Cefoxitin Dosage
Medically reviewed by Drugs.com. Last updated on Feb 16, 2024.
Applies to the following strengths: 1 g; 2 g; 10 g; 1 g/50 mL; 2 g/50 mL; 1 g/50 mL-iso-osmotic dextrose; 2 g/50 mL-iso-osmotic dextrose
Usual Adult Dose for:
- Aspiration Pneumonia
- Intraabdominal Infection
- Joint Infection
- Osteomyelitis
- Peritonitis
- Pneumonia
- Bacterial Infection
- Urinary Tract Infection
- Skin and Structure Infection
- Pelvic Inflammatory Disease
- Endometritis
- Septicemia
- Cesarean Section
- Surgical Prophylaxis
- Gonococcal Infection - Uncomplicated
Usual Pediatric Dose for:
- Intraabdominal Infection
- Joint Infection
- Osteomyelitis
- Peritonitis
- Pneumonia
- Septicemia
- Bacterial Infection
- Urinary Tract Infection
- Skin and Structure Infection
- Pelvic Inflammatory Disease
- Endometritis
- Surgical Prophylaxis
- Cesarean Section
- Gonococcal Infection - Uncomplicated
Additional dosage information:
Usual Adult Dose for Aspiration Pneumonia
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Intraabdominal Infection
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Joint Infection
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Osteomyelitis
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Peritonitis
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Pneumonia
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Bacterial Infection
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Urinary Tract Infection
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Skin and Structure Infection
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Uncomplicated infections included cutaneous infections, pneumonia, and urinary tract infections.
- High-dose infections include gas gangrene.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including Bacteroides fragilis), Clostridium species, Escherichia coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, Escherichia coli, Haemophilus influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., Enterococcus faecalis/Streptococcus faecalis), S aureus (including penicillinase-producing strains), and Streptococcus pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, Peptococcus niger, Peptostreptococcus species, Proteus mirabilis, S aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by E coli, Klebsiella species, Morganella morganii, P mirabilis, Proteus vulgaris, and Providencia species (including Providencia rettgeri)
Infectious Diseases Society of America (IDSA) Recommendations:
1 gram IV every 6 to 8 hours
Duration of therapy:
- Bone/joint infection without residual infected tissue (e.g., postamputation): 2 to 5 days)
- Moderate diabetic foot infection, including residual infected soft tissue (soft tissue only): 1 to 3 weeks
- Severe diabetic foot infection (soft tissue only): 2 to 4 weeks
- Residual infected, but viable, bone: 4 to 6 weeks
- No surgery or postoperative residual dead bone: 3 months or longer
Comment: Patients with diabetic foot infections should be started on parenteral treatment and should be switched to oral formulations when possible.
Uses:
- Alternative treatment of infections following animal bites
- Preemptive antimicrobial therapy to prevent infection in dog or cat bites
- Alternative treatment for infected animal bite-related wounds caused by Pasteurella multocida
- Empiric treatment of moderate or severe diabetic foot infections caused by methicillin-susceptible S aureus (MSSA), other Streptococcus species, Enterobacteriaceae, and/or obligate anaerobes
Usual Adult Dose for Pelvic Inflammatory Disease
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- This drug does not have activity against Chlamydia trachomatis.
- Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
- Surgical drainage should be performed in infections involving collections of pus.
Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, Neisseria gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and Streptococcus agalactiae
US Centers for Disease Control and Prevention (US CDC) Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin
- Duration of therapy: 14 days
Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day
- Duration of therapy: 14 days
Comments:
- At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
- Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
- Oral therapy may be initiated within 24 to 28 hours of clinical improvement.
Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or Mycoplasma hominis
Usual Adult Dose for Endometritis
Uncomplicated infections (bacteremia absent/unlikely): 1 gram IV every 6 to 8 hours
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- This drug does not have activity against Chlamydia trachomatis.
- Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
- Surgical drainage should be performed in infections involving collections of pus.
Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, Neisseria gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and Streptococcus agalactiae
US Centers for Disease Control and Prevention (US CDC) Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin
- Duration of therapy: 14 days
Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day
- Duration of therapy: 14 days
Comments:
- At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
- Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
- Oral therapy may be initiated within 24 to 28 hours of clinical improvement.
Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or Mycoplasma hominis
Usual Adult Dose for Septicemia
Moderately severe to severe infections: 1 gram IV every 4 hours OR 2 grams IV every 6 to 8 hours
Infections needing high-doses: 2 grams IV every 4 hours OR 3 grams IV every 6 hours
Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Surgical drainage should be performed in infections involving collections of pus.
Use: Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
Usual Adult Dose for Cesarean Section
Single-dose regimen: 2 grams IV ONCE as soon as the umbilical cord is clamped
3-dose regimen: 2 grams IV every 4 hours for 3 doses, given as soon as the umbilical cord is clamped, then at 4 and 8 hours after the initial dose
Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
Use: Prophylaxis of infection in patients undergoing cesarean section
Usual Adult Dose for Surgical Prophylaxis
2 grams IV 30 to 60 minutes prior to surgery, followed by 2 grams every 6 hours after the first dose
- Duration of therapy: 24 hours
Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
Use: Prophylaxis of infection in patients undergoing abdominal hysterectomy uncontaminated gastrointestinal surgery, or vaginal hysterectomy
American Society of Health-System Pharmacists (ASHP), IDSA, Society for Healthcare Epidemiology of America (SHEA), and Surgical Infection Society (SIS) Recommendations:
2 grams IV ONCE
Comment: The recommended redosing interval from the initiation of the preoperative dose is 2 hours.
Uses:
Recommended agent for surgical prophylaxis in patients who are undergoing the following procedures:
- Appendectomy for uncomplicated appendicitis
- Biliary tract (e.g., elective high-risk, open procedure)
- Colorectal
- Hysterectomy (abdominal/vaginal)
- Small intestine (e.g., obstructed)
- Some urologic procedures (e.g., clean-contaminated with entry into urinary tract)
Alternative agent for surgical prophylaxis in patients who are undergoing the following procedures:
- Open biliary tract procedures
Adjunctive agent (with metronidazole) for surgical prophylaxis in patients who are undergoing colon procedures
Usual Adult Dose for Gonococcal Infection - Uncomplicated
US CDC recommendations:
Uncomplicated anorectal and urogenital gonococcal infections: 2 grams IM ONCE plus probenecid
Comments:
- 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.
Use: Treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum caused by N gonorrhoeae
Usual Pediatric Dose for Intraabdominal Infection
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Joint Infection
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Osteomyelitis
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Peritonitis
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Pneumonia
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Septicemia
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Bacterial Infection
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Urinary Tract Infection
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Skin and Structure Infection
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- Higher doses should be used to treat severe or serious infections.
- Surgical drainage should be performed in infections involving collections of pus.
Uses:
- Treatment of bone and joint infections caused by S aureus (including penicillinase-producing strains)
- Treatment of intraabdominal infections (e.g., intraabdominal abscess, peritonitis) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, and Klebsiella species
- Treatment of lower respiratory tract infections (e.g., lung abscesses, pneumonia) caused by Bacteroides species, E coli, H influenzae, Klebsiella species, other streptococci (excluding enterococci, e.g., E faecalis/S faecalis), S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of septicemia caused by Bacteroides species (including B fragilis), E coli, Klebsiella species, S aureus (including penicillinase-producing strains), and S pneumoniae
- Treatment of skin and structure infections cause by Bacteroides species (including B fragilis), Clostridium species, E coli, Klebsiella species, P niger, Peptostreptococcus species, P mirabilis, S aureus (including penicillinase-producing strains), S epidermidis, S pyogenes and other streptococci (excluding enterococci, e.g., E faecalis/S faecalis)
- Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, M morganii, P mirabilis, P vulgaris, and Providencia species (including Providencia rettgeri)
American Academy of Pediatrics (AAP) Recommendations:
Gestational age less than 32 weeks:
Postnatal age (PNA) 7 days or less: 35 mg/kg IV OR IM every 12 hours
PNA over 72 years: 35 mg/kg IV OR IM every 8 hours
Gestational age 32 weeks and older: 35 mg/kg IV OR IM every 8 hours
Pediatric patients beyond the newborn period: 80 to 160 mg/kg IV OR IM per day, given in divided doses 3 to 4 times a day
- Maximum dose: 12 grams/day
Neonates (72 hours) or older: 40 mg/kg IV ONCE with/without IV gentamicin
- Maximum dose: 3 grams/dose
Uses:
- Treatment of ruptured viscus in traumatic wounds caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
- Treatment of ruptured viscus via colorectal or appendectomy caused by enteric gram-negative bacilli, Clostridium species, enterococci, and/or anaerobes (Bacteroides species)
International Society for Peritoneal Dialysis (ISPD) Recommendations:
PROPHYLAXIS: 30 to 40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: Empirical doses should be given just prior to the procedure.
