Cefotaxime (Monograph)

Brand name: Claforan
Drug class: Third Generation Cephalosporins
VA class: AM117
CAS number: 64485-93-4

Medically reviewed by Drugs.com on Sep 20, 2023. Written by ASHP.

Introduction

Antibacterial; β-lactam antibiotic; third generation cephalosporin.^a ^b

Uses for Cefotaxime

Bone and Joint Infections

Treatment of serious bone and joint infections caused by susceptible S. aureus, streptococci (including S. pyogenes), Pseudomonas (including Ps. aeruginosa), or P. mirabilis.²³⁰

Genitourinary Tract Infections

Treatment of serious genitourinary tract infections caused by susceptible S. aureus (including penicillinase-producing strains), S. epidermidis, enterococci, Citrobacter, Enterobacter, E. coli, Klebsiella, Morganella morganii, P. mirabilis, P. vulgaris, Providencia stuartii, P. rettgeri, Pseudomonas (including Ps. aeruginosa), or S. marcescens.²³⁰

GI Infections

Empiric treatment of infectious diarrhea^{† [off-label]}.⁴¹² Alternative for empiric treatment of severe diarrhea in HIV-infected individuals; ciprofloxacin is drug of choice.⁴¹²

Treatment of gastroenteritis caused by Salmonella^{† [off-label]}.¹⁹⁷ ²⁴⁵ ²⁷⁵ ⁴¹² (See Typhoid Fever and Other Salmonella Infections under Uses.)

Treatment of GI infections caused by Yersinia enterocolitica or Y. pseudotuberculosis^{† [off-label]}.²¹⁸ ²⁴⁵ ²⁷⁵ Usually self-limited infections, but anti-infectives may be indicated in immunocompromised individuals, for severe infections, or when septicemia or other invasive disease occurs.²¹⁸ ²⁴⁵ ²⁷⁵

Gynecologic Infections

Treatment of gynecologic infections (including pelvic inflammatory disease [PID], endometritis, pelvic cellulitis) caused by susceptible S. epidermidis, streptococci (including enterococci), E. coli, Enterobacter, Klebsiella, P. mirabilis, Bacteroides (including B. fragilis), Clostridium, Fusobacterium (including F. nucleatum), Peptococcus, and Peptostreptococcus.²³⁰

When parenteral regimen is used for treatment of PID, CDC recommends IV cefoxitin or cefotetan given in conjunction with oral doxycycline or IV clindamycin given in conjunction with gentamicin.¹⁶⁷ While other parenteral cephalosporins (e.g., cefotaxime, ceftriaxone) also may be effective, CDC states these drugs are less active than cefoxitin or cefotetan against anaerobic bacteria.¹⁶⁷

When 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 cefotaxime given in conjunction with oral doxycycline (with or without oral metronidazole).¹⁶⁷

Intra-abdominal Infections

Treatment of serious intra-abdominal infections (including peritonitis) caused by susceptible streptococci, E. coli, Klebsiella, P. mirabilis, Clostridium, Bacteroides, or anaerobic cocci (including Peptococcus and Peptostreptococcus).²³⁰

Meningitis and Other CNS Infections

Treatment of meningitis and ventriculitis caused by susceptible H. influenzae, N. meningitidis, S. pneumoniae,²³⁰ ²⁷⁵ ²⁹¹ ²⁹⁴ ²⁹⁶ ³³⁵ E. coli, or K. pneumoniae.²³⁰ ²⁷⁵ ²⁹¹ ²⁹⁴ ²⁹⁶ ³³⁶

A drug of choice when a third generation cephalosporin is indicated for empiric treatment of bacterial meningitis;²⁷⁵ ²⁹⁰ ²⁹⁶ ³¹⁹ should not be used alone for empiric treatment when Listeria monocytogenes, enterococci, staphylococci, or Ps. aeruginosa may be involved.²⁷⁵ ²⁹⁰ ²⁹⁶ ³¹⁹

Treatment of brain abscesses and other CNS infections^{† [off-label]} (e.g., subdural empyema, intracranial epidural abscesses).³¹⁹ ³³⁶ ³⁴⁷ Concomitant metronidazole usually recommended for empiric therapy;³¹⁹ ³⁴⁷ used in conjunction with a penicillinase-resistant penicillin or vancomycin if staphylococci suspected.³¹⁹ ³⁴⁷

Respiratory Tract Infections

Treatment of serious lower respiratory tract infections, including community-acquired pneumonia (CAP)¹⁹⁷ ²⁶⁹ ³⁴² caused by susceptible Streptococcus pneumoniae, S. pyogenes (group A β-hemolytic streptococci), other streptococci (except enterococci), Staphylococcus aureus (including penicillinase-producing strains), Escherichia coli, Klebsiella, Haemophilus influenzae (including ampicillin-resistant strains), H. parainfluenzae, Proteus mirabilis, indole-positive Proteus, Serratia marcescens, Enterobacter, or Pseudomonas (including Ps. aeruginosa).²³⁰

Recommended by ATS and IDSA as an alternative for treatment of CAP caused by penicillin-susceptible S. pneumoniae and as a preferred drug for treatment of CAP caused by penicillin-resistant S. pneumoniae, provided in vitro susceptibility has been demonstrated.²⁶⁹ Also recommended in certain combination regimens used for empiric treatment of CAP.²⁶⁹ Select regimen for empiric treatment of CAP based on most likely pathogens and local susceptibility patterns; after pathogen is identified, modify to provide more specific therapy (pathogen-directed therapy).²⁶⁹

For empiric inpatient treatment of CAP in patients not requiring treatment in an intensive care unit (non-ICU patients), IDSA and ATS recommend monotherapy with a fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin) or, alternatively, a combination regimen that includes a β-lactam (usually cefotaxime, ceftriaxone, or ampicillin) given in conjunction with a macrolide (azithromycin, clarithromycin, erythromycin).²⁶⁹

For empiric inpatient treatment of CAP in ICU patients when Pseudomonas and oxacillin-resistant (methicillin-resistant) S. aureus are not suspected, IDSA and ATS recommend a combination regimen that includes a β-lactam (cefotaxime, ceftriaxone, fixed combination of ampicillin and sulbactam) given in conjunction with either azithromycin or a fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin).²⁶⁹

Septicemia

Treatment of bacteremia/septicemia caused by E. coli, Klebsiella, S. marcescens, S. aureus, or streptococci (including S. pneumoniae).²³⁰ An aminoglycoside often is used concomitantly.²³⁰

Select anti-infective for treatment of sepsis syndrome based on probable source of infection, causative organism, immune status of patient, and local patterns of bacterial resistance.¹⁹⁷

For initial treatment of life-threatening sepsis in adults, some clinicians suggest that a third or fourth generation cephalosporin (cefepime, cefotaxime, ceftriaxone, ceftazidime), the fixed combination of piperacillin and tazobactam, or a carbapenem (doripenem, imipenem, meropenem) be used in conjunction with vancomycin; some also suggest including an aminoglycoside or fluoroquinolone during initial few days of treatment.¹⁹⁷

Skin and Skin Structure Infections

Treatment of serious skin and skin structure infections caused by susceptible S. aureus, S. epidermidis, S. pyogenes, other streptococci (including enterococci), Acinetobacter, E. coli, Citrobacter (including C. freundii), Enterobacter, Klebsiella, P. mirabilis, P. vulgaris, M. morganii, P. rettgeri, Pseudomonas, Serratia, Bacteroides (including B. fragilis), Fusobacterium (including F. nucleatum), or anaerobic cocci (including Peptococcus and Peptostreptococcus).²³⁰

Capnocytophaga Infections

Alternative to penicillin G for treatment of infections caused by Capnocytophaga^{† [off-label]} (e.g., septicemia, meningitis, endocarditis).¹⁹⁷

Gonorrhea and Associated Infections

Alternative for treatment of uncomplicated cervical, urethral, or rectal gonorrhea caused by susceptible Neisseria gonorrhoeae in adults or adolescents.¹⁶⁷ ²³⁰ ²⁷⁵ ³⁶⁶ ³⁶⁷ Drug of choice is IM ceftriaxone.¹⁶⁷ ²⁷⁵ Although IM cefotaxime may be effective for urogenital and anorectal gonorrhea, CDC states it offers no advantages over IM ceftriaxone and has uncertain efficacy for pharyngeal gonorrhea.¹⁶⁷

Alternative for initial treatment of disseminated gonococcal infections^† caused by susceptible N. gonorrhoeae.¹⁶⁷ ²⁷⁵ Ceftriaxone is drug of choice for initial parenteral treatment of disseminated gonorrhea in adults, adolescents, or children.¹⁶⁷ ²⁷⁵

Treatment of disseminated gonococcal infections^†,¹⁶⁷ ²⁷⁵ gonococcal scalp abscesses^†,¹⁶⁷ ²⁷⁵ and gonococcal ophthalmia neonatorum^† in neonates.¹⁶⁷ ²⁷⁵

Lyme Disease

Treatment of early neurologic Lyme disease^† with acute neurologic manifestations such as meningitis or radiculopathy.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ IV ceftriaxone is the drug of choice; alternatives are IV cefotaxime or IV penicillin G.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ Although an oral regimen (doxycycline, amoxicillin, cefuroxime axetil) may be effective for early localized or early disseminated Lyme disease associated with erythema migrans in the absence of specific neurologic manifestations or advanced atrioventricular (AV) heart block,²⁷⁰ ²⁷³ ²⁷⁵ ²⁸⁴ ²⁸⁵ ²⁸⁶ ²⁸⁷ ³³⁸ ³⁵¹ ³⁵³ ³⁵⁵ ³⁵⁶ ³⁵⁷ a parenteral regimen usually is recommended when there are acute neurologic manifestations.²⁷⁰ ²⁷³ ²⁷⁵ ²⁸⁴ ²⁸⁵ ²⁸⁶ ²⁸⁷ ³³⁸ ³⁵¹ ³⁵³ ³⁵⁵ ³⁵⁶

Treatment of Lyme carditis^† when a parenteral regimen is indicated.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ IV ceftriaxone is the drug of choice; alternatives are IV cefotaxime or IV penicillin G.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ Although a parenteral regimen usually is recommended for initial treatment of hospitalized patients, an oral regimen (doxycycline, amoxicillin, cefuroxime axetil) can be used to complete therapy and for the treatment of outpatients.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴

Treatment of Lyme arthritis^† when a parenteral regimen is indicated.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ ³⁶¹ IV ceftriaxone is the drug of choice; alternatives are IV cefotaxime or IV penicillin G.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ ³⁶¹ Although the comparative safety and efficacy of oral versus IV anti-infectives for treatment of Lyme arthritis have not been fully evaluated,³⁵¹ those with concomitant neurologic disease generally should receive a parenteral regimen.²⁷³ ²⁷⁵ ³⁵¹ ³⁵⁴ ³⁶¹

Treatment of late neurologic Lyme disease^† affecting the CNS or peripheral nervous system (e.g., encephalopathy, neuropathy).³⁵¹ IV ceftriaxone is the drug of choice; alternatives are IV cefotaxime or IV penicillin G.³⁵¹

Typhoid Fever and Other Salmonella Infections

Treatment of typhoid fever (enteric fever) or septicemia caused by Salmonella typhi or S. paratyphi^†, including multidrug-resistant strains.²⁷⁵ ³⁰⁶

