mefoxin Dosage and Administration

Administration

Administer by IV injection or infusion.149 150 151 156 Also has been given by IM injection.100

IV route preferred in patients with bacteremia, septicemia, or other severe or life-threatening infections, or in patients with lowered resistance resulting from debilitating conditions (e.g., malnutrition, trauma, surgery, diabetes, heart failure, malignancy), particularly with shock.149 150 151 156

For solution and drug compatibility information, see Compatibility under Stability.

IV Injection

Reconstitution

Reconstitute vials containing 1 or 2 g of cefoxitin with 10 mL or 10 or 20 mL, respectively, of sterile water for injection to provide solutions containing approximately 95 or 180 or 95 mg/mL, respectively.150

Rate of Administration

Inject appropriate dose of reconstituted solution directly into a vein over a 3- to 5-minute period or slowly into the tubing of a compatible IV solution.150

IV Infusion

Other IV solutions flowing through a common administration tubing or site should be discontinued while cefoxitin is infused.149 151 156

Reconstitution

Reconstitute vials containing 1 or 2 g of cefoxitin with 10 mL or 10–20 mL, respectively, of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection to provide solutions containing approximately 95 or 95–180 mg/mL, respectively.149 150 Further dilute the reconstituted solutions in 50 mL to 1 L of a compatible IV solution.150

Reconstitute 10-g pharmacy bulk package with 43 or 93 mL of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection and then further dilute in 50 mL to 1 L of a compatible IV solution.151

Reconstitute (activate) commercially available Duplex drug delivery system containing 1 or 2 g of lyophilized cefoxitin and 50 mL of dextrose injection in separate chambers according to the manufacturer’s directions.149

Thaw the commercially available premixed injection (frozen) at room temperature (25°C) or under refrigeration (5°C); do not thaw by immersion in a water bath or by exposure to microwave radiation.156 A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature.156 Discard thawed injection if an insoluble precipitate is present or if container seals or outlet ports are not intact or leaks are found.156 Do not use in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.156

Rate of Administration

Administer by intermittent or continuous IV infusion.149 151 156

IM Injection

Administer IM injections deeply into a large muscle, such as the upper outer quadrant of the gluteus maximus.c Use aspiration to ensure needle is not in a blood vessel.c

Reconstitution

IM injections are prepared by adding 2 mL of sterile water for injection or 0.5 or 1% lidocaine hydrochloride injection (without epinephrine) to each g of cefoxitin to provide solutions containing approximately 400 mg/mL.c

Dosage

Available as cefoxitin sodium; dosage expressed in terms of cefoxitin.149 150 151 156

Pediatric Patients

General Pediatric Dosage
IV

Children ≥3 months of age: 80–160 mg/kg daily given in 4–6 equally divided doses.149 150 151 156

AAP recommends 80–100 mg/kg daily given in 3–4 equally divided doses for mild to moderate infections or 80–160 mg/kg daily given in 4–6 equally divided doses for severe infections in children >1 month of age.147

Perioperative Prophylaxis
IV

Children ≥3 months of age: Manufacturers recommend 30–40 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision), followed by 30–40 mg/kg every 6 hours for up to 24 hours.149 150 151 156

Some clinicians recommend 20–40 mg/kg of cefoxitin given prior to induction of anesthesia.115 148

Some clinicians recommend additional doses during the procedure (e.g., every 2–3 hours) if surgery is prolonged >4 hours or major blood loss occurs.106 115 121 148 Postoperative doses usually unnecessary and may increase risk of bacterial resistance.106 115 121 148

Adults

General Adult Dosage
Uncomplicated Infections (Bacteremia Absent or Unlikely)
IV

1 g every 6–8 hours.149 150 151 156

Moderately Severe or Severe Infections
IV

1 g every 4 hours or 2 g every 6–8 hours.149 150 151 156

Infections Requiring Higher Dosage (e.g., Gangrene)
IV

2 g every 4 hours or 3 g every 6 hours.149 150 151 156

Gonorrhea and Associated Infections
Uncomplicated Urethral, Cervical, or Rectal Gonorrhea
IM

2 g as a single dose given with oral probenecid (1 g).100 155

Pelvic Inflammatory Disease
IV

2 g every 6 hours;100 114 155 used in conjunction with IV or oral doxycycline (100 mg every 12 hours).100 114 155 Cefoxitin may be discontinued 24 hours after clinical improvement occurs and oral doxycycline (100 mg every 12 hours) continued to complete 14 days of treatment.100