Uses:
- Preferred empirical treatment for other gastrointestinal or genitourinary procedures in patients undergoing peritoneal dialysis
- Treatment of peritonitis
Usual Pediatric Dose for Pelvic Inflammatory Disease
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- This drug does not have activity against C trachomatis.
- Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
- Surgical drainage should be performed in infections involving collections of pus.
Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, N gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and S agalactiae
US CDC Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin
- Duration of therapy: 14 days
Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day
- Duration of therapy: 14 days
Comments:
- At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
- Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
- Oral therapy may be initiated within 24 to 28 hours of clinical improvement.
Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or M hominis
Usual Pediatric Dose for Endometritis
3 months and older: 80 to 160 mg/kg IV per day, given in 4 to 6 equal doses
- Maximum dose: 12 grams/day
- Duration of therapy: At least 10 days (group A beta-hemolytic streptococcal infections)
Comments:
- This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
- This drug does not have activity against C trachomatis.
- Patients with pelvic inflammatory disease potentially caused by C trachomatis should be given appropriate anti-chlamydial therapy.
- Surgical drainage should be performed in infections involving collections of pus.
Use: Treatment of gynecological infections (e.g., endometritis, pelvic cellulitis, pelvic inflammatory disease) caused by Bacteroides species (including B fragilis), Clostridium species, E coli, N gonorrhoeae (including penicillinase-producing strains), P niger, Peptostreptococcus species, and S agalactiae
US CDC Recommendations:
Parenteral Treatment: 2 grams IV every 6 hours PLUS IV/oral doxycycline and IV gentamicin
- Duration of therapy: 14 days
Alternative IM/Oral Treatment: 2 grams IM ONCE PLUS probenecid orally ONCE PLUS doxycycline orally given 2 times a day
- Duration of therapy: 14 days
Comments:
- At least 24 hours of inpatient observation is recommended for patients with tubo-ovarian abscesses.
- Daily doses have not been evaluated for treatment of this condition; however, it has been efficacious in analogous conditions.
- Oral therapy may be initiated within 24 to 28 hours of clinical improvement.
Use: Recommended adjunctive treatment of pelvic inflammatory disease due to C trachomatis, N gonorrhoeae, or M hominis
Usual Pediatric Dose for Surgical Prophylaxis
3 months and older: 30 to 40 mg/kg IV 30 to 60 minutes prior to surgery, followed by 30 to 40 mg/kg every 6 hours after the first dose
- Duration of therapy: 24 hours
Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
Use: Prophylaxis of infection in patients undergoing abdominal hysterectomy uncontaminated gastrointestinal surgery, or vaginal hysterectomy
AAP Recommendations:
Neonates (72 hours) or older: 40 mg/kg IV ONCE PLUS IV gentamicin
- Maximum dose: 3 grams/dose
Use: Preoperative antimicrobial prophylaxis in neonatal patients older than 72 hours and children undergoing uncomplicated, nonperforated colorectal or appendectomy with the following likely pathogens: enteric gram-negative bacilli, enterococci, and/or anaerobes (Bacteroides species)
ASHP, IDSA, SHEA, and SIS Recommendations:
40 mg/kg IV ONCE
- Maximum dose: 2 grams/dose
Comment: The recommended redosing interval from the initiation of the preoperative dose is 2 hours.
