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Cefotan Side Effects

Generic name: cefotetan

Medically reviewed by Last updated on Mar 27, 2022.

Note: This document contains side effect information about cefotetan. Some dosage forms listed on this page may not apply to the brand name Cefotan.

Applies to cefotetan: injection powder for solution.

Serious side effects of Cefotan

Along with its needed effects, cefotetan (the active ingredient contained in Cefotan) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking cefotetan:

Less common

  • Abdominal or stomach cramps or tenderness
  • back, leg, or stomach pains
  • black, tarry stools
  • bleeding gums
  • bloating
  • chest pain
  • chills
  • cough
  • dark urine
  • diarrhea
  • diarrhea, watery and severe, which may also be bloody
  • difficulty with breathing
  • fever
  • general body swelling
  • headache
  • increased thirst
  • loss of appetite
  • nausea or vomiting
  • nosebleeds
  • pain
  • painful or difficult urination
  • pale skin
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusual weight loss
  • yellowing of the eyes or skin


  • Blood in the urine
  • bluish color
  • change in frequency of urination or amount of urine
  • changes in skin color
  • drowsiness
  • increased thirst
  • swelling of the feet or lower legs
  • tenderness
  • weakness

Incidence not known

  • Blistering, peeling, or loosening of the skin
  • cough or hoarseness
  • coughing up blood
  • difficulty with swallowing
  • dizziness
  • fast heartbeat
  • fever with or without chills
  • general feeling of tiredness or weakness
  • high fever
  • increased menstrual flow or vaginal bleeding
  • itching
  • itching of the vagina or genital area
  • joint or muscle pain
  • lower back or side pain
  • nosebleeds
  • pain during sexual intercourse
  • paralysis
  • pinpoint red spots on the skin
  • prolonged bleeding from cuts
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rash
  • red or black, tarry stools
  • red or dark brown urine
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • seizures
  • skin rash
  • sudden decrease in the amount of urine
  • swollen or painful glands
  • thick, white vaginal discharge with no odor or with a mild odor
  • tightness in the chest
  • unpleasant breath odor
  • vomiting of blood
  • wheezing

For Healthcare Professionals

Applies to cefotetan: injectable powder for injection, intravenous powder for injection, intravenous solution.


Hematologic side effects have been reported in 1.4% of patients and include eosinophilia (0.5%), positive direct Coombs' test (0.4%), thrombocytosis (0.3%), agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia, and increased prothrombin time with or without bleeding. Cephalosporin-class antibiotics have been associated with aplastic anemia, hemorrhage, pancytopenia, and neutropenia.[Ref]

Cefotetan contains a methylthiotetrazole side chain. Moxalactam, another broad spectrum cephalosporin, also has this side chain and is commonly associated with bleeding problems. This side chain is thought to be the moiety responsible for the development of hypoprothrombinemia in patients receiving these cephalosporins. Administration of parenteral vitamin K has been shown to reverse the coagulation abnormalities.

Rare cases of hemolytic anemia, sometimes fatal, are associated with cefotetan. In some cases, antibodies that react with red blood cells that have been exposed to cefotetan have been identified.[Ref]


Hypersensitivity reactions have been reported in 1.2% of patients and include rash (0.7%), pruritus (0.14%), anaphylactic reactions, and urticaria. Cephalosporin-class antibiotics have been associated with pruritus, Stevens-Johnson syndrome, erythema multiforme, and toxic epidermal necrolysis.[Ref]

There may be cross-reactivity in penicillin allergic patients. Anaphylaxis is rare with cefotetan, although three cases are reported in female patients with no known drug allergies and no known prior exposure to cefotetan.

A case of occupational contact dermatitis due to cephalosporin allergy has been reported in a nurse who prepared cephalosporin solutions for administration to patients. The dermatitis resolved after the nurse stopped preparing the solutions.[Ref]


Diarrhea seems to be the most common gastrointestinal side effect, although it is usually mild, self-limited, and rarely requires discontinuation of therapy. If diarrhea is persistent, testing for Clostridium difficile colitis and discontinuation of therapy is recommended. Pseudomembranous colitis may occur during or after discontinuation of therapy.[Ref]

Gastrointestinal side effects have been reported in 1.5% of patients and have included diarrhea (1.25%), nausea (0.14%), pseudomembranous colitis, and hiccups. Cephalosporin-class antibiotics have been associated with vomiting, abdominal pain, and colitis.[Ref]


Pain with intramuscular injection is common, but may be minimized by administering cefotetan (the active ingredient contained in Cefotan) with lidocaine as a diluent. Injection pain usually resolves over several minutes to one hour.[Ref]

Local side effects have been reported in less than 1% of patients and include phlebitis with intravenous administration (0.3%) and discomfort (0.2%). Local pain frequently occurs with intramuscular injections.[Ref]


Renal side effects have included increases in serum creatinine and blood urea nitrogen (BUN), and rarely nephrotoxicity. Cephalosporin-class antibiotics have been associated with toxic nephropathy and renal dysfunction.[Ref]