IM

2 g as a single dose given with oral probenecid (1 g);100 114 155 followed by a 14-day regimen of oral doxycycline (100 mg twice daily) with or without oral metronidazole (500 mg twice daily).100 114 155

Mycobacterium abscessus Infections
IV

If used in initial combination regimens for treatment of serious skin, soft tissue, and bone infections (see Mycobacterial Infections under Uses), ATS and IDSA recommend up to 12 g daily given in divided doses for at least 2 weeks until clinical improvement.157 At least 4 months of antimycobacterial treatment is necessary for treatment of serious skin and soft tissue infections; 6 months of antimycobacterial treatment recommended for bone infections.157

Perioperative Prophylaxis
Gynecologic and Obstetric Surgery
IV

Hysterectomy (abdominal, vaginal, laparoscopic): Single 1- or 2-g dose given within 30–60 minutes prior to surgery.106 149 150 151 156 Although manufacturers also recommend additional 2-g doses every 6 hours (for up to 24 hours), 149 150 151 156 postoperative doses usually unnecessary and may increase risk of bacterial resistance.106

Cesarean section: Single 1- or 2-g dose given within 30–60 minutes prior to surgery.106 149 150 151 156 Manufacturers recommend giving the dose as soon as the umbilical cord is clamped,149 150 151 156 but there is some evidence that giving the dose prior to skin incision is more effective than after clamping.106 Although manufacturers state additional 2-g doses can be given at 4 and 8 hours after the initial dose,149 150 151 156 postoperative doses usually unnecessary and may increase risk of bacterial resistance.106

Some clinicians recommend additional doses during the procedure (e.g., every 2–3 hours) if surgery is prolonged >4 hours or major blood loss occurs.106 115 121 148

Colorectal Surgery, Appendectomy (Nonperforated), or Other GI Surgery
IV

Single 1- or 2-g dose given within 0.5–1 hour prior to incision.106 115

Some clinicians recommend additional doses during the procedure (e.g., every 2–3 hours) if surgery is prolonged >4 hours or major blood loss occurs.106 115 121 148

Although manufacturers state 2 g can be given every 6 hours after the procedure for up to 24 hours,149 150 151 postoperative doses usually unnecessary and may increase risk of bacterial resistance.106 121 148

Prescribing Limits

Pediatric Patients

Maximum 12 g daily.149 150 151 156

Adults

Maximum 12 g daily.149 150 151 156

Special Populations

Renal Impairment

Dosage adjustments necessary in those with Clcr ≤50 mL/minute.149 150 151 156

Adults with Clcr ≤50 mL/minute: Give an initial loading dose of 1–2 g followed by maintenance dosage based on Clcr (see Table 1).149 150 151 156

Table 1. Maintenance Dosage for Adults with Renal Impairment149150151156

Clcr (mL/min)

Dosage

30–50

1–2 g every 8–12 h

10–29

1–2 g every 12–24 h

5–9

0.5–1 g every 12–24 h

<5

0.5–1 g every 24–48 h

Adults undergoing hemodialysis: Give a loading dose of 1–2 g after each dialysis period followed by maintenance dosage based on Clcr (see Table 1).149 150 151 156

Pediatric patients with renal impairment: Make dosage adjustments similar to those recommended for adults.149 150 151 156

Geriatric Patients

Cautious dosage selection because of age-related decreases in renal function.149 150 151 156 (See Renal Impairment under Dosage and Administration.)

Cautions for Mefoxin

Contraindications

  • Known hypersensitivity to cefoxitin or cephalosporins.149 150 151 156

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Diarrhea and Colitis (CDAD)

Possible emergence and overgrowth of nonsusceptible organisms with prolonged therapy.149 150 151 156 Careful observation of the patient is essential.149 150 151 156 Institute appropriate therapy if superinfection occurs.149 150 151 156

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.149 150 151 156 C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) has been reported with nearly all anti-infectives, including cefoxitin, and may range in severity from mild diarrhea to fatal colitis.149 150 151 156

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.149 150 151 156 Careful medical history is necessary since CDAD has been reported to occur as late as 2 months or longer after anti-infective therapy is discontinued.149 151 156