Uses:
Recommended agent for surgical prophylaxis in patients who are undergoing the following procedures:
- Appendectomy for uncomplicated appendicitis
- Biliary tract (e.g., elective high-risk, open procedure)
- Colorectal
- Hysterectomy (abdominal/vaginal)
- Small intestine (e.g., obstructed)
- Some urologic procedures (e.g., clean-contaminated with entry into urinary tract)
Alternative agent for surgical prophylaxis in patients who are undergoing the following procedures:
- Open biliary tract procedures
Adjunctive agent (with metronidazole) for surgical prophylaxis in patients who are undergoing colon procedures
Usual Pediatric Dose for Cesarean Section
Single-dose regimen: 2 grams IV ONCE as soon as the umbilical cord is clamped
3-dose regimen: 2 grams IV every 4 hours for 3 doses, given as soon as the umbilical cord is clamped, then at 4 and 8 hours after the initial dose
Comment: This drug may be given via IV injection over 3 to 5 minutes or via IV infusion.
Use: Prophylaxis of infection in patients undergoing cesarean section
Usual Pediatric Dose for Gonococcal Infection - Uncomplicated
US CDC recommendations:
Uncomplicated anorectal and urogenital gonococcal infections in adolescents: 2 grams IM ONCE plus probenecid
Comments:
- 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.
Use: Treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum caused by N gonorrhoeae
Renal Dose Adjustments
Pediatric:
3 months and older: Doses and frequencies should be adjusted consisted with adult renal dose adjustments.
Adults:
Loading dose: 1 to 2 grams via IV injection over 3 to 5 minutes ONCE
Maintenance dose:
- Mild renal dysfunction (CrCl 30 to 50 mL/min): 1 to 2 grams over 3 to 5 minutes or IV infusion every 8 to 12 hours
- Moderate renal dysfunction (CrCl 10 to 29 mL/min): 1 to 2 grams over 3 to 5 minutes or IV infusion every 12 to 24 hours
- Severe renal dysfunction (CrCl 5 to 9 mL/min): 0.5 to 1 gram over 3 to 5 minutes or IV infusion every 12 to 48 hours
- Essentially no renal function (CrCl less than 5 mL/min): 0.5 to 1 gram over 3 to 5 minutes or IV infusion every 24 to 48 hours
Liver Dose Adjustments
Data not available
Precautions
CONTRAINDICATIONS:
- Hypersensitivity to the active component, the cephalosporin group of antibiotics, or to any of the ingredients
Safety and efficacy have not been established in patients younger than 3 months.
Consult WARNINGS section for additional precautions.
Dialysis
Hemodialysis:
Pediatric:
3 months and older: Doses and frequencies should be adjusted consistent with adult renal dose adjustments.
Adults:
Loading dose: 1 to 2 grams IV after each hemodialysis
Maintenance dose:
- Mild renal dysfunction (CrCl 30 to 50 mL/min): 1 to 2 grams IV every 8 to 12 hours
- Moderate renal dysfunction (CrCl 10 to 29 mL/min): 1 to 2 grams IV every 12 to 24 hours
- Severe renal dysfunction (CrCl 5 to 9 mL/min): 0.5 to 1 gram IV every 12 to 48 hours
- Essentially no renal function (CrCl less than 5 mL/min): 0.5 to 1 gram IV every 24 to 48 hours
Other Comments
Administration advice:
- IM: This drug should be given deep into a large muscle (e.g., upper outer quadrant of the gluteus maximus, lateral thigh).
- IV: This drug may be given via IV injection (over 3 to 5 minutes) OR infusion; intraarterial administration should be avoided.
Storage requirements:
- The manufacturer product information should be consulted.
Reconstitution/preparation techniques:
- The manufacturer product information should be consulted.
IV compatibility:
- The manufacturer product information should be consulted.
General:
- Local epidemiological and susceptibility patterns should be used to guide treatment selection in the absence of patient-specific culture and susceptibility information.
- Some experts recommend against using this drug to treat meningitis.
Monitoring:
- HEMATOLOGIC: Hematopoietic system function tests periodically, especially during prolonged treatment
- HEPATIC: Liver function tests periodically, especially during prolonged treatment
- RENAL: Renal function monitoring, especially regularly when used with aminoglycosides and periodically during prolonged treatment
Patient advice:
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
- Patients should be directed to take the full course of treatment, even if they feel better.
- Patients should be instructed to report signs/symptoms of Clostridium difficile (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment
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