Treatment of gastroenteritis caused by Salmonella^† (e.g., S. enteritidis, S. typhimurium) in individuals with severe Salmonella gastroenteritis and in those who are at increased risk of invasive disease.¹⁹⁷ ²⁴⁵ ²⁷⁵ ⁴¹²

Alternative for treatment of Salmonella gastroenteritis in HIV-infected individuals to prevent extraintestinal spread of the infection.⁴¹² CDC, NIH, and IDSA recommend ciprofloxacin as drug of choice for treatment of Salmonella gastroenteritis (with or without bacteremia) in HIV-infected adults; other fluoroquinolones (levofloxacin, moxifloxacin) also may be effective.⁴¹² Depending on in vitro susceptibility, alternatives are co-trimoxazole or third generation cephalosporins (ceftriaxone, cefotaxime).⁴¹²

Vibrio Infections

Treatment of severe Vibrio parahaemolyticus^† infection when anti-infective therapy is indicated in addition to supportive care.²¹⁸

Treatment of infections caused by V. vulnificus^†.¹⁹⁷ ²⁵⁰ Optimum anti-infective therapy has not been identified; a tetracycline or third generation cephalosporin (e.g., cefotaxime, ceftazidime) is recommended.¹⁹⁷ ²¹⁸ ²⁵⁰ Because the case fatality rate associated with V. vulnificus is high, initiate anti-infective therapy promptly if indicated.²⁵⁰ ²⁹⁴

Perioperative Prophylaxis

Has been used for perioperative prophylaxis in patients undergoing liver transplantation^†; some experts recommend a regimen of cefotaxime and ampicillin for such prophylaxis.¹⁶⁹

Has been used for perioperative prophylaxis to reduce the incidence of infection in patients undergoing contaminated or potentially contaminated surgery (e.g., biliary tract, colorectal, other intra-abdominal or GI surgery, genitourinary surgery, abdominal or vaginal hysterectomy) and in patients undergoing cesarean section.¹⁶⁹ ²³⁰ Other anti-infectives (e.g., cefazolin) usually recommended for these procedures.¹⁶⁸ ¹⁶⁹

First or second generation cephalosporins (cefazolin, cefotetan, cefoxitin, cefuroxime) generally preferred when a cephalosporin is used for perioperative prophylaxis.¹⁶⁸ ¹⁶⁹ Third generation cephalosporins (cefotaxime, ceftriaxone, ceftazidime) and fourth generation cephalosporins (cefepime) not usually recommended for perioperative prophylaxis since they are expensive, some are less active against staphylococci than first or second generation cephalosporins, they have wider spectrums of activity than necessary for organisms encountered in elective surgery, and their use for prophylaxis may promote emergence of resistant organisms.¹⁶⁸ ¹⁶⁹

Cefotaxime Dosage and Administration

Administration

Administer by IV injection or infusion or by deep IM injection.²³⁰

IV route preferred in patients with septicemia, bacteremia, peritonitis, meningitis, 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 if shock is present.²³⁰

Large IM doses may be painful; IV administration may be preferred when large doses are indicated.^b

Cefotaxime ADD-Vantage vials and the commercially available frozen cefotaxime injection in dextrose should be used only for IV infusion.

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

IV Injection

Reconstitution

Reconstitute vials containing 500 mg, 1 g, or 2 g of cefotaxime with 10 mL of sterile water for injection to provide solutions containing approximately 50, 95, or 180 mg/mL, respectively.²³⁰

Rate of Administration

Inject directly into a vein over a period of 3-5 minutes or slowly into the tubing of a freely flowing compatible IV solution.²³⁰

Do not inject IV over <3 minutes; rapid (over <1 minute) injection is associated with potentially life-threatening arrhythmias.²³⁰

IV Infusion

Reconstitution and Dilution

Reconstitute infusion bottles containing 1 or 2 g of cefotaxime with 50–100 mL of 0.9% sodium chloride injection or 5% dextrose injection to provide solutions containing 10–20 or 20–40 mg/mL, respectively.²³⁰ May be diluted further in 50 mL to 1 L of compatible IV solution.²³⁰

Reconstitute 10-g pharmacy bulk package according to the manufacturer’s directions and then dilute further in a compatible IV solution.²³⁰

Reconstitute ADD-Vantage vials or infusion bottles containing 1 or 2 g of cefotaxime according to the manufacturer’s directions.²³⁰

Thaw the commercially available premixed injection (frozen) at room temperature or in a refrigerator; do not thaw by immersion in a water bath or by exposure to microwave radiation.²³⁰ A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature.²³⁰ Discard thawed injection if an insoluble precipitate is present or if container seals or outlet ports are not intact or leaks are found.²³⁰ Do not use in series connections with other plastic containers; 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.²³⁰

Rate of Administration

For intermittent IV infusion, infuse over 20–30 minutes via butterfly or scalp vein-type needles.^b

During infusion, discontinue other IV solutions flowing through a common administration tubing or site²³⁰ unless the solutions are known to be compatible and the flow-rate is adequately controlled.^b

IM Injection

Inject IM deeply into a large muscle mass such as the upper outer quadrant of the gluteus maximus.²³⁰ Use aspiration to avoid inadvertent injection into a blood vessel.²³⁰

2-g IM doses should be divided and administered at 2 different injection sites.²³⁰

Reconstitution

Reconstitute vials containing 500 mg, 1 g, or 2 g of cefotaxime with 2, 3, or 5 mL, respectively, of sterile or bacteriostatic water for injection to provide solutions containing approximately 230, 300, or 330 mg/mL, respectively.²³⁰

Dosage

Available as cefotaxime sodium; dosage expressed in terms of cefotaxime.²³⁰

Pediatric Patients

General Dosage for Neonates

IV or IM

Manufacturer recommends 50 mg/kg every 12 hours for those <1 week of age and 50 mg/kg every 8 hours for those 1–4 weeks of age.²³⁰ ³⁶⁶ ³⁶⁷

Neonates ≤7 days of age: AAP recommends 50 mg/kg every 12 hours, regardless of weight.²⁷⁵

Neonates 8–28 days of age: AAP recommends 50 mg/kg every 8–12 hours in those weighing ≤2 kg and 50 mg/kg every 8 hours in those weighing >2 kg.²⁷⁵

General Dosage for Infants and Children 1 Month to 12 Years of Age

IV or IM

50–180 mg/kg daily given in 4–6 equally divided doses in those weighing <50 kg.²³⁰ ³⁶⁶ ³⁶⁷ The higher dosage should be used for more severe or serious infections.²³⁰ ³⁶⁶ ³⁶⁷

Children beyond neonatal period: AAP recommends 50–180 mg/kg daily given in 3 or 4 equally divided doses for treatment of mild to moderate infections and 200–225 mg/kg daily given in 4 or 6 equally divided doses for treatment of severe infections.²⁷⁵

Children weighing >50 kg should receive the usual adult dosage.²³⁰ ³⁶⁶ ³⁶⁷ (See Adult Dosage under Dosage and Administration.)

Meningitis and Other CNS Infections

IV

Manufacturers recommend that children 1 month to 12 years of age weighing <50 kg receive dosage at the high end of the range of 50–180 mg/kg daily.²³⁰ ³⁶⁶ ³⁶⁷ Some clinicians recommend that infants and children <18 years of age with meningitis receive 50 mg/kg IV every 6 hours.²⁹⁶ Others recommend 100–150 mg/kg daily given in divided doses every 8–12 hours in neonates ≤7 days of age, 150–200 mg/kg daily given in divided doses every 6–8 hours in neonates 8–28 days of age, and 225–300 mg/kg daily given in divided doses every 6–8 hours in older infants and children.³⁶⁵

AAP recommends up to 300 mg/kg daily given in 4 or 6 divided doses for treatment of meningitis in pediatric patients beyond the neonatal period.²⁷⁵

Duration of treatment is 7 days for uncomplicated meningitis caused by susceptible H. influenzae or N. meningitidis; ≥10–14 days for complicated cases or meningitis caused by S. pneumoniae; and ≥21 days for meningitis caused by susceptible Enterobacteriaceae.²⁷⁵ ²⁹⁶ ³¹⁸

Gonorrhea and Associated Infections

Disseminated Gonococcal Infection or Gonococcal Scalp Abscess in Neonates†

IV or IM

25 mg/kg every 12 hours for 7 days recommended by CDC and AAP; if meningitis is documented, continue for 10–14 days.¹⁶⁷ ²⁷⁵

Disseminated Gonorrhea in Children ≥8 Years of Age or Weighing ≥45 kg†

CDC recommends 1 g every 8 hours; continue for 24–48 hours after improvement begins and switch to an oral regimen (cefixime) to complete ≥1 week of treatment.¹⁶⁷

Uncomplicated Urethral, Cervical, or Rectal Gonorrhea in Adolescents

Single 500-mg dose recommended by CDC and AAP.¹⁶⁷ ²⁷⁵

Lyme Disease†

Early Neurologic Lyme Disease†

150–200 mg/kg daily (up to 6 g daily) given in divided doses every 6–8 hours for 14 days (range: 10–28 days) recommended by IDSA and others for early Lyme disease in children with acute neurologic manifestations (e.g., meningitis, radiculopathy).²⁷³ ³⁵¹ ³⁵⁴

Lyme Carditis†

150–200 mg/kg daily (up to 6 g daily) given in divided doses every 6–8 hours for 14 days (range: 14–21 days) recommended by IDSA and others for those with AV heart block and/or myopericarditis associated with early Lyme disease when a parenteral regimen is indicated (e.g., hospitalized patients).²⁷³ ³⁵¹ ³⁵⁴

Parenteral regimen can be switched to an oral regimen (doxycycline, amoxicillin, cefuroxime axetil) to complete therapy when clinically indicated.³⁵¹

Lyme Arthritis†

150–200 mg/kg daily (up to 6 g daily) given in divided doses every 6–8 hours for 14 days (range: 14–28 days) for children with evidence of neurologic disease or when arthritis has not responded to an oral regimen.³⁵¹

Late Neurologic Lyme Disease†

150–200 mg/kg daily (up to 6 g daily) given in divided doses every 6–8 hours for 14 days (range: 14–28 days) recommended by IDSA for children with late neurologic disease affecting the CNS or peripheral nervous system.²⁷³ ³⁵¹

Response to anti-infective treatment usually is slow and may be incomplete in such patients.³⁵¹ IDSA states that retreatment is not recommended unless relapse is shown by reliable objective measures.³⁵¹

Adults

General Adult Dosage

Uncomplicated Infections

IV or IM

1 g every 12 hours.²³⁰ ³⁶⁶ ³⁶⁷

Moderate to Severe Infections

IV or IM

1–2 g every 8 hours.²³⁰ ³⁶⁶ ³⁶⁷

Severe or Life-threatening Infections

2 g every 6–8 hours.²³⁰ ³⁶⁶ ³⁶⁷ For life-threatening infections, 2 g every 4 hours.²³⁰ ³⁶⁶ ³⁶⁷

Meningitis and Other CNS Infections

IV

2 g every 6–8 hours for 7–21 days.²³⁰ ²⁹⁶ Some clinicians recommend 8–12 g daily in divided doses every 4–6 hours.³⁶⁵