If CDAD is suspected or confirmed, anti-infective therapy not directed against C. difficile may need to be discontinued.149 150 151 151 156 Some mild cases may respond to discontinuance alone.116 117 118 119 120 149 150 151 Manage moderate to severe cases with fluid, electrolyte, and protein supplementation, anti-infective therapy active against C. difficile (e.g., oral metronidazole or vancomycin), and surgical evaluation when clinically indicated.116 117 118 119 120 149 150 151 151 156

Sensitivity Reactions

Hypersensitivity Reactions

Possible hypersensitivity reactions, including rash (maculopapular or erythematous), pruritus, fever, eosinophilia, urticaria, anaphylaxis, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis.149 150 151 a 156

If an allergic reaction occurs, discontinue cefoxitin and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an adequate airway and oxygen).149 150 151 156

Cross-hypersensitivity

Partial cross-allergenicity among β-lactam antibiotics, including penicillins, cephalosporins, and cephamycins.149 150 151 156

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cefoxitin, cephalosporins, penicillins, or other drugs.149 150 151 156 Cautious use recommended in individuals hypersensitive to penicillins.149 150 151 156 a Avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.a

General Precautions

History of GI Disease

Use with caution in patients with a history of GI disease, particularly colitis.149 150 151 156 (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis [CDAD] under Cautions.)

Laboratory Monitoring

Periodically assess organ system functions, including renal, hepatic, and hematopoietic, during prolonged therapy.149 150 151 156

Patients with Diabetes

The commercially available Duplex delivery system containing 1 or 2 g of lyophilized cefoxitin and 50 mL of dextrose 2.2 or 4% injection should be used with caution in patients with overt or known subclinical diabetes mellitus or in patients with carbohydrate intolerance for any reason.149

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of cefoxitin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.149 150 151 156

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.149 150 151 156 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.149 150 151 156

Sodium Content

Contains approximately 53.8 mg (2.3 mEq) of sodium per g of cefoxitin.149 150 151 156

Specific Populations

Pregnancy

Category B.149 150 151 156

Lactation

Distributed into milk in low concentrations; use with caution.149 150 151 156

Pediatric Use

Safety and efficacy in infants <3 months of age have not been established.149 150 151 156

Use of high doses in children ≥3 months of age have been associated with an increased incidence of eosinophilia and elevated serum AST concentration.149 150 151 156

Cefoxitin reconstituted with bacteriostatic water for injection containing benzyl alcohol should not be used in infants.150 151 Benzyl alcohol as a preservative has been associated with toxicity in neonates; although these effects have not been demonstrated in infants >3 months of age, small infants in this age range may also be at risk for benzyl alcohol toxicity.150 151

Geriatric Use

No overall differences in safety and efficacy in those ≥65 years of age compared with younger adults, but the possibility of increased sensitivity in some geriatric individuals cannot be ruled out.149 150 156

Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function.149 150 156 Select dosage with caution and consider monitoring renal function because of age-related decreases in renal function.149 150 156 (See Renal Impairment under Dosage and Administration.)

Renal Impairment

High and prolonged serum concentrations may occur.149 150 151 156

Reduce dosage in those with Clcr ≤50 mL/minute.149 150 151 156 See Renal Impairment under Dosage and Administration.

Common Adverse Effects

Local reactions at the IV administration site (including thrombophlebitis), hypersensitivity reactions, diarrhea.149 150 151 156

Interactions for Mefoxin

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Aminoglycosides

Possible increased risk of nephrotoxicity149 150 151

Physical incompatibility if solutions directly mixed together149 150 151

Closely monitor renal function if used concomitantly149 150 151

Administer separately; do not admix149 150 151

Probenecid

Decreased renal excretion and higher and more prolonged serum concentrations of cefoxitin149 150 151

Tests for creatinine

High concentrations (>100 mcg/mL) may cause falsely elevated serum or urine creatinine values when the Jaffe reaction is used149 150 151

Avoid using blood samples for creatinine determinations if they were drawn from the patient within 2 hours after a cefoxitin dose149 150 151

Tests for glucose

Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution149 150 151 a

Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)149 150 151

Mefoxin Pharmacokinetics

Absorption

Bioavailability

Not appreciably absorbed from the GI tract; must be administered parenterally.c

Following IM administration in healthy adults, peak serum concentrations attained within 20–30 minutes.c

Distribution

Extent

Widely distributed into body tissues and fluids, including ascitic, pleural, and synovial fluid.c

Therapeutic concentrations may be obtained in bile if biliary obstruction is not present.c

Diffuses poorly into CSF following IM or IV administration, even when meninges are inflamed.c

