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Cefoxitin Sodium

Pronunciation

Pronunciation: seff-OX-ih-tin SO-dee-uhm
Class: Antibiotic, Cephalosporin

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)

Mefoxin
- Injection, solution 1 g in dextrose
- Injection, solution 2 g in dextrose

Pharmacology

Inhibits mucopeptide synthesis in bacterial cell wall.

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Pharmacokinetics

Absorption

IV

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 half-life is 41 to 59 min (IV). About 85% is excreted unchanged by the kidneys in 6 h.

Special Populations

Elderly

The half-life is increased (51 to 90 min).

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

Cesarean Section
Females

IV 2 g as soon as the umbilical cord is clamped or a 3-dose regimen consisting of 2 g as soon as the umbilical cord is clamped followed by 2 g 4 and 8 h after the initial dose.

Infection
Adults

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

Children 3 mo of age and older

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

Surgical Prophylaxis
Adults

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

Children 3 mo of age and older

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

Renal Function Impairment
Adults CrCl 30 to 50 mL/min

1 to 2 g every 8 to 12 h.

CrCl 10 to 29 mL/min

1 to 2 g every 12 to 24 h.

CrCl 5 to 9 mL/min

0.5 to 1 g every 12 to 24 h.

CrCl less than 5 mL/min

0.5 to 1 g every 24 to 48 h.

Children

Modify dose.

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.
  • Thaw frozen premixed containers at room temperature or under refrigeration. Do not force thaw by immersion in water baths or by microwave irradiation.
  • Do not add any additives to the premixed solution.

Storage/Stability

Store powder in vials between 36° and 77°F. Store the premixed IV solution at or below −4°F. Thawed premixed solutions are stable at 77°F for 24 h or 36° to 46°F for 21 days. The dry powder and solutions tend to darken, depending on storage conditions; however, product potency is not adversely affected.

Drug Interactions

Aminoglycosides

May increase risk of nephrotoxicity.

Probenecid

Inhibition of renal excretion of cefoxitin.

Incompatibility

Aminoglycosides

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.

Dermatologic

Flushing, pruritus, rash (including exfoliative dermatitis and TEN), urticaria.

GI

Colitis (including pseudomembranous colitis), diarrhea, nausea, vomiting.

Genitourinary

Dysuria, elevated renal function tests, hematuria, pyuria, renal function impairment, reversible interstitial nephritis, toxic nephropathy; acute renal failure (rare).

Hematologic

anemia, aplastic anemia, decreased platelet function, eosinophilia, hemolytic anemia, hemorrhage, leukocytosis, lymphocytosis, neutropenia, thrombocytopenia.

Hepatic

Abnormal LFT results, hepatic function impairment, jaundice.

Lab Tests

A positive direct Coombs test may develop, especially in patients with azotemia.

Miscellaneous

Anaphylaxis, angioedema, hypersensitivity (including Stevens-Johnson syndrome, erythema multiforme); candidal overgrowth; dyspnea; exacerbation of myasthenia gravis; serum sickness–like reactions (eg, skin rashes, polyarthritis; arthralgia, fever); phlebitis, thrombophlebitis, and pain at injection site.

Precautions

Monitor

Monitor for coagulation abnormalities. Monitor organ system functions, including renal, hepatic, and hematopoietic, periodically during prolonged therapy. Monitor patient's response to therapy. Monitor patient for GI, dermatologic, and general body adverse reactions, and signs of superinfection.


Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established in children 3 mo of age and younger.

Elderly

Because elderly patients are more likely to have decreased renal function, take care in dose selection and monitor renal function.

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.

GI effects

Use with caution in GI disease, particularly colitis.

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.

Copyright © 2009 Wolters Kluwer Health.

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