Although mild changes may occur in serum creatinine, blood urea nitrogen and liver function tests, these are usually transient and do not require discontinuation of therapy. No increases in urinary excretion of alanine aminopeptidase (AAP) or N-acetyl-beta-D-glucosaminidase (NAG), enzymes indicative of renal tubular damage, were noted in one study. However, at least one case of acute interstitial nephritis is associated with cefotetan. The authors believed this was due to cefotetan, but could not rule out nephrotoxicity due to concomitantly administered piperacillin.[Ref]


Hepatic side effects have occurred in 1.2% of patients and include increases in ALT (SGPT) (0.7%), AST (SGOT) (0.3%), alkaline phosphatase (0.14%), and LDH (0.14%). Cephalosporin-class antibiotics have been associated with hepatic dysfunction including cholestasis and elevated bilirubin.[Ref]


Other side effects have rarely included fever. Cephalosporin-class antibiotics have been associated with superinfection.[Ref]


Genitourinary side effects associated with cephalosporin-class antibiotics have included vaginitis and vaginal candidiasis.[Ref]

Nervous system

Nervous system side effects associated with some cephalosporin-class antibiotics have included seizures, especially in patients with renal dysfunction.[Ref]


1. Kline SS, Mauro VF, Forney RB Jr, et al. "Cefotetan-induced disulfiram-type reactions and hypoprothrombinemia." Antimicrob Agents Chemother 31 (1987): 1328-31

2. Holt J "Hypoprothrombinemia and bleeding diathesis associated with cefotetan therapy in surgical patients." Arch Surg 123 (1988): 523

3. Conjura A, Bell W, Lipsky JJ "Cefotetan and hypoprothrombinemia." Ann Intern Med 108 (1988): 643

4. Nguyen VD, Nagelberg H, Agarwal BN "Acute interstitial nephritis associated with cefotetan therapy." Am J Kidney Dis 16 (1990): 259-61

5. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA "Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan." Arch Surg 126 (1991): 524-5

6. Ehmann WC "Cephalosporin-induced hemolysis: a case report and review of the literature." Am J Hematol 40 (1992): 121-5

7. Garratty G, Nance S, Lloyd M, Domen R "Fatal immune hemolytic anemia due to cefotetan." Transfusion 32 (1992): 269-71

8. Wurtz RM, Sande MA "Cefotetan and coagulopathy." J Infect Dis 160 (1989): 555-6

9. Christie DJ, Lennon SS, Drew RL, Swinehart CD "Cefotetan-induced immunologic thrombocytopenia." Br J Haematol 70 (1988): 423-6

10. "Cefotetan disodium (cefotan)." Med Lett Drugs Ther 28 (1986): 70-2

11. "Product Information. Cefotan (cefotetan)." Stuart Pharmaceuticals (2002):

12. Chenoweth CE, Judd WJ, Steiner EA, Kauffman CA "Cefotetan-induced immune hemolytic anemia." Clin Infect Dis 15 (1992): 863-5

13. Martin C, Thomachot L, Albanese J "Clinical pharmacokinetics of cefotetan." Clin Pharmacokinet 26 (1994): 248-58

14. Garratty G, Leger RM, Arndt PA "Severe immune hemolytic anemia associated with prophylactic use of cefotetan in obstetric and gynecologic procedures." Am J Obstet Gynecol 181 (1999): 103-4

15. Robinson HE, Maxwell EL, Prince HM, O'reilly MA, Jakobovits A "Cefotetan-induced life-threatening haemolysis." Med J Aust 184 (2006): 251

16. Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA "Ertapenem versus cefotetan prophylaxis in elective colorectal surgery." N Engl J Med 355 (2006): 2640-51

17. Ward A, Richards DM "Cefotetan: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use." Drugs 30 (1985): 382-426

18. Bloomberg RJ "Cefotetan-induced anaphylaxis." Am J Obstet Gynecol 159 (1988): 125-6

19. Filipe P, Almeida RSLS, Rodrigo FG "Occupational allergic contact dermatitis from cephalosporins." Contact Dermatitis 34 (1996): 226

20. Romano A, Mayorga C, Torres MJ, Artesani MC, Suau R, Sanchez F, Perez E, Venuti A, Blanca M "Immediate allergic reactions to cephalosporins: Cross-reactivity and selective responses." J Allerg Clin Immunol 106 (2000): 1177-83

21. Adam HK, Houghton HL, Yates RA, et al. "Pharmacokinetics and tolerance of a 24-h infusion of cefotetan disodium (with and without loading dose) in normal Caucasian volunteers." J Antimicrob Chemother 11 (1983): 193-9

22. Yates RA, Cockshott ID, Houghton HL, et al. "Pharmacokinetics and tolerance of single intramuscular doses of cefotetan in normal Caucasian volunteers." J Antimicrob Chemother 11 (1983): 207-12

23. Trollfors B, Norrby R, Bergmark J, et al. "Comparative toxicity of gentamicin and cefotetan." Scand J Infect Dis 18 (1986): 139-46

24. Smith BR, LeFrock JL, Thyrum PT, et al. "Cefotetan pharmacokinetics in volunteers with various degrees of renal function." Antimicrob Agents Chemother 29 (1986): 887-93

25. Morris JT, McAllister CK "Cefotetan-induced singultus." Ann Intern Med 116 (1992): 522-3

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.