Readily crosses the placentac and is distributed into milk in low concentrations.c

Plasma Protein Binding

50–80%.c

Elimination

Metabolism

≤2% of a dose is metabolized to descarbamylcefoxitin, which is microbiologically inactive.c

Elimination Route

Rapidly eliminated in urine by glomerular filtration and renal tubular excretion.c About 85% of a dose excreted unchanged in urine within 6 hoursc

Half-life

Adults with normal renal function: 0.7–1.1 hours.c

Special Populations

Patients with renal impairment: Serum concentrations higher and serum half-life prolonged.c Serum half-life averages 6.3 hours or 21.5 hours in adults with Clcr about 18 mL/min or 2 mL/min, respectively.c

Geriatric adults 64–88 years of age with renal function normal for their age: 0.9–1.5 hours.149 150 151 156

Stability

Storage

Parenteral

Powder for Injection or IV Infusion

2–25° C;150 151 avoid exposure to temperatures >50° C.150 151

Powder and reconstituted solutions may darken; does not indicate loss of potency.150 151 156

Reconstituted solutions for IV administration prepared using sterile or bacteriostatic water, 0.9% sodium chloride, or 5% dextrose are stable for 6 hours at room temperature or 1 week when refrigerated at <5°C.150 151

Piggyback units containing 1 or 2 g of cefoxitin prepared using 5 or 10% dextrose or 0.9% sodium chloride are stable for 24 hours at room temperature or 1 week when refrigerated at <5°C.c

Store commercially available Duplex drug delivery system containing 1 or 2 g of lyophilized cefoxitin and 50 mL of dextrose injection at 20–25°C (may be exposed to 15–30°C).149 Following reconstitution (activation), use these IV infusions within 12 hours if stored at room temperature or within 7 days if stored in a refrigerator; do not freeze.149

Injection (Frozen) for IV Infusion

-20°C or lower.156 After thawing, stable for 24 hours at room temperature (25°C) or 21 days under refrigeration (2–8°C).156

Do not refreeze after thawing.156

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in Ringer’s injection, lactated

Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9%

Dextrose 5 or 10% in water

Invert sugar 10% in sodium chloride 0.9%

Invert sugar 5 or 10% in water

Ionosol B with dextrose 5% in water

Mannitol 5 or 10% in water

Normosol M in dextrose 5% in water

Ringer’s injection

Ringer’s injection, lactated

Sodium bicarbonate 5%

Sodium chloride 0.9%

Sodium lactate (1/6) M

Drug Compatibility
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Cimetidine HCl

Clindamycin phosphate

Gentamicin sulfate

Kanamycin sulfate

Metronidazole HCl with sodium bicarbonate

Multivitamins

Sodium bicarbonate (Neut)

Tobramycin sulfate

Verapamil HCl

Vitamin B complex with C

Incompatible

Ranitidine HCl

Variable

Aztreonam

Metronidazole

Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Amifostine

Amphotericin B cholesteryl sulfate complex

Aztreonam

Bivalirudin

Cyclophosphamide

Dexmedetomidine HCl

Diltiazem HCl

Docetaxel

Doxorubicin HCl liposome injection

Etoposide phosphate

Famotidine

Fluconazole

Foscarnet sodium

Gemcitabine HCl

Granisetron HCl

Hetastarch in lactated electrolyte injection (Hextend)

Hydromorphone HCl

Linezolid

Magnesium sulfate

Meperidine HCl

Morphine sulfate

Ondansetron HCl

Perphenazine

Propofol

Ranitidine HCl

Remifentanil HCl

Teniposide

Thiotepa

Incompatible

Fenoldopam mesylate

Filgrastim

Gatifloxacin

Hetastarch in sodium chloride 0.9%

Pentamidine isethionate

Variable

Vancomycin HCl

Actions and Spectrum

  • Cephamycin;149 150 151 a sometimes classified with second generation cephalosporin based on spectrum of activity.a

  • Usually bactericidal.149 150 151 a

  • Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.149 150 151 a

  • Spectrum of activity includes some gram-positive and -negative aerobic bacteria and some anaerobic bacteria; inactive against Chlamydia, fungi, and viruses.a

  • Gram-positive aerobes: Active in vitro and in clinical infections against S. aureus (including penicillinase-producing strains), S. epidermidis, S. pneumoniae, S. pyogenes (group A β-hemolytic streptococci), and S. agalactiae (group B streptococci).149 150 151 Oxacillin-resistant staphylococci (methicillin-resistant staphylococci) and most enterococci (e.g., Enterococcus faecalis) are resistant.149 150 151

