Cefoxitin Sodium

Trade Names:
Cefoxitin Sodium
- Powder for Injection 1 g (2.3 mEq sodium/g)
- Powder for Injection 2 g (2.3 mEq sodium/g)
- Powder for Injection 10 g (2.3 mEq sodium/g)
- Injection 1 g
- Injection 2 g

Pharmacology

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Inhibits mucopeptide synthesis in bacterial cell wall.

Pharmacokinetics

Absorption

C _max is 110 mcg/mL (1 g dose). T _max is 5 min.

Distribution

Passes into pleural and joint fluids and is detectable in antibacterial concentrations in the bile. Excreted in human milk (low concentrations).

Elimination

The t _½ is 41 to 59 min (IV). About 85% is excreted unchanged by the kidneys in 6 h.

Special Populations

The t _½ is increased. Dosage adjustment is recommended.

Indications and Usage

Treatment of infections of lower respiratory tract, urinary tract, skin and skin structures, bone and joint; treatment of intra-abdominal infections, gynecological infections, and septicemia caused by susceptible microorganisms; perioperative prophylaxis. Many infections caused by gram-negative bacteria resistant to some cephalosporins and penicillins respond to cefoxitin.

Contraindications

Hypersensitivity to cephalosporins.

Dosage and Administration

IV/IM 1 to 2 g every 6 to 8 h.

IV/IM 80 to 160 mg/kg/day in divided doses every 4 to 6 h (max, 12 g/day).

IV/IM 2 g just prior to surgery, then 2 g every 6 h for 24 h.

IV/IM 30 to 40 mg/kg just prior to surgery, then 30 to 40 mg/kg every 6 h for 24 h.

General Advice

• For IM administration, reconstitute each gram with 2 mL of sterile water for injection or 2 mL of lidocaine 0.5% without epinephrine to minimize discomfort. Inject deeply into large muscle (eg, gluteus or lateral thigh).
• For IV use, reconstitute each gram with 10 mL of sterile water for injection. Administer slowly over 3 to 5 min. Reconstituted drug may be diluted in 50 to 100 mL of sodium chloride 0.9% or D5W and infused over 30 min.

Storage/Stability

Store powder in vials between 36° and 77°F. Store the premixed IV solution at or below −4°F. The dry powder and solutions tend to darken, depending on storage conditions; however, product potency is not adversely affected.

Drug Interactions

May increase risk of nephrotoxicity.

Inhibition of renal excretion of cefoxitin.

Incompatibility

Do not add aminoglycosides to cefoxitin solutions because inactivation of both drugs may result; administer at separate sites if concurrent therapy is indicated.

Laboratory Test Interactions

May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-tape ); false-positive test result for proteinuria with acid and denaturization-precipitation tests; false-positive direct Coombs test result in certain patients (eg, those with azotemia); false elevations in urinary 17-ketosteroid values. High concentrations may interfere with creatinine concentrations measured by the Jaffe reaction, producing false results; do not analyze serum samples for creatinine if obtained within 2 hr of drug administration.

Adverse Reactions

Cardiovascular

Hypotension.

GI

Nausea; vomiting; diarrhea; colitis, including pseudomembranous colitis.

Genitourinary

Renal function impairment; elevated renal function tests; pyuria; dysuria; reversible interstitial nephritis; hematuria; toxic nephropathy.

Hematologic

Eosinophilia; neutropenia; lymphocytosis; leukocytosis; thrombocytopenia; decreased platelet function; anemia; hemolytic anemia; aplastic anemia; hemorrhage.

Hepatic

Hepatic function impairment; jaundice; abnormal LFT results.

Miscellaneous

Hypersensitivity, including Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis; candidal overgrowth; serum sickness–like reactions (eg, skin rashes, polyarthritis; arthralgia, fever); phlebitis, thrombophlebitis, and pain at injection site.

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

In children 3 mo of age and older, high doses of cefoxitin have been associated with increased incidence of eosinophilia and elevated AST.

Hypersensitivity

Reactions range from mild to life-threatening. Administer drug with caution to penicillin-sensitive patients because of possible cross-reactivity.

Renal Function

Use drug with caution. Dosage adjustment based on renal function may be required.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

Pseudomembranous colitis

Consider in patients in whom diarrhea develops.

Overdosage

Symptoms

Seizures.

Patient Information

• Instruct patient to check body temperature daily. If fever persists for more than a few days or if high fever (higher than 102°F) or shaking chills are noted, notify health care provider immediately.
• Advise patient to maintain normal fluid intake while using this medication.
• Advise diabetic patient to use enzyme-based tests (eg, Clinistix , Testape ) for monitoring urine glucose because drug may give false results with other tests.
• Warn patient to report these symptoms to health care provider: nausea, vomiting, diarrhea, skin rash, hives, sore throat, bruising, bleeding, muscle or joint pain.
• Instruct patient to report signs of superinfection: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
• Warn patient that diarrhea that contains blood or pus may be a sign of serious disorders. Tell patient to seek medical care and not to treat at home.
• Instruct patient to seek emergency care if he or she experiences wheezing or difficulty breathing.

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