Meningitis Caused by S. pneumoniae

Initially, 350 mg/kg daily given in 4 divided doses; reduce dosage to 225 mg/kg daily given in 3 divided doses if organism is susceptible to penicillin.³²⁷ ³³⁵

GI Infections†

Infectious Diarrhea†

HIV-infected: 1 g every 8 hours.⁴¹² If no clinical response after 5–7 days, consider stool culture and in vitro susceptibility testing.⁴¹²

Salmonella Gastroenteritis†

HIV-infected: 1 g every 8 hours.⁴¹²

Recommended duration is 7–14 days if CD4⁺ T-cells ≥200 cells/mm³ (≥14 days if patient is bacteremic or infection is complicated) or 2–6 weeks if CD4⁺ T-cells <200 cells/mm³.⁴¹²

Respiratory Tract Infections

Community-acquired Pneumonia

IV or IM

1 g every 6–8 hours.²⁶⁹

Duration of treatment depends on the causative pathogen, illness severity at the onset of anti-infective therapy, response to treatment, comorbid illness, and complications.²⁶⁹

Gonorrhea and Associated Infections

Uncomplicated Urethral, Cervical, or Rectal Gonorrhea

Single 500-mg dose recommended by CDC.¹⁶⁷

Manufacturers recommend single 500-mg dose for treatment of gonococcal urethritis/cervicitis in males and females and rectal gonorrhea in females and single 1-g dose for treatment of rectal gonorrhea in males.²³⁰ ³⁶⁶ ³⁶⁷

Disseminated Gonorrhea†

CDC recommends 1 g every 8 hours; continue for 24–48 hours after improvement begins and switch to an oral regimen (cefixime) to complete ≥1 week of treatment.¹⁶⁷

Lyme Disease †

Early Neurologic Lyme Disease†

2 g every 8 hours for 14 days (range: 10–28 days) recommended by IDSA and others for adults with acute neurologic manifestations (e.g., meningitis, radiculopathy).²⁷³ ³⁵¹ ³⁵⁴

Lyme Carditis†

2 g every 8 hours for 14 days (range: 14–21 days) recommended by IDSA and others for adults with AV heart block and/or myopericarditis associated with early Lyme disease when a parenteral regimen is indicated (e.g., hospitalized patients).³⁵¹ ³⁵⁴

Parenteral regimen can be switched to an oral regimen (doxycycline, amoxicillin, cefuroxime axetil) to complete therapy when clinically indicated.³⁵¹

Lyme Arthritis†

2 g every 8 hours for 14 days (range: 14–28 days) recommended by IDSA for adults with evidence of neurologic disease or when arthritis has not responded to an oral regimen.³⁵¹

Late Neurologic Lyme Disease†

2 g every 8 hours for 14 days (range: 14–28 days) recommended by IDSA for adults with late neurologic disease affecting the CNS or peripheral nervous system.²⁷³ ³⁵¹

Perioperative Prophylaxis

Contaminated or Potentially Contaminated Surgery

IV or IM

Manufacturers recommend 1 g 30–90 minutes prior to surgery.²³⁰

Some experts recommend 1 g in most adults and 2 g in obese patients given within 60 minutes prior to surgical incision.¹⁶⁹

If procedure is prolonged (>3–4 hours) or if major blood loss occurs, additional intraoperative doses may be given every 3 hours.¹⁶⁹ Duration of prophylaxis should be <24 hours for most procedures;¹⁶⁸ no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.¹⁶⁸ ¹⁶⁹

Cesarean Section

IV or IM

Manufacturers recommend 1 g IV as soon as the umbilical cord is clamped, followed by additional 1-g IM or IV doses given 6 and 12 hours after the first dose.²³⁰

Prescribing Limits

Pediatric Patients

Maximum 12 g daily for children weighing >50 kg.²³⁰ ³⁶⁶ ³⁶⁷

Adults

Maximum 12 g daily.²³⁰ ³⁶⁶ ³⁶⁷

Special Populations

Hepatic Impairment

No dosage adjustments required.²⁸⁹ ²⁹⁰

Renal Impairment

Patients with Cl_cr <20 mL/minute per 1.73 m² should receive 50% of the usual dose given at the usual time intervals.²³⁰

Patients undergoing hemodialysis should receive 0.5–2 g as a single daily dose with a supplemental dose after each dialysis period.²⁶⁵

Cautions for Cefotaxime

Contraindications

Known hypersensitivity to cefotaxime or other cephalosporins.²³⁰

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Diarrhea and Colitis

Possible emergence and overgrowth of nonsusceptible organisms, especially Enterobacter, Pseudomonas, enterococci, or Candida.²³⁰ Careful observation of the patient is essential.²³⁰ Institute appropriate therapy if superinfection occurs.²³⁰

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.²³⁰ ³⁴² ³⁴⁴ ³⁴⁵ C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including cefotaxime, and may range in severity from mild diarrhea to fatal colitis.²³⁰ ³⁴² ³⁴⁴ ³⁴⁵ C. difficile produces toxins A and B which contribute to development of CDAD;²³⁰ ³⁴² hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.²³⁰

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.²³⁰ ³⁴² ³⁴⁴ ³⁴⁵ Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued.²³⁰ ³⁴²

If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever possible.²³⁰ ³⁴² Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.²³⁰ ³⁴² ³⁴⁴ ³⁴⁵

Cardiac Effects

Potentially life-threatening arrhythmia reported with rapid injection (<1 minute) through a central venous catheter.²³⁰ Do not inject IV over <3 minutes.²³⁰ (See IV Injection under Dosage and Administration.)

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.²³⁰

If a hypersensitivity reaction occurs, discontinue cefotaxime and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an adequate airway and oxygen).²³⁰

Cross-hypersensitivity

Partial cross-allergenicity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.^a

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.²³⁰ Cautious use recommended in individuals hypersensitive to penicillins:^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

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of cefotaxime and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.²³⁰

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.²³⁰ In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.²³⁰

History of GI Disease

Use with caution in patients with a history of GI disease, particularly colitis.²³⁰ (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis under Cautions.)

Local Effects

May be locally irritating to tissues.²³⁰ Inflammation, phlebitis, and thrombophlebitis reported with IV administration;^b pain, induration, and tenderness may occur at IM injection sites.²³⁰

Perivascular extravasation responds to changing the infusion site;²³⁰ extensive perivascular extravasation may result in tissue damage requiring surgery.²³⁰

Regularly monitor infusion sites and change site when appropriate.²³⁰

Hematologic Effects

Possible transient neutropenia, granulocytopenia, leukopenia, eosinophilia, or thrombocytopenia.²³⁰

Agranulocytosis may occur rarely during prolonged therapy.²³⁰ Monitor blood cell counts if treatment lasts >10 days.²³⁰

CNS Effects

Seizures reported with some cephalosporins, especially in patients with renal impairment who received dosages inappropriate for the degree of renal impairment.²³⁰

If seizures occur, discontinue cefotaxime and administer anticonvulsant therapy as indicated.²³⁰

Sodium Content

Contains approximately 50.5 mg (2.2 mEq) of sodium per g of cefotaxime.²³⁰ ³⁶⁶ ³⁶⁷

Specific Populations

Pregnancy

Category B.²³⁰

Lactation

Distributed into milk; use with caution.²³⁰

Pediatric Use

Adverse effects similar to those reported in adults.²⁹¹

Safety of the chemical components that may leach out of the plastic containing commercially available frozen cefotaxime sodium injections not established.²³⁰

Geriatric Use

No overall differences in safety or 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.²³⁰ ³⁶⁶ ³⁶⁷

Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function.²³⁰ ³⁶⁶ ³⁶⁷ Select dosage with caution and consider monitoring renal function because of age-related decreases in renal function.²³⁰ ³⁶⁶ ³⁶⁷ (See Renal Impairment under Dosage and Administration.)

Hepatic Impairment

Possible increased plasma half-life and clearance of cefotaxime and its major metabolite.¹¹⁷ ²⁸⁹

Renal Impairment

Plasma half-life of cefotaxime and its major metabolite increased in severe renal impairment.¹³ ¹⁶ ¹⁹ Possibility of seizures if dosage is inappropriately high for the degree of renal impairment.²³⁰

Dosage adjustment recommended in those with Cl_cr <20 mL/minute per 1.73 m³.²³⁰

Common Adverse Effects

Local reactions at injection sites, hypersensitivity reactions, GI effects.²³⁰

Drug Interactions

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Aminoglycosides

Possible increased risk of nephrotoxicity.²³⁰

In vitro evidence of additive or synergistic antibacterial activity; antagonism also reported.^a

Closely monitor renal function, especially if high aminoglycoside dosage is used or therapy is prolonged.²³⁰

Administer separately; do not admix.²³⁰

Probenecid

Decreased renal clearance and increased concentrations of cefotaxime and its metabolites.^b

Tests for glucose

Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution.^a

Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape.)^a

Cefotaxime Pharmacokinetics

Absorption

Bioavailability

Not appreciably absorbed from GI tract; must be administered parenterally.^b

Following IM administration, peak serum concentrations attained within 30 minutes.⁶ ⁸ ¹¹ ²³⁰

Distribution

Extent

Widely distributed into body tissues and fluids, including aqueous humor, bronchial secretions,²²⁴ sputum, middle ear effusions, bone,¹¹⁵ bile,¹¹⁵ ¹¹⁶ and ascitic,¹¹⁷ pleural, and prostatic fluids.⁹

Distributed into CSF; highest concentrations attained in those with inflamed meninges.²⁶³ ²⁶⁴ ²⁸⁸ ²⁹⁰ ^b

Crosses the placenta²¹ and is distributed into milk.²¹

Plasma Protein Binding

13–38%.² ⁶ ¹¹

Elimination

Metabolism

Partially metabolized in the liver to desacetylcefotaxime, which has antibacterial activity.² ⁷ ¹⁴ Desacetylcefotaxime is further metabolized into inactive metabolites in the liver.² ⁷ ¹⁴ ¹⁸

Elimination Route

Cefotaxime and its metabolites excreted principally in urine.² ¹⁴ In adults with normal renal function, 40–60% of a dose excreted as unchanged drug; 24% excreted as the active metabolite.^b

Half-life

Terminal serum half-life of cefotaxime and desacetylcefotaxime is 0.9–1.7 and 1.4–1.9 hours, respectively.² ⁷ ¹⁰ ¹¹ ¹³ ¹⁴ ¹⁹

Special Populations

Terminal half-lives of cefotaxime and desacetylcefotaxime may be prolonged in patients with hepatic impairment.¹¹⁷ ²⁸⁹

Terminal half-life of cefotaxime only slightly prolonged in adults with Cl_cr ≥20 mL/minute per 1.73 m².¹³ ¹⁶ In those with Cl_cr of ≤10 mL/minute per 1.73 m², terminal half-lives of 1.4–11.5 and 8.2–56.8 hours reported for cefotaxime and desacetylcefotaxime, respectively.¹³ ¹⁶ ¹⁹

Stability

Storage

Parenteral

Powder for Injection or IV Infusion

15–30°C;²³⁰ ³⁶⁶ ³⁶⁷ protect from light.²³⁰ ³⁶⁶ ³⁶⁷

Following reconstitution with sterile water for injection, IV solutions containing 50 or 95 mg/mL are stable for 24 hours at room temperature (≤22°C) or 7 days when refrigerated (≤5°C).²³⁰ IV solutions reconstituted with 0.9% sodium chloride injection or 5% dextrose injection and further diluted in a compatible IV solution are stable for 24 hours at room temperature (≤22°C) or at least 5 days when refrigerated (≤5°C).²³⁰