  • Gram-negative aerobes: Active in vitro and in clinical infections against E. coli, H. influenzae, Klebsiella (including K. pneumoniae), M. morganii, N. gonorrhoeae, P. mirabilis, P. vulgaris, and Providencia (including P. rettgeri).149 150 151 Also active in vitro against Eikenella corrodens (non-β-lactamase-producing strains),149 150 151 K. oxytoca,149 150 151 Salmonella,c and Shigella.c Many strains of Enterobacter cloacae and most strains of Pseudomonas aeruginosa are resistant.149 150 151

  • Anaerobes: Active in vitro and in clinical infections against Bacteroides distasonis, B. fragilis, B. ovatus, B. thetaiotaomicron, Clostridium (including C. perfringens but not C. difficile), Peptococcus niger, and Peptostreptococcus.149 150 151 c Also active in vitro against Fusobacterium, Prevotella bivia,149 150 151 Propionibacterium.c

  • Active in vitro against some mycobacteria, including Mycobacterium abscessus,157 M. fortuitum,157 and M. mucogenicum.157 Has variable activity against M. smegmatis;157 however, M. chelonae157 and M. immunogenum157 are resistant.

Advice to Patients

  • Advise patients that antibacterials (including cefoxitin) should only be used to treat bacterial infections; they do not treat viral infections (e.g., the common cold).149 150 151

  • Importance of completing full course of therapy, even if feeling better after a few days.149 150 151

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefoxitin or other antibacterials in the future.149 150 151

  • Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.156 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.156

  • Importance of informing clinicians if an allergic reaction occurs.149 150 151

  • Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.149 150 151

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs.149 150 151

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cefoxitin Sodium

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection

1 g (of cefoxitin)*

Cefoxitin Sodium for Injection

2 g (of cefoxitin)*

Cefoxitin Sodium for Injection

10 g (of cefoxitin) pharmacy bulk package*

Cefoxitin Sodium for Injection

For injection, for IV infusion

1 g (of cefoxitin)

Cefoxitin for Injection and Dextrose Injection (available in dual-chambered Duplex drug delivery system)

Braun

2 g (of cefoxitin)

Cefoxitin for Injection and Dextrose Injection (available in dual-chambered Duplex drug delivery system)

Braun

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cefoxitin Sodium in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection (frozen), for IV infusion

20 mg (of cefoxitin) per mL (1 g) in 4% Dextrose*

Mefoxin in Dextrose Injection

Bioniche

40 mg (of cefoxitin) per mL (2 g) in 2.2% Dextrose*

Mefoxin in Dextrose Injection

Bioniche

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions January 1, 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006; 55(RR-11):1-96.

101. Arsura EL, Fazio RA, Wickremesinghe PC. Pseudomembranous colitis following prophylactic antibiotic use in primary cesarean section. Am J Obstet Gynecol. 1985; 151:87-9. [IDIS 195132] [PubMed 3966512]

102. Block BS, Mercer LJ, Ismail MA et al. Clostridium difficile-associated diarrhea follows perioperative prophylaxis with cefoxitin. Am J Obstet Gynecol. 1985; 153:835-8. [IDIS 211025] [PubMed 4073152]

103. Austin SM, Barooah B, Kim CS. Reversible acute cardiac injury during cefoxitin-induced anaphylaxis in a patient with normal coronary arteries. Am J Med. 1984; 77:729-32. [IDIS 191619] [PubMed 6486149]

105. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing; twelfth informational supplement. NCCLS document M100-S12. Wayne, PA: NCCLS; 2002 Jan.

106. Anon. Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett. 2009; 7:47-52. [PubMed 19461558]

107. DiPiro JT, Bowden TA Jr, Hooks VH III. The prophylactic use of cephalosporins for surgery. JAMA. 1985; 253:3399-400. [PubMed 3999322]

108. Burnakis TG. Surgical antimicrobial prophylaxis: principles and guidelines. Pharmacotherapy. 1984; 4:248-71. [IDIS 393587] [PubMed 6438611]

109. Merck & Co, Inc. Mefoxin (cefoxitin for injection) prescribing information. Whitehouse Station, NJ; 2004 Jun.

110. Platt R. Antibiotic prophylaxis in surgery. Rev Infect Dis. 1984; 6(Suppl 4):S880-6.

111. Van Scoy RE, Wilkowske CJ. Prophylactic use of antimicrobial agents. Mayo Clin Proc. 1983; 58:241-5. [IDIS 169724] [PubMed 6403778]

112. Guglielmo BJ, Hohn DC, Koo PJ et al. Antibiotic prophylaxis in surgical procedures: a critical analysis of the literature. Arch Surg. 1983; 118:943-55. [IDIS 173790] [PubMed 6347124]

113. Neu HC. Cephalosporin antibiotics as applied in surgery of bones and joints. Clin Orthop. 1984; 190:50-64. [PubMed 6386261]

114. Anon. Drugs for sexually transmitted infections. Treat Guidel Med Lett. 2007; 5:81-88. [PubMed 17703143]

115. American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 1999; 56:1839-88. [PubMed 10511234]

116. Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis. 1998; 26:1027-36. [IDIS 407733] [PubMed 9597221]

117. Gerding DN, Johnson S, Peterson LR et al for the Society for Healthcare Epidemiology of American. Position paper on Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995; 16:459-77. [PubMed 7594392]

118. Fekety R for the American College of Gastroenterology Practice Parameters Committee. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol. 1997; 92:739-50 (IDIS 386628) [IDIS 386628] [PubMed 9149180]

119. American Society of Health-System Pharmacists Commission on Therapeutics. ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile-associated disease. Am J Health-Syst Pharm. 1998; 55:1407-11. [IDIS 407213] [PubMed 9659970]

120. Wilcox MH. Treatment of Clostridium difficile infection. J Antimicrob Chemother. 1998; 41(Suppl C):41-6. [IDIS 407246] [PubMed 9630373]

121. Mangram AJ, Horan TC, Pearson ML et al. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999; 20:250-78. [PubMed 10219875]

122. Sawaya GF, Grady D, Kerlikowske K et al. Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis. Obstet Gynecol. 1996; 87:884-90. [IDIS 367107] [PubMed 8677129]

123. Anon. Choice of antibacterial drugs. Med Lett Treat Guid. 2007; 5:33-50.

124. Nichols Rl, Smith JW, Garcia RY et al. Current practices of preoperative bowel preparation among North American colorectal surgeons. Clin Infect Dis. 1997; 24:609-19. [IDIS 384359] [PubMed 9145734]

125. Schoetz DJ, Roberts PL, Murray JJ et al. Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations: a randomized prospective study. Ann Surg. 1990; 212:209-12. [IDIS 269407] [PubMed 2100983]

127. Kaiser AB. Antimicrobial prophylaxis in surgery. N Engl J Med. 1986; 315:1129-38. [IDIS 222343] [PubMed 3531863]

128. Brown RB, Klar J, Lemeshow S et al. Enhanced bleeding with cefoxitin or moxalactam: statistical analysis within a defined population of 1493 patients. Arch Intern Med. 1986; 146:2159-64. [IDIS 223647] [PubMed 3778044]

130. Centers for Disease Control. Antibiotic-resistant strains of Neisseria gonorrhoeae: policy guidelines for detection, management, and control. MMWR Morb Mortal Wkly Rep. 1987; 36(Suppl 5S):1-18S.

131. Rice RJ, Thompson SE. Treatment of uncomplicated infections due to Neisseria gonorrhoeae: a review of clinical efficacy and in vitro susceptibility studies from 1982 through 1985. JAMA. 1986; 255:1739-46. [IDIS 213027] [PubMed 3005679]

132. Miller DW, Shove GA, Jones T et al. Disseminated gonorrhea caused by penicillinase-producing Neisseria gonorrhoeae—Wisconsin, Pennsylvania. MMWR Morb Mortal Wkly Rep. 1987; 36:161-2,167. [PubMed 3102922]

133. Knapp JS, Zenilman JM, Biddle JW et al. Frequency and distribution in the United States of strains of Neisseria gonorrhoeae with plasmid-mediated, high-level resistance to tetracycline. J Infect Dis. 1987; 155:819-22. [PubMed 3102635]

134. Bowie WR, Shaw CE, Chan DGW et al. In-vitro susceptibility of 400 isolates of Neisseria gonorrhoeae in Vancouver, 1982–84. CMAJ. 1986; 135:489-93. [IDIS 222427] [PubMed 3091234]