Following reconstitution with sterile or bacteriostatic water for injection, IM solutions containing 230–330 mg/mL are stable in their original containers for 12 hours at room temperature (≤22°C) or 10 days when refrigerated (≤5°C).²³⁰

Powder for injection and solutions may darken.²³⁰

For Injection, for IV Infusion

Claforan ADD-Vantage vials: <30°C; protect from light.²³⁰ After reconstitution as directed in 0.9% sodium chloride injection or 5% dextrose injection, stable for 24 hours at ≤22°C;²³⁰ do not freeze.²³⁰

Injection (Frozen)

-20°C or lower.²³⁰ Thawed solution stable 24 hours at room temperature (≤22°C) or 7 days under refrigeration (≤5°C).²³⁰

Do not refreeze after thawing.²³⁰

Compatibility

Parenteral

Cefotaxime sodium is most stable at a pH of 5–7 and should not be diluted with IV solutions that have a pH >7.5 (e.g., sodium bicarbonate).²³⁰

Solution Compatibility

Compatible
Dextrose 5 or 10% in water^HID ²³⁰
Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9%²³⁰
Invert sugar 10%²³⁰
Ringer’s injection, lactated²³⁰
Sodium chloride 0.9%^HID
Sodium lactate (1/6) M²³⁰
Travasol 8.5% without electrolytes²³⁰

Drug Compatibility

Admixture CompatibilityHID
Compatible
Clindamycin phosphate
Metronidazole
Metronidazole HCl
Verapamil HCl
Variable
Amikacin sulfate
Gentamicin sulfate

Y-site CompatibilityHID
Compatible
Acyclovir sodium
Amifostine
Aztreonam
Bivalirudin
Cyclophosphamide
Dexmedetomidine HCl
Diltiazem HCl
Docetaxel
Etoposide phosphate
Famotidine
Fenoldopam mesylate
Fludarabine phosphate
Granisetron HCl
Hetastarch in lactated electrolyte injection (Hextend)
Hydromorphone HCl
Levofloxacin
Lorazepam
Magnesium sulfate
Melphalan HCl
Meperidine HCl
Midazolam HCl
Milrinone lactate
Morphine sulfate
Ondansetron HCl
Pemetrexed disodium
Perphenazine
Propofol
Remifentanil HCl
Sargramostim
Teniposide
Thiotepa
Tolazoline HCl
Vinorelbine tartrate
Incompatible
Allopurinol sodium
Azithromycin
Filgrastim
Fluconazole
Gemcitabine HCl
Hetastarch in sodium chloride 0.9%
Pentamidine isethionate
Variable
Vancomycin HCl

Actions and Spectrum

Based on spectrum of activity, classified as a third generation cephalosporin.^a Usually less active in vitro against susceptible staphylococci than first generation cephalosporins; has an expanded spectrum of activity against gram-negative bacteria compared with first and second generation cephalosporins.^a ^b
Usually bactericidal.^a
Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.²³⁰ ^a
Spectrum of activity includes many gram-positive aerobic bacteria, some gram-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. pneumoniae, S. pyogenes (group A β-hemolytic streptococci), S. agalactiae (group B streptococci), S. aureus (including β-lactamase-producing strains), and some enterococci (e.g., Enterococcus faecalis).²³⁰ ^a ^b Also active in vitro against some viridans streptococci.³⁵⁰ Oxacillin-resistant (methicillin-resistant) staphylococci and some enterococci are resistant.^a ^b
Gram-negative aerobes: active in vitro and in clinical infections against Acinetobacter, Citrobacter, Enterobacter, E. coli, H. influenzae (including ampicillin-resistant strains), H. parainfluenzae, Klebsiella, M. morganii, N. gonorrhoeae, N. meningitidis, P. mirabilis, P. vulgaris, P. rettgeri, P. stuartii, and Serratia.²³⁰ ^a ^b Also active in vitro against Campylobacter,²²² ²²³ Capnocytophaga,³¹² ³¹⁴ ³¹⁵ Eikenella corrodens,²²⁰ ²²¹ ²⁴⁹ Moraxella,²³² ²³⁶ ²⁴⁰ ²⁴⁴ Salmonella,^a ^b Shigella,^a ^b and Vibrio vulnificus.²⁹² Active against some strains of Pseudomonas aeruginosa, but less active against susceptible Ps. aeruginosa than ceftazidime.^b
Anaerobes and other organisms: active in vitro and in clinical infections against Bacteroides, Eubacterium, Fusobacterium, Peptococcus, Peptostreptococcus, Propionibacterium, Veillonella, and some strains of Clostridium.²³⁰ ²⁶⁵ ^a ^b Also active against the spirochete Borrelia burgdorferi.²⁶⁵

Advice to Patients

Advise patients that antibacterials (including cefotaxime) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).²³⁰
Importance of completing full course of therapy, even if feeling better after a few days.²³⁰
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 cefotaxime or other antibacterials in the future.²³⁰
Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.²³⁰ 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.²³⁰
Importance of informing clinicians if an allergic reaction occurs.²³⁰
Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs as well as any concomitant illnesses.²³⁰
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.²³⁰
Importance of informing patients of other important precautionary information.²³⁰ (See Cautions.)

Preparations

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

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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

Cefotaxime Sodium
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	For injection	500 mg (of cefotaxime)*	Cefotaxime Sodium for Injection
			Claforan	Sanofi-Aventis
		1 g (of cefotaxime)*	Cefotaxime Sodium for Injection
			Claforan	Sanofi-Aventis
		2 g (of cefotaxime)*	Cefotaxime Sodium for Injection
			Claforan	Sanofi-Aventis
		10 g (of cefotaxime) pharmacy bulk package*	Cefotaxime Sodium for Injection
			Claforan	Sanofi-Aventis
	For injection, for IV infusion	1 g (of cefotaxime)	Claforan	Sanofi-Aventis
			Claforan ADD-Vantage	Sanofi-Aventis
		2 g (of cefotaxime)	Claforan	Sanofi-Aventis
			Claforan ADD-Vantage	Sanofi-Aventis

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

Cefotaxime Sodium in Dextrose
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection (frozen), for IV infusion	20 mg (of cefotaxime) per mL (1 g) in 3.4% Dextrose*	Cefotaxime Sodium Iso-osmotic in Dextrose Injection (Galaxy [Baxter])
		40 mg (of cefotaxime) per mL (2 g) in 1.4% Dextrose*	Cefotaxime Sodium Iso-osmotic in Dextrose Injection (Galaxy [Baxter])

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

References

2. Hoechst-Roussel Pharmaceuticals Inc. Claforan (cefotaxime sodium) sterile IM–IV: clinical and laboratory experience—an update. Somerville, NJ; 1981 Oct.

6. Esmieu F, Guibert J, Rosenkilde HC. Pharmacokinetics of cefotaxime in normal human volunteers. J Antimicrob Chemother. 1980; 6(Suppl A):83-92. http://www.ncbi.nlm.nih.gov/pubmed/6252184?dopt=AbstractPlus

7. Reeves DS, White LO, Holt HA. Human metabolism of cefotaxime. J Antimicrob Chemother. 1980; 6(Suppl A):93-101. http://www.ncbi.nlm.nih.gov/pubmed/6252185?dopt=AbstractPlus

8. Neu HC, Aswapokee P, Fu KP et al. Cefotaxime kinetics after intravenous and intramuscular injection of single and multiple doses. Clin Pharmacol Ther. 1980; 27:677-85. http://www.ncbi.nlm.nih.gov/pubmed/6245831?dopt=AbstractPlus

9. Grabe M, Andersson KE, Forsgren A et al. Concentrations of cefotaxime in serum, urine and tissues of urological patients. Infection. 1981; 9:154-8.

10. Luthy R, Munch R, Blaser J et al. Human pharmacology of cefotaxime (HR 756), a new cephalosporin. Antimicrob Agents Chemother. 1979; 16:127-33. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=352809&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/485125?dopt=AbstractPlus

11. Fu K, Aswapokee P, Ho I et al. Pharmacokinetics of cefotaxime. Antimicrob Agents Chemother. 1979; 16:592-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=352911&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/526000?dopt=AbstractPlus

12. Wise R, Baker S, Livingston R. Comparison of cefotaxime and moxalactam pharmacokinetics and tissue levels. Antimicrob Agents Chemother. 1980; 18:369-71. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=284007&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6252833?dopt=AbstractPlus

13. Wise R, Wright N, Wills PJ. Pharmacology of cefotaxime and its desacetyl metabolite in renal and hepatic disease. Antimicrob Agents Chemother. 1981; 19:526-31. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181470&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6264849?dopt=AbstractPlus

14. Luthy R, Blaser J, Bonetti A et al. Comparative multiple-dose pharmacokinetics of cefotaxime, moxalactam, and ceftazidime. Antimicrob Agents Chemother. 1981; 20:567-75. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181752&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6275776?dopt=AbstractPlus

15. Kafetzis DA, Brater DC, Kanarios J et al. Clinical pharmacology of cefotaxime in pediatric patients. Antimicrob Agents Chemother. 1981; 20:487-90. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181728&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6282194?dopt=AbstractPlus

16. Wise R, Wright N. cefotaxime metabolism and renal function. Lancet. 1979; 1:1106-7.

17. Clumeck N, Vanhoof R, Valaethem Y. Cefotaxime and nephrotoxicity. Lancet. 1979; 1:835.

18. Chamberlain J, Coombes JD, Dell D et al. Metabolism of cefotaxime in animals and man. J Antimicrob Chemother. 1980; 6(Suppl A):69-78. http://www.ncbi.nlm.nih.gov/pubmed/6252182?dopt=AbstractPlus

19. Fillastre JP, Leroy A, Humvert G et al. Pharmacokinetics of cefotaxime in subjects with normal and impaired renal function. J Antimicrob Chemother. 1980; 6(Suppl A):103-11. http://www.ncbi.nlm.nih.gov/pubmed/6252138?dopt=AbstractPlus

20. Karimi A, Seeger K, Stolke D et al. Cefotaxime concentration of cerebrospinal fluid. J Antimicrob Chemother. 1980; 6(Suppl A):119-20. http://www.ncbi.nlm.nih.gov/pubmed/6252140?dopt=AbstractPlus

21. Kafetzis DA, Lazarides CV, Siafas CA et al. Transfer of cefotaxime in human milk and from mother to fetus. J Antimicrob Chemother. 1980; 6(Suppl A):135-41. http://www.ncbi.nlm.nih.gov/pubmed/6252147?dopt=AbstractPlus

39. Kobayashi Y, Morikawa Y, Huruta T et al. Clinical evaluation of cefotaxime in the treatment of purulent meningitis in children. Clin Ther. 1981; 4(Suppl A):89-110. http://www.ncbi.nlm.nih.gov/pubmed/6276000?dopt=AbstractPlus

48. Neu HC, Aswapokee N, Fu KP et al. Antibacterial activity of a new 1-oxa cephalosporin compared with that of other β-lactam compounds. Antimicrob Agents Chemother. 1979; 16:141-9. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=352811&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/314774?dopt=AbstractPlus

50. Hall WH, Opfer BJ, Gerding DN. Comparative activity of the oxa-β-lactam LY127935, cefotaxime, cefoperazone, cefamandole, and ticarcillin against multiply resistant gram-negative bacilli. Antimicrob Agents Chemother. 1980; 17:273-9. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=283771&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6247970?dopt=AbstractPlus

59. File TM, Tan JS. Enterococcal sensitivity to third generation cephalosporins. Lancet. 1981; 2:477. http://www.ncbi.nlm.nih.gov/pubmed/6115237?dopt=AbstractPlus

61. Kurtz TO, Winston DJ, Hindler JA et al. Comparative in vitro activity of moxalactam, cefotaxime, cefoperazone, piperacillin, and aminoglycosides against gram-negative bacilli. Antimicrob Agents Chemother. 1980; 18:645-8. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=284064&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6255864?dopt=AbstractPlus

64. Lang SDR, Edwards DJ, Durack DT. Comparison of cefoperazone, cefotaxime, and moxalactam (LY127935) against aerobic gram-negative bacilli. Antimicrob Agents Chemother. 1980; 17:488-93. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=283815&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6252831?dopt=AbstractPlus

65. Barza M, Tally FP, Jacobus NV et al. In vitro activity of LY127935. Antimicrob Agents Chemother. 1979; 16:287-92. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=352847&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/507785?dopt=AbstractPlus

66. Pulliam L, Hadley WK, Mills J. In vitro comparison of third-generation cephalosporins, piperacillin, dibekacin, and other aminoglycosides against aerobic bacteria. Antimicrob Agents Chemother. 1981; 19:490-2. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181459&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6454384?dopt=AbstractPlus

68. Wise R, Andrews JM, Bedford KA. LY127935, a novel oxa-β-lactam: an in vitro comparison with other β-lactam antibiotics. Antimicrob Agents Chemother. 1979; 16:341-5. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=352858&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/507788?dopt=AbstractPlus

69. Masuyoshi S, Arai S, Miyamoto M et al. In vitro antimicrobial activity of cefotaxime, a new cephalosporin. Antimicrob Agents Chemother. 1980; 18:1-8. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=283930&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6251749?dopt=AbstractPlus

70. Cherubin CE, Corrado ML, Sierra MF et al. Susceptibility of gram-positive cocci to various antibiotics, including cefotaxime, moxalactam, and N-formimidoyl thienamycin. Antimicrob Agents Chemother. 1981; 20:553-5. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181744&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6282200?dopt=AbstractPlus

72. Trager GM, White GW, Zimelis VM et al. In vitro comparison of three new cephalosporins: LY-127935, cefotaxime and cefoperazone. Chemotherapy. 1981; 27:34-8. http://www.ncbi.nlm.nih.gov/pubmed/6260435?dopt=AbstractPlus

75. Appelbaum PC, Tamim J, Stavitz J et al. Sensitivity of Acinetobacter calcoaceticus strains to seven cephalosporins. Lancet. 1981; 2:472. http://www.ncbi.nlm.nih.gov/pubmed/6115226?dopt=AbstractPlus

78. Verbist L. Comparison of in vitro activities of eight β-lactamase-stable cephalosporins against β-lactamase-producing gram-negative bacilli. Antimicrob Agents Chemother. 1981; 19:407-13. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181446&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6972728?dopt=AbstractPlus

80. Tutlane VA, McCloskey RV, Trent JA. In vitro comparison of N-formimidoyl thienamycin, piperacillin, cefotaxime, and cefoperazone. Antimicrob Agents Chemother. 1981; 20:140-3. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181646&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6269481?dopt=AbstractPlus

100. Papdatos CJ, Kafetzis DA, Kanarios J. Cefotaxime in the treatment of severe paediatric infections. J Antimicrob Chemother. 1980; 6(Suppl A):243-8. http://www.ncbi.nlm.nih.gov/pubmed/6252164?dopt=AbstractPlus

106. King A, Warren C, Shannon K et al. The in vitro antibacterial activity of cefotaxime compared with that of cefuroxime and cefoxitin. J Antimicrob Chemother. 1980; 6:479-94. http://www.ncbi.nlm.nih.gov/pubmed/6253433?dopt=AbstractPlus

109. Neu HC, Aswapokee N, Fu KP. HR 756, a new cephalosporin active against gram-positive and gram-negative aerobic and anaerobic bacteria. Antimicrob Agents Chemother. 1979; 15:273-81. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=352646&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/426518?dopt=AbstractPlus

115. Kosmidis J, Stathakis CH, Mantopoulos K et al. Clinical pharmacology of cefotaxime including penetration into bile, sputum, bone and cerebrospinal fluid. J Antimicrob Chemother. 1980; 6(suppl A):147-51. http://www.ncbi.nlm.nih.gov/pubmed/6252149?dopt=AbstractPlus

116. Soussy CJ, Deforges LP, Le Van Thoi J et al. Cefotaxime concentration in the bile and wall of the gallbladder. J Antimicrob Chemother. 1980; 6(Suppl A):125-30. http://www.ncbi.nlm.nih.gov/pubmed/6252143?dopt=AbstractPlus

117. Moreau L, Durand H, Biclet P et al. Cefotaxime concentrations in ascites. J Antimicrob Chemother. 1980; 6(Suppl A):121-2. http://www.ncbi.nlm.nih.gov/pubmed/6252141?dopt=AbstractPlus

166. Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep. 2012; 61:590-4. http://www.ncbi.nlm.nih.gov/pubmed/22874837?dopt=AbstractPlus

167. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010; 59(RR-12):1-110.

168. . Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett. 2012; 10:73-8; quiz 79-80. http://www.ncbi.nlm.nih.gov/pubmed/22996382?dopt=AbstractPlus

169. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70:195-283. http://www.ncbi.nlm.nih.gov/pubmed/23327981?dopt=AbstractPlus

197. Anon. Drugs for bacterial infections. Med Lett Treat Guid. 2010; 8:43-52.

202. Barry AL, Brown SD, Novick WJ. In vitro activities of cefotaxime, ceftriaxone, ceftazidime, cefpirome, and penicillin against Streptococcus pneumoniae isolates. Antimicrob Agents Chemother. 1995; 39:2193-6. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=162912&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8619565?dopt=AbstractPlus

203. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: Twenty-first informational supplement. CLSI document M100-S21. Wayne, PA; 2011.

210. Bartlett JG. Treatment of antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1984; 6(Suppl 1):S235-41.

215. Sanders CC, Sanders WE Jr. Microbial resistance to newer generation β-lactam antibiotics: clinical and laboratory implications. J Infect Dis. 1985; 151:399-406. http://www.ncbi.nlm.nih.gov/pubmed/2982957?dopt=AbstractPlus

216. Sanders CC. Novel resistance selected by the new expanded-spectrum cephalosporins: a concern. J Infect Dis. 1983; 147:585-9. http://www.ncbi.nlm.nih.gov/pubmed/6601169?dopt=AbstractPlus

217. Curtis NAC, Eisenstadt RL, Rudd C et al. Inducible type I β-lactamases of gram-negative bacteria and resistance to β-lactam antibiotics. J Antimicrob Chemother. 1986; 17:51-61. http://www.ncbi.nlm.nih.gov/pubmed/3485092?dopt=AbstractPlus

218. Centers for Disease Control and Prevention. Diagnosis and management of foodborne illness. A primer for physicians. MMWR Recomm Rep. 2001; 50(RR-2):1-69. http://www.cdc.gov/mmwr/PDF/rr/rr5002.pdf

219. Jones RN, Barry AL. Antimicrobial activity of ceftriaxone, cefotaxime, desacetylcefotaxime, and cefotaxime-desacetylcefotaxime in the presence of human serum. Antimicrob Agents Chemother. 1987; 31:818-20. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174842&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3606081?dopt=AbstractPlus

220. Goldstein EJ, Cherubin CE, Shulman M. Comparison of microtiter broth dilution and agar dilution methods for susceptibility testing of Eikenella corrodens. Antimicrob Agents Chemother. 1983; 23:42-5. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=184613&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6338819?dopt=AbstractPlus

221. Goldstein EJ, Gombert ME, Agyare EO. Susceptibility of Eikenella corrodens to newer beta-lactam antibiotics. Antimicrob Agents Chemother. 1980; 18:832-3. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=284099&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/7004350?dopt=AbstractPlus

222. Ahonkhai VI, Cerubin CE, Sierra MF et al. In vitro susceptibility of Campylobacter fetus subsp jejuni to N-formimidoyl thienamycin, rosaramicin, cefoperazone, and other antimicrobial agents.. Antimicrob Agents Chemother. 1981; 20:850-1. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=181813&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6459767?dopt=AbstractPlus

223. Van der Auwera P, Scorneaux B. In vitro susceptibility of Campylobacter jejuni to 27 antimicrobial agents and various combinations of β-lactams with clavulanic acid or sulbactam. Antimicrob Agents Chemother. 1985; 28:37-40. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176305&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/2994557?dopt=AbstractPlus

224. Fick RB, Alexander MR, Prince RA et al. Penetration of cefotaxime into respiratory secretions. Antimicrob Agents Chemother. 1987; 31:815-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174841&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3606080?dopt=AbstractPlus

225. Nichols RL, Wikler MA, McDevitt JT et al. Coagulopathy associated with extended-spectrum cephalosporins in patients with serious infections. Antimicrob Agents Chemother. 1987; 31:281-5. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174706&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3471181?dopt=AbstractPlus

226. Saxon A, Beall GN, Rohr AS et al. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med. 1987; 107:204-15. http://www.ncbi.nlm.nih.gov/pubmed/3300459?dopt=AbstractPlus

227. Norrby SR. Adverse reactions and interactions with newer cephalosporins and cephamycin antibiotics. Medical Toxicol. 1986; 1:32-46.

228. Barriere SL, Flaherty JF. Third generation cephalosporins: a critical evaluation. Clin Pharm. 1984; 3:351-73. http://www.ncbi.nlm.nih.gov/pubmed/6432420?dopt=AbstractPlus

229. Balant L, Dayer P, Auckenthaler R. Clinical pharmacokinetics of the third generation cephalosporins. Clin Pharmacokinet. 1985; 10:101-43. http://www.ncbi.nlm.nih.gov/pubmed/3888488?dopt=AbstractPlus

230. Sanofi-Aventis. Claforan (cefotaxime) injection and for injection prescribing information. Bridgewater, NJ; 2009 Jul.