135. Anon. Infection with Mycobacterium abscessus associated with intramuscular injection of adrenal cortex extract—Colorado and Wyoming, 1995–1996. MMWR Morb Mortal Wkly Rep. 1996; 45:713-5. [IDIS 371154] [PubMed 8769652]

136. Hemsell DL, Wendel GD, Gall SA et al. Multicenter comparison of cefotetan and cefoxitin in the treatment of acute obstetric and gynecologic infections. Am J Obstet Gynecol. 1988; 158:722-7. [IDIS 310460] [PubMed 3281462]

138. Bartlett JG. Antibiotic-associated diarrhea. Clin Infect Dis. 1992; 573-81.

139. Kelly CP, Pothoulakis C, LaMont JT. Clostridium difficile colitis. N Engl J Med. 1994; 330:257-62. [IDIS 324298] [PubMed 8043060]

140. Spangler SK, Jacobs MR, Appelbaum PC. Activity of CP 99,219 compared with those of ciprofloxacin, grepafloxacin, metronidazole, cefoxitin, piperacillin, and piperacillin-tazobactam against 489 anaerobes. Antimicrob Agents Chemother. 1994; 38:2471-6. [PubMed 7840591]

141. O’Keefe JP, Venezio FR, Divincenzo CA et al. Activity of newer β-lactam agents against clinical isolates of Bacteroides fragilis and other Bacteroides species. Antimicrob Agents Chemother. 1987; 31:2002-4. [IDIS 253333] [PubMed 3439807]

142. Goldstein EJC, Citron DM. Annual incidence, epidemiology, and comparative in vitro susceptibilities to cefoxitin, cefotetan, cefmetazole, and ceftizoxime of recent community-acquired isolates of the Bacteroides fragilis group. J Clin Microbiol. 1988; 26:2361-6. [PubMed 3235664]

143. Grimes DA, Bount JH, Patrick J et al. Antibiotic treatment of pelvic inflammatory disease: trends among private physicians in the United States, 1966 through 1983. JAMA. 1986; 256:3223-6. [PubMed 3783865]

144. Walker CK, Kahn JG, Washington AE et al. Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy. J Infect Dis. 1993; 168:969-78. [IDIS 320603] [PubMed 8376843]

145. Cunha BA. Treatment of pelvic inflammatory disease. Clin Pharm. 1990; 9:275-85. [IDIS 265474] [PubMed 2184973]

146. Hemsell DL, Little BB, Faro S et al. Comparison of three regimens recommended by the Centers for Disease Control and Prevention for the treatment of women hospitalized with acute pelvic inflammatory disease. Clin Infect Dis. 1994; 19:720-7. [IDIS 337500] [PubMed 7803638]

147. American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006.

148. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project. Clin Infect Dis. 2004; 38:1706-15. [PubMed 15227616]

149. B Braun Medical. Cefoxitin for injection and dextrose injection (1 g and 2 g in Duplex container) prescribing information. Irvine, CA; 2008 Apr.

150. Apotex. Cefoxitin for injection, USP prescribing information. Weston, FL. 2005 Aug.

151. Abraxis Pharmaceutical Products. Cefoxitin for injection, USP pharmacy bulk package prescribing information. Schaumburg, IL. 2008 Feb.

152. Lewis RT. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. Can J Surg. 2002; 45:173-80. [PubMed 12067168]

153. Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M et al. Prospective, randomized study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics? Int J Colorectal Dis. 2005; 20:542-6.

154. Wren SM, Ahmed N, Jamal A et al. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. Arch Surg. 2005; 140:752-6. [PubMed 16103284]

155. Centers for Disease Control and Prevention. Updated recommended treatment regimens for gonococcal infections and associated conditions—United States, April 2007. From CDC website (). Accessed 2007 April 12.

156. Bioniche Pharma USA. Mefoxin (cefoxitin sodium) injection, iso-osmotic solution in dextrose prescribing information. Lake Forest, IL; 2008 Jul.

157. Griffith DE, Aksamit T, Brown-Elliott BA et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175:367-416. [PubMed 17277290]

a. AHFS Drug Information 2009. McEvoy GK, ed. Cephalosporins General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2009:93-109.

c. AHFS Drug Information. McEvoy GK, ed. Cefoxitin sodium. Bethesda, MD: American Society of Health-System Pharmacists; 2009:209-14.

HID. Trissel LA. Handbook on injectable drugs. 13th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2005:288-296.

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