231. American Academy of Pediatrics. Report of the task force on diagnosis and management of meningitis. Pediatrics. 1986; 78(Suppl):959-82. http://www.ncbi.nlm.nih.gov/pubmed/3763317?dopt=AbstractPlus

232. Alvarez S, Jones M, Holtsclaw-Berk S et al. In vitro susceptibilities and β-lactamase production of 53 isolates of Branhamella catarrhalis. Antimicrob Agents Chemother. 1985; 27:646-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180113&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3873905?dopt=AbstractPlus

233. Hammerschlag MR, Gleyzer A. In vitro activity of a group of broad-spectrum cephalosporins and other β-lactam antibiotics against Chlamydia trachomatis. Antimicrob Agents Chemother. 1983; 23:493-4. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=184677&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6847175?dopt=AbstractPlus

234. Muytjens HL, Heessen FW. In vitro activities of thirteen β-lactam antibiotics against Chlamydia trachomatis. Antimicrob Agents Chemother. 1982; 22:520-1. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=183777&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/7137988?dopt=AbstractPlus

235. Cullmann W, Opferkuch W, Stieglitz M et al. A comparison of the antibacterial activities of N-formimidoyl thienamycin (MKO787) with those of other recently developed β-lactam derivatives. Antimicrob Agents Chemother. 1982; 22:302-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=183729&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6821459?dopt=AbstractPlus

236. Mandell W, Neu HC. In vitro activity of CI-934, a new quinolone, compared with that of other quinolones and other antimicrobial agents. Antimicrob Agents Chemother. 1986; 29:852-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=284166&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3729343?dopt=AbstractPlus

237. Neu HC, Labthavikul P. In vitro antibacterial activity and β-lactamase stability of E-0702, a new cephalosporin. Antimicrob Agents Chemother. 1983; 24:313-20. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=185318&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6605718?dopt=AbstractPlus

238. Schell RF, Francisco M, Bihl JA et al. The activity of ceftazidime compared with those of aztreonam, newer cephalosporins and Sch 29482 against nonfermentative gram-negative bacilli. Chemotherapy. 1985; 31:181-90. http://www.ncbi.nlm.nih.gov/pubmed/3888543?dopt=AbstractPlus

239. Fass RJ. In vitro activity of ciprofloxacin (Bay o 9867). Antimicrob Agents Chemother. 1983; 24:568-74. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=185375&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6228192?dopt=AbstractPlus

240. Jones RN, Barry AL, Thornsberry C et al. The anti-microbial activity, beta-lactamase stability, and disk diffusion susceptibility testing of carumonam (RO 17-2301, AMA-1080), a new monobactam. Am J Clin Pathol. 1986; 86:608-18. http://www.ncbi.nlm.nih.gov/pubmed/3096130?dopt=AbstractPlus

241. Eliopoulos GM, Reiszner E, Moellering RC Jr. In vitro activity of Sch 34343 against enterococci and other gram-positive bacteria. Antimicrob Agents Chemother. 1985; 27:28-32. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176199&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3845792?dopt=AbstractPlus

242. Eliopoulos GM, Moellering AE, Reiszner E et al. In vitro activities of the quinolone antimicrobial agents A-56619 and A-56620. Antimicrob Agents Chemother. 1985; 28:514-20. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180295&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3935046?dopt=AbstractPlus

243. Baxter Healthcare Corporation. Descriptive information on premixed frozen products. Baxter Healthcare Corporation: Deerfield, IL; 1992 Sep.

244. Calder MA, Croughan MJ, McLeod DT et al. The incidence and antibiotic susceptibility of Branhamella catarrhalis in respiratory infections. Drugs. 1986; 31(Suppl 3):11-6. http://www.ncbi.nlm.nih.gov/pubmed/3488189?dopt=AbstractPlus

245. Guerrant RL, Gilder TV, Steiner TS et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001; 32:331-50. http://www.ncbi.nlm.nih.gov/pubmed/11170940?dopt=AbstractPlus

246. Goldstein EJC, Citron DM. Comparative in vitro inhibitory and killing activity of cefpirome, ceftazidime, and cefotaxime against Pseudomonas aeruginosa, Enterococci, Staphylococcus epidermidis, and methicillin-susceptible and -resistant and tolerant and nontolerant Staphylococcus aureus. Antimicrob Agents Chemother. 1985; 28:160-2. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176333&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3929677?dopt=AbstractPlus

247. Garzone P, Lyon J, Yu VL. Third-generation and investigational cephalosporins: II. Microbiologic review and clinical summaries. Drug Intell Clin Pharm. 1983; 17:615-22. http://www.ncbi.nlm.nih.gov/pubmed/6311502?dopt=AbstractPlus

248. Jones RN, Thornsberry C. Cefotaxime: a review of in vitro antimicrobial properties and spectrum of activity. Rev Infect Dis. 1982; 4(Suppl):S300-15.

249. Goldstein EJC, Cherubin CE, Corrado ML et al. Comparative susceptibility of Yersinia enterolitica, Eikenella corrodens, and penicillin-resistant and penicillin-susceptible Streptococcus pneumoniae to β-lactam and alternative antimicrobial agents. Rev Infect Dis. 1982; 4(Suppl):S406-10.

250. Anon. Vibrio vulnificus infections associated with eating raw oysters—Los Angeles, 1996. MMWR Morb Mortal Wkly Rep. 1996; 45:621-4. http://www.ncbi.nlm.nih.gov/pubmed/8965788?dopt=AbstractPlus

252. Kumar A, Kelly KJ. In vitro activity of cefixime (CL284635) and other antimicrobial agents against Haemophilus isolates from pediatric patients. Chemotherapy. 1988; 34:30-5. http://www.ncbi.nlm.nih.gov/pubmed/3258232?dopt=AbstractPlus

253. Nakashio S, Nakamura M. In vitro activity of cefotaxime against clinically significant pathogens. Drugs. 1988; 35:14-21. http://www.ncbi.nlm.nih.gov/pubmed/3260852?dopt=AbstractPlus

254. Kawakami Y, Okimura Y, Horiuchi N et al. In vitro activity of cefotaxime, ceftizoxime, cefmenoxime, and latamoxef in comparison with other β-lactam antibiotics against recent clinical isolates of Haemophilus influenzae and Haemophilus parainfluenzae. Microbiol Immunol. 1982; 26:617-21.

255. Chin NX, Neu HC. In vitro antibacterial activity and beta-lactamase stability of CL 118523, an aminothiazol iminomethoxy cephalosporin. Chemiotherapia. 1987; 6:329-36.

256. Chin NX, Neu HC. Comparative in vitro activity and beta-lactamase stability of CGP 31523A, a new aminothiazolyl cephalosporin. Chemioterapia. 1986; 5:92-100. http://www.ncbi.nlm.nih.gov/pubmed/3518967?dopt=AbstractPlus

257. Vuram-Rapp U, Kayser FH, Barberis-Maino L. Antibacterial properties of imipenem with special reference to the activity against methicillin-resistant staphylococci, cefotaxime-resistant enterobacteriaceae and Pseudomonas aeruginosa. J Antimicrob Chemother. 1986; 18:27-33. http://www.ncbi.nlm.nih.gov/pubmed/3102452?dopt=AbstractPlus

258. Moellering RC Jr, Eliopoulos GM. Activity of cefotaxime against enterococci. Diagn Microbiol Infect Dis. 1984; 2(Suppl 3):85-90S. http://www.ncbi.nlm.nih.gov/pubmed/6232086?dopt=AbstractPlus

259. Winstanley TG, Spencer RC. An in vitro study of the interaction between cefotaxime and desacetylcefotaxime. Drugs Exp Clin Res. 1986; 12:967-71. http://www.ncbi.nlm.nih.gov/pubmed/3471432?dopt=AbstractPlus

260. Elliott AM, Karam GH, Cobbs CG. Interaction of cefotaxime and aminoglycosides against enterococci in vitro. Antimicrob Agents Chemother. 1983; 24:847-50. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=185394&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6318661?dopt=AbstractPlus

261. Goldstein EJC, Citron DM. Comparative in vitro inhibitory and killing activity of cefpirome, ceftazidime, and cefotaxime against Pseudomonas aeruginosa, enterococci, Staphylococcus epidermidis, and methicillin-susceptible and -resistant and tolerant and nontolerant Staphylococcus aureus. Antimicrob Agents Chemother. 1985; 28:160-2. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176333&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3929677?dopt=AbstractPlus

262. Thornsberry C, Jones RN, Barry AL et al. Antimicrobial susceptibility tests with cefotaxime and correlation with clinical bacteriologic response. Rev Infect Dis. 1982; 4(Suppl):S316-24.

263. Asmar Bi, Thirumoorthi MC, Buckley JA et al. Cefotaxime diffusion into cerebrospinal fluid of children with meningitis. Antimicrob Agents Chemother. 1985; 28:138-40. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176325&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/4037772?dopt=AbstractPlus

264. Trang JM, Jacobs RF, Kearns GL et al. Cefotaxime and desacetylcefotaxime pharmacokinetics in infants and children with meningitis. Antimicrob Agents Chemother. 1985; 28:791-5. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180330&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/4083862?dopt=AbstractPlus

265. Preac-Mursic V, Wilske B, Schierz G et al. In vitro and in vivo susceptibility of Borrelia burgdorferi. Eur J Clin Microbiol. 1987; 6:424-6. http://www.ncbi.nlm.nih.gov/pubmed/3665899?dopt=AbstractPlus

266. Hassler D, Zoller L, Haude M et al. Cefotaxime versus penicillin in the late stage of Lyme disease—prospective, randomized therapeutic study. Infection. 1990; 18:16-20. http://www.ncbi.nlm.nih.gov/pubmed/2179134?dopt=AbstractPlus

267. Pfister H-W, Preac-Mursic V, Wilske B et al. Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme borreliosis. Arch Neurol. 1989; 46:1190-4. http://www.ncbi.nlm.nih.gov/pubmed/2684107?dopt=AbstractPlus

268. Abdel-Hag NM, Asmar BI, Abuhammour WM et al. Yersinia enterocolitica infection in children. Pediatr Infect Dis J. 2000; 19:954-8. http://www.ncbi.nlm.nih.gov/pubmed/11055595?dopt=AbstractPlus

269. Mandell LA, Wunderink RG, Anzueto A et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. http://www.ncbi.nlm.nih.gov/pubmed/17278083?dopt=AbstractPlus

270. Luft BJ, Gorevic PD, Halperin JJ et al. A perspective on the treatment of Lyme borreliosis. Rev Infect Dis. 1989; 11(Suppl 6):S1518-25.

271. Neu HC. A perspective on therapy of Lyme infection. Ann NY Acad Sci. 1988; 539:314-6. http://www.ncbi.nlm.nih.gov/pubmed/3056200?dopt=AbstractPlus

272. Reviewers’ comments on Lyme disease revisions (personal observations). 1989 Dec 4.

273. Anon. Treatment of Lyme Disease. Med Lett Drugs Ther. 2000; 42:37-9. http://www.ncbi.nlm.nih.gov/pubmed/10825919?dopt=AbstractPlus

274. Steere AC, Schoen RT, Taylor E. The clinical evolution of Lyme arthritis. Ann Intern Med. 1987; 107:725-31. http://www.ncbi.nlm.nih.gov/pubmed/3662285?dopt=AbstractPlus

275. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.

276. Anon. Prevalence of penicillin-resistant Streptococcus pneumoniae—Connecticut, 1992-1993. MMWR Morb Mortal Wkly Rep. 1994; 43:216,217,223. http://www.ncbi.nlm.nih.gov/pubmed/8127327?dopt=AbstractPlus

277. Leggiadro RJ. Penicillin- and cephalosporin-resistant Streptococcus pneumoniae: an emerging threat Pediatrics. 1994; 93:500-3.

278. Baxter Healthcare Corporation. Descriptive information on premixed products. Deerfield, IL; 1994 Feb 21.

279. Hofmann J, Cetron MS, Farley MM et al. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med. 1995; 333:481-6. http://www.ncbi.nlm.nih.gov/pubmed/7623880?dopt=AbstractPlus

280. Pallares R, Linares J, Vadillo M et al. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med. 1995; 333:474-80. http://www.ncbi.nlm.nih.gov/pubmed/7623879?dopt=AbstractPlus

281. Klass PE, Klein JO. Therapy of bacterial sepsis, meningitis and otitis media in infants and children: 1992 poll of directors of programs in pediatric infectious diseases. Pediatr Infect Dis J. 1992; 11:702-5. http://www.ncbi.nlm.nih.gov/pubmed/1448307?dopt=AbstractPlus

282. Feigin RD, McCracken GH, Klein JO. Diagnosis and management of meningitis. Pediatr Infect Dis J. 1992; 11:785-814. http://www.ncbi.nlm.nih.gov/pubmed/1448332?dopt=AbstractPlus

283. Sloas NM, Barrett FF, Chesney PJ et al. Cephalosporin treatment failures in penicillin- and cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J. 1992; 11:662-6. http://www.ncbi.nlm.nih.gov/pubmed/1523079?dopt=AbstractPlus

284. Sigal LH. Early disseminated Lyme disease: cardiac manifestations. Am J Med. 1995; 98(4A):25-8S.

285. Sigal LH. Management of Lyme disease refractory to antibiotic therapy. Rheum Dis Clin North Am. 1995; 21:217-30. http://www.ncbi.nlm.nih.gov/pubmed/7732170?dopt=AbstractPlus

286. Spach DH, Liles WC, Campbell GL et al. Tick-borne diseases in the United States. N Engl J Med. 1993; 329:936-47. http://www.ncbi.nlm.nih.gov/pubmed/8361509?dopt=AbstractPlus

287. Nadelman RB, Wormser GP. Erythema migrans and early Lyme disease. Am J Med. 1995; 98(4A):15-23S.

288. Nau R, Prange HW, Muth P et al. Passage of cefotaxime and ceftriaxone into cerebrospinal fluid of patients with inflamed meninges. Antimicrob Agents Chemother. 1993; 37:1518-24. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=188005&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8363385?dopt=AbstractPlus

289. Ko RJ, Sattler FR, Nichols S et al. Pharmacokinetics of cefotaxime and desacetylcefotaxime in patients with liver disease. Antimicrob Agents Chemother. 1991; 35:1376-80. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=245175&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/1929296?dopt=AbstractPlus

290. Todd PA, Brogden RN. Cefotaxime: an update of its pharmacology and therapeutic use. Drugs. 1990; 40:608-51. http://www.ncbi.nlm.nih.gov/pubmed/2083516?dopt=AbstractPlus

291. Jacobs RF, Darville T, Parks JA et al. Safety profile and efficacy of cefotaxime for the treatment of hospitalized children. Clin Infect Dis. 1992; 14:56-65. http://www.ncbi.nlm.nih.gov/pubmed/1571464?dopt=AbstractPlus

292. Chuang YC, Liu JW, Ko WC et al. In vitro synergism between cefotaxime and minocycline against Vibrio vulnificus. Antimicrob Agents Chemother. 1997; 41:2214-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=164095&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/9333050?dopt=AbstractPlus

293. Chuang YC, Ko WC, Wang St et al. Minocycline and cefotaxime in the treatment of experimental murine Vibrio vulnificus infection. Antimicrob Agents Chemother. 1998; 42:1319-22. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=105595&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/9624467?dopt=AbstractPlus

294. Kumamoto KS, Vukich DJ. Clinical infections of Vibrio vulnificus: a case report and review of the literature. J Emerg Med. 1998; 16:61-6. http://www.ncbi.nlm.nih.gov/pubmed/9472762?dopt=AbstractPlus

295. Anon. Vibrio vulnificus infections associated with raw oyster consumption—Florida, 1981-1992. MMWR Morb Mortal Wkly Rep. 1993; 42:405-7. http://www.ncbi.nlm.nih.gov/pubmed/8497241?dopt=AbstractPlus

296. Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. N Engl J Med. 1997; 336:708-16. http://www.ncbi.nlm.nih.gov/pubmed/9041103?dopt=AbstractPlus

297. American Academy of Pediatrics Committee on Infectious Diseases. Therapy for children with invasive pneumococcal infections. Pediatrics. 1997; 99:289-99. http://www.ncbi.nlm.nih.gov/pubmed/9024464?dopt=AbstractPlus

298. Walker CK, Kahn JG, Washington AE et al. Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy. J Infect Dis. 1993; 168:969-78. http://www.ncbi.nlm.nih.gov/pubmed/8376843?dopt=AbstractPlus

299. Cunha BA. Treatment of pelvic inflammatory disease. Clin Pharm. 1990; 9:275-85. http://www.ncbi.nlm.nih.gov/pubmed/2184973?dopt=AbstractPlus

300. 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. http://www.ncbi.nlm.nih.gov/pubmed/7803638?dopt=AbstractPlus

301. Adu A, Armour CL. Drug utilisation review (DUR) of the third generation cephalosporins: focus on ceftriaxone, ceftazidime and cefotaxime. Drugs. 1995; 50:423-39. http://www.ncbi.nlm.nih.gov/pubmed/8521766?dopt=AbstractPlus

302. Kishiyam JL, Adelman DC. The cross-reactivity and immunology of β-lactam antibiotics. Drug Saf. 1994; 10:318-27. http://www.ncbi.nlm.nih.gov/pubmed/8018304?dopt=AbstractPlus

303. Thompson JW, Jacobs RF. Adverse effects of newer cephalosporins: an update. Drug Saf. 1993; 9:132-42. http://www.ncbi.nlm.nih.gov/pubmed/8397890?dopt=AbstractPlus

304. Nataro JP. Treatment of bacterial enteritis. Pediatr Infect Dis J. 1998; 17:420-2. http://www.ncbi.nlm.nih.gov/pubmed/9613658?dopt=AbstractPlus

305. Zenilman JM. Typhoid fever. JAMA. 1997; 278:847-50. http://www.ncbi.nlm.nih.gov/pubmed/9293994?dopt=AbstractPlus

306. Soe GB, Overturf GD. Treatment of typhoid fever and other systemic salmonelloses with cefotaxime, ceftriaxone, cefoperazone, and other newer cephalosporins. Rev Infect Dis. 1987; 9:719-36. http://www.ncbi.nlm.nih.gov/pubmed/3125577?dopt=AbstractPlus

307. Mermin JH, Townes JM, Gerber M et al. Typhoid fever in the United States, 1985-1994: changing risks of international travel and increasing antimicrobial resistance. Arch Intern Med. 1998; 158:633-8. http://www.ncbi.nlm.nih.gov/pubmed/9521228?dopt=AbstractPlus

308. Guerrero MLF, Ramos JM, Nunez A et al. Focal infections due to non-typhi Salmonella in patients with AIDS: report of 10 cases and review. Clin Infect Dis. 1997; 25:690-7. http://www.ncbi.nlm.nih.gov/pubmed/9314463?dopt=AbstractPlus

310. Solomkin JS, Mazuski JE, Bradley JS et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50:133-64. http://www.ncbi.nlm.nih.gov/pubmed/20034345?dopt=AbstractPlus

311. Karam GH, Sanders CV, Aldridge KE. Role of newer antimicrobial agents in the treatment of mixed aerobic and anaerobic infections. Surg Gynecol Obstet. 1991; 172(Suppl):57-64. http://www.ncbi.nlm.nih.gov/pubmed/2024228?dopt=AbstractPlus

312. Cormican MG, Jones RN. Antimicrobial activity of cefotaxime tested against infrequently isolated pathogenic species (unusual pathogens). Diagn Microbiol Infect Dis. 1995; 22:43-8. http://www.ncbi.nlm.nih.gov/pubmed/7587049?dopt=AbstractPlus

313. Gomez-Garces JL, Alos JI, Sanchez J et al. Bacteremia by multidrug-resistant Capnocytophaga sputigena. J Clin Microbiol. 1994; 32:1067-9. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=267185&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8027314?dopt=AbstractPlus

314. Hawkey PM, Smith SD, Hayes J et al. In vitro susceptibility of Capnocytophaga species to antimicrobial agents. Antimicrob Agents Chemother. 1987; 31:331-2. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174718&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3566254?dopt=AbstractPlus

315. Rummen JL, Gordts B, Van Landuyt HW. In vitro susceptibility of Capnocytophaga species to 29 antimicrobial agents. Antimicrob Agents Chemother. 1986; 30:739-42. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176524&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/3800350?dopt=AbstractPlus

316. Pers C, Gahrn-Hanson B, Frederiksen W. Capnocytophaga canimorsus septicemia in Denmark, 1982-1995: review of 39 cases. Clin Infect Dis. 1996; 23:71-5. http://www.ncbi.nlm.nih.gov/pubmed/8816132?dopt=AbstractPlus

317. Pitkin DH, Sheikh W, Nadler HL. Comparative in vitro activity of meropenem versus other extended-spectrum antimicrobials against randomly chosen and selected resistant clinical isolates tested in 26 North American centers. Clin Infect Dis. 1997; 24(Suppl 2):S238-48.

318. Tunkel AP, Scheld WM. Issues in the management of bacterial meningitis. Am Fam Physician. 1997; 56:1355-62. http://www.ncbi.nlm.nih.gov/pubmed/9337758?dopt=AbstractPlus

319. Townsend GC, Scheld WM. Infections of the central nervous system. Adv Intern Med. 1998; 43:403-47. http://www.ncbi.nlm.nih.gov/pubmed/9506189?dopt=AbstractPlus

320. Paris MM, Ramilo I, McCracken GH. Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother. 1995; 2171-5.

321. Buchingham SC, Brown SP, San Joaquin VH. Breakthrough bacteremia and meningitis during treatment with cephalosporins parenterally for pneumococcal pneumonia. J Pediatr. 1998; 132:174-6. http://www.ncbi.nlm.nih.gov/pubmed/9470026?dopt=AbstractPlus

322. Pacheco TR, Cooper CK, Hardy DJ et al. Failure of cefotaxime treatment in an adult with Streptococcus pneumoniae meningitis. Am J Med. 1997; 102:303-5. http://www.ncbi.nlm.nih.gov/pubmed/9217602?dopt=AbstractPlus

323. Wubbel L, McCracken GH. Management of bacterial meningitis: 1998. Pediatr Rev. 1998; 19:78-84. http://www.ncbi.nlm.nih.gov/pubmed/9509854?dopt=AbstractPlus

324. McIntyre PB, Berkey CS, King SM et al. Dexamethasone as adjunctive therapy in bacterial meningitis: a meta-analysis of randomized clinical trials since 1988. JAMA. 1997; 278:925-31. http://www.ncbi.nlm.nih.gov/pubmed/9302246?dopt=AbstractPlus

325. Chesney PJ, Halsey NA, Marcy SM. Treatment of bacterial meningitis. N Engl J Med. 1997; 337:793-4. http://www.ncbi.nlm.nih.gov/pubmed/9289652?dopt=AbstractPlus

326. Quagliarello V, Scheld WM. Treatment of bacterial meningitis. N Engl J Med. 1997; 337:794. http://www.ncbi.nlm.nih.gov/pubmed/9289653?dopt=AbstractPlus

327. Bhattacharya S. Management of meningitis caused by penicillin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother. 1996; 40:827-8. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=163213&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8851626?dopt=AbstractPlus

328. Ahmed A. A critical evaluation of vancomycin for treatment of bacterial meningitis. Pediatr Infect Dis J. 1997; 16:895-903. http://www.ncbi.nlm.nih.gov/pubmed/9306486?dopt=AbstractPlus

329. Kleiman MB, Weinberg GA, Reynolds JK et al. Meningitis with beta-lactam-resistant Streptococcus pneumoniae: the need for early repeat lumbar puncture. Pediatr Infect Dis J. 1993; 12:782-4. http://www.ncbi.nlm.nih.gov/pubmed/8414810?dopt=AbstractPlus

330. Centers for Disease Control and Prevention. Drug-resistant Streptococcus pneumoniae—Kentucky and Tennessee, 1993. MMWR Morb Mortal Wkly Rep. 1994; 43:23-7. http://www.ncbi.nlm.nih.gov/pubmed/8277937?dopt=AbstractPlus

331. Friedland IR, Shelton S, Paris M et al. Dilemmas in diagnosis and management of cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J. 1993; 12:196-200. http://www.ncbi.nlm.nih.gov/pubmed/8451095?dopt=AbstractPlus

332. Chesney PJ. The escalating problem of antimicrobial resistance in Streptococcus pneumoniae. Am J Dis Child. 1992; 146:912-6. http://www.ncbi.nlm.nih.gov/pubmed/1636656?dopt=AbstractPlus

333. John CC. Treatment failure with use of a third-generation cephalosporin for penicillin-resistant pneumococcal meningitis: case report and review. Clin Infect Dis. 1994; 18:188-93. http://www.ncbi.nlm.nih.gov/pubmed/8161625?dopt=AbstractPlus

334. Hofmann J, Cetron MS, Farley MM et al. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med. 1995; 333:481-6. http://www.ncbi.nlm.nih.gov/pubmed/7623880?dopt=AbstractPlus

335. Viladrich PF, Cabellos C, Pallares R et al. High doses of cefotaxime in treatment of adult meningitis due to Streptococcus pneumoniae with decreased susceptibilities to broad-spectrum cephalosporins. Antimicrob Agents Chemother. 1996; 40:218-20. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=163086&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8787909?dopt=AbstractPlus

336. Sjolin J, Lilja A, Eriksson N et al. Treatment of brain abscess with cefotaxime and metronidazole: prospective study on 15 consecutive patients. Clin Infect Dis. 1993; 17:857-63. http://www.ncbi.nlm.nih.gov/pubmed/8286626?dopt=AbstractPlus

338. Nadelman RB, Wormser GP. Lyme borreliosis. Lancet. 1998; 352:557-65. http://www.ncbi.nlm.nih.gov/pubmed/9716075?dopt=AbstractPlus

340. Rahn DW, Felz MW. Lyme disease update. Current approach to early, disseminated, and late disease. Postgrad Med. 1998; 103:51-4, 57-9, 63-4. http://www.ncbi.nlm.nih.gov/pubmed/9590986?dopt=AbstractPlus

341. Luft BJ. Treatment of erythema migrans. Ann Intern Med. 1997; 126:408-9.

342. Cohen SH, Gerding DN, Johnson S et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31:431-55. http://www.ncbi.nlm.nih.gov/pubmed/20307191?dopt=AbstractPlus

344. 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. http://www.ncbi.nlm.nih.gov/pubmed/9149180?dopt=AbstractPlus

345. 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. http://www.ncbi.nlm.nih.gov/pubmed/9659970?dopt=AbstractPlus

347. Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis. 1997; 25:763-81. http://www.ncbi.nlm.nih.gov/pubmed/9356788?dopt=AbstractPlus

348. Reviewers’ comments (personal observations).

349. Sobraques M, Maurin M, Birtles RJ et al. In vitro susceptibilities of four Bartonella bacilliformis strains to 30 antibiotic compounds. Antimicrob Agents Chemother. 1999; 43:2090-2. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=89424&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/10428946?dopt=AbstractPlus

350. Aracil B, Gomez-Garces JL, Alos JI. A study of susceptibility of 100 clinical isolates belonging to the Streptococcus milleri group to 16 cephalosporins. J Antimicrob Chemother. 1999; 43:399-402. http://www.ncbi.nlm.nih.gov/pubmed/10223596?dopt=AbstractPlus

351. Wormser GP, Dattwyler RJ, Shapiro ED et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; 43:1089-134. http://www.ncbi.nlm.nih.gov/pubmed/17029130?dopt=AbstractPlus

352. Heffelfinger JD, Dowell SF, Jorgensen JH et al. Management of community-acquired pneumonia in the era of pneumococcal resistance. A report from the drug-resistant Streptococcus pneumoniae therapeutic working group. Arch Intern Med. 2000; 160:1399-1408. http://www.ncbi.nlm.nih.gov/pubmed/10826451?dopt=AbstractPlus

353. Nocton JJ, Steere AC. Lyme disease. Adv Intern Med. 1995; 40:69-117. http://www.ncbi.nlm.nih.gov/pubmed/7747659?dopt=AbstractPlus

354. Steere AC. Lyme disease. N Engl J Med. 2001; 345:115-25. http://www.ncbi.nlm.nih.gov/pubmed/11450660?dopt=AbstractPlus

355. Steere AC. Musculoskeletal manifestations of Lyme disease. Am J Med. 1995; 98(4A):44-48S.

356. Shapiro ED. Lyme disease in children. Am J Med. 1995; 98(4A):69-73S.

357. Pachner AR. Early disseminated Lyme disease: Lyme meningitis. Am J Med. 1995; 98(4A):30-37S.

358. Klempner MS, Hu LT, Evans J et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001; 345:85-92. http://www.ncbi.nlm.nih.gov/pubmed/11450676?dopt=AbstractPlus

359. Patel R, Grogg KL, Edwards WD et al. Death from inappropriate therapy for Lyme disease. Clin Infect Dis. 2000; 31:1107-9. http://www.ncbi.nlm.nih.gov/pubmed/11049799?dopt=AbstractPlus

360. Centers for Disease Control and Prevention. Ceftriaxone-associated biliary complications of treatment of suspected disseminated Lyme disease—New Jersey, 1990-1992. MMWR Morb Mortal Wkly Rep. 1993; 42:39-42. http://www.ncbi.nlm.nih.gov/pubmed/8419791?dopt=AbstractPlus

361. Thompson C, Spielman A, Krause P. Coinfecting deer-associated zoonoses: Lyme disease, babesiosis, and ehrlichiosis. Clin Infect Dis. 2000; 33:676-85.

362. Luft BJ, Gardner P, Lightfoot RW Jr. Appropriateness of parenteral antibiotic treatment for patients with presumed Lyme disease. Ann Intern Med. 1993; 119:518. http://www.ncbi.nlm.nih.gov/pubmed/8357119?dopt=AbstractPlus

363. Lightfoot RW, Luft BJ, Rahn DW et al. Empiric parenteral antibiotic treatment of patients with fibromyalgia and fatigue and a positive serologic result for Lyme disease. A cost-effectiveness analysis. Ann Intern Med. 1993; 119:503-9. http://www.ncbi.nlm.nih.gov/pubmed/8357117?dopt=AbstractPlus

364. Ettestad PJ, Campbell GL, Welbel SF et al. Biliary complications in the treatment of unsubstantiated Lyme disease. J Infect Dis. 1995; 171:356-61. http://www.ncbi.nlm.nih.gov/pubmed/7844372?dopt=AbstractPlus

365. Tunkel AR, Hartman BJ, Kaplan SL et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004; 39:1267-84. http://www.ncbi.nlm.nih.gov/pubmed/15494903?dopt=AbstractPlus

366. American Pharmaceutical Partners, Inc. Cefotaxime for injection, USP prescribing information. Schaumburg, IL. 2004 Nov.

367. American Pharmaceutical Partners, Inc. Cefotaxime for injection, USP pharmacy bulk package prescribing information. Schaumburg, IL. 2004 Nov.

368. Pfister HW, Preac-Mursic V, Wilske B et al. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. J Infect Dis. 1991; 163:311-8. http://www.ncbi.nlm.nih.gov/pubmed/1988514?dopt=AbstractPlus

412. Panel on Opportunistic Infections in HIV-infected Adults and Adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (May 7, 2013). Updates may be available at HHS AIDS Information (AIDSinfo) website. http://www.aidsinfo.nih.gov

a. AHFS Drug Information 2003. McEvoy GK, ed. Cephalosporins General Statement. American Society of Health-System Pharmacists; 2003:125-39.

b. AHFS Drug Information 2003. McEvoy GK, ed. Cefotaxime. American Society of Health-System Pharmacists; 2003:168-78.

HID. Trissel LA. Handbook on injectable drugs. 13th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:296-303.

More about cefotaxime

Patient resources

Professional resources

Cefotaxime prescribing information

Related treatment guides

Medical Disclaimer

Drug Status

Availability Prescription only Rx

Pregnancy & Lactation Risk data available

CSA Schedule* Not a controlled drug N/A

Approval History Drug history at FDA

User Reviews & Ratings

Review this drug

Cefotaxime (Monograph)

Introduction

Uses for Cefotaxime

Bone and Joint Infections

Genitourinary Tract Infections

GI Infections

Gynecologic Infections

Intra-abdominal Infections

Meningitis and Other CNS Infections

Respiratory Tract Infections

Septicemia

Skin and Skin Structure Infections

Capnocytophaga Infections

Gonorrhea and Associated Infections

Lyme Disease

Typhoid Fever and Other Salmonella Infections

Vibrio Infections

Perioperative Prophylaxis

Related/similar drugs

Cefotaxime Dosage and Administration

Administration

IV Injection

Reconstitution

Rate of Administration

IV Infusion

Reconstitution and Dilution

Rate of Administration

IM Injection

Reconstitution

Dosage

Pediatric Patients

General Dosage for Neonates

IV or IM

General Dosage for Infants and Children 1 Month to 12 Years of Age

IV or IM

Meningitis and Other CNS Infections

IV

Gonorrhea and Associated Infections

Disseminated Gonococcal Infection or Gonococcal Scalp Abscess in Neonates†

Disseminated Gonorrhea in Children ≥8 Years of Age or Weighing ≥45 kg†

Uncomplicated Urethral, Cervical, or Rectal Gonorrhea in Adolescents

Lyme Disease†

Early Neurologic Lyme Disease†

Lyme Carditis†

Lyme Arthritis†

Late Neurologic Lyme Disease†

Adults

General Adult Dosage

Uncomplicated Infections

Moderate to Severe Infections

Severe or Life-threatening Infections

Meningitis and Other CNS Infections

IV

Meningitis Caused by S. pneumoniae

GI Infections†

Infectious Diarrhea†

Salmonella Gastroenteritis†

Respiratory Tract Infections

Community-acquired Pneumonia

Gonorrhea and Associated Infections

Uncomplicated Urethral, Cervical, or Rectal Gonorrhea

Disseminated Gonorrhea†

Lyme Disease †

Early Neurologic Lyme Disease†

Lyme Carditis†

Lyme Arthritis†

Late Neurologic Lyme Disease†

Perioperative Prophylaxis

Contaminated or Potentially Contaminated Surgery

Cesarean Section

Prescribing Limits

Pediatric Patients

Adults

Special Populations

Hepatic Impairment

Renal Impairment

Cautions for Cefotaxime

Contraindications

Warnings/Precautions

Warnings