Acute bacterial rhinosinusitis, severe infection requiring hospitalization (off-label use): IV: 2 g every 4 to 6 hours for 5 to 7 days (IDSA [Chow 2012]).
Bite wound (animal) (off-label use): IV: 1 to 2 g every 6 to 8 hours in combination with clindamycin or metronidazole for anaerobic coverage (IDSA [Stevens 2014]).
Brain abscess (empiric treatment): IV: 2 g every 4 to 6 hours in combination with other antimicrobial therapy as warranted (eg, metronidazole) (Arlotti 2010; Brouwer 2014; Kowlessar 2006).
Cesarean delivery: IM, IV: 1 g IV as soon as the umbilical cord is clamped, then 1 g IV or IM at 6 and 12 hours after the first dose.
Chronic obstructive pulmonary disease, acute exacerbation (hospitalized patients without risk factors for P. aeruginosa) (off-label use): IV: 1 g every 8 hours for 5 to 7 days; may switch to oral therapy following clinical improvement (GOLD 2021; Sethi 2021; van Zanten 2007).
Gonococcal infection, disseminated (arthritis and arthritis-dermatitis syndrome) (alternative agent) (off-label use): IV: 1 g every 8 hours. Total duration of therapy is at least 7 days (including oral step-down therapy); can usually switch to susceptibility-guided oral therapy after 24 to 48 hours. Give in combination with treatment for chlamydia if it has not been excluded (CDC [Workowski 2021]).
Gonococcal infection, uncomplicated (infection of the cervix, rectum, or urethra) (alternative agent):
Note: Use cefotaxime only if ceftriaxone is unavailable given a lack of contemporary efficacy data (CDC [Workowski 2021]).
IM: 500 mg as a single dose (CDC [Workowski 2021]; McCormack 1993); give in combination with treatment for chlamydia if it has not been excluded. Note: When treatment failure is suspected (eg, detection of N. gonorrhoeae after treatment without additional sexual exposure), consult an infectious diseases specialist. Report failures to the CDC through state and local health departments (CDC [Workowski 2021]).
Intra-abdominal infection, mild to moderate, community-acquired infection in patients without risk factors for resistance or treatment failure:
Cholecystitis, acute: IV: 2 g every 8 hours; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (SIS [Mazuski 2017]; SIS/IDSA [Solomkin 2010]; Vollmer 2021). Note: The addition of anaerobic therapy (eg, metronidazole) is recommended if biliary-enteric anastomosis is present (SIS/IDSA [Solomkin 2010]).
Other intra-abdominal infections (eg, perforated appendix, diverticulitis, intra-abdominal abscess): IV: 2 g every 8 hours in combination with metronidazole (Barshak 2021). Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Sawyer 2015; SIS [Mazuski 2017]); for diverticulitis or uncomplicated appendicitis managed without intervention, duration is 7 to 10 days (Barshak 2021; Pemberton 2021).
Lyme disease (Borrelia spp. infection) (alternative agent) (off-label use):
Carditis, patients requiring hospitalization: IV: 2 g every 8 hours for 14 to 21 days (including oral step-down therapy) (IDSA/AAN/ACR [Lantos 2021]).
Acute neurologic disease (eg, meningitis, radiculopathy), patients requiring hospitalization: IV: 2 g every 8 hours for 14 to 21 days (IDSA/AAN/ACR [Lantos 2021]).
Late neurologic disease: IV: 2 g every 8 hours for 14 to 28 days (IDSA/AAN/ACR [Lantos 2021]).
Recurrent arthritis after adequate oral treatment: IV: 2 g every 8 hours for 14 days; may extend to 28 days if inflammation is not resolving (IDSA/AAN/ACR [Lantos 2021].
Meningitis, bacterial: As a component of empiric therapy (community-acquired infections) or pathogen-specific therapy (eg, Cutibacterium acnes, H. influenzae, N. meningitidis, S. agalactiae, S. pneumoniae, and susceptible gram-negative bacilli; alternative agent for certain pathogens):
IV: 2 g every 4 to 6 hours; for empiric therapy, use in combination with other appropriate agents (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]).
Pneumonia, community-acquired: Inpatients without risk factors for Pseudomonas aeruginosa:
IV: 1 to 2 g every 8 hours as part of an appropriate combination regimen. Total duration (which may include oral step-down therapy) is a minimum of 5 days; patients should be clinically stable with normal vital signs before therapy is discontinued (ATS/IDSA [Metlay 2019]).
Salmonella species infection (alternative agent) (off-label use):
Enteric fever (Salmonella typhi and paratyphi): Empiric therapy for severe disease or an alternative directed therapy for quinolone-nonsusceptible infection: IV: 1 to 2 g every 6 to 8 hours for 10 to 14 days. Note: May be switched to an oral regimen based on susceptibility testing, if available. Geographic location at time of acquisition impacts risk of resistance; cefotaxime is not recommended if there is concern for extensively drug-resistant Salmonella spp. (Ryan 2021; WHO 2003).
Nontyphoidal Salmonella GI infection: IV: 1 to 2 g every 8 hours for 3 to 14 days (7 to 14 days in HIV-infected patients with a CD4 count ≥200 cells/mm3). Immunosuppressed patients (eg, HIV infected with CD4 count <200 cells/mm3) warrant a longer duration of treatment (eg, weeks to months). Note: Reserve antibiotic treatment for patients with severe illness or at high risk of invasive disease (eg, extremes of age, immunosuppression); reserve parenteral therapy for those who cannot tolerate oral agents (HHS [OI adult] 2020); Hohmann 2020a).
Nontyphoidal Salmonella bloodstream infection: IV: 1 to 2 g every 8 hours for 14 days. Note: Immunosuppressed patients (eg, HIV infected with CD4 count <200 cells/mm3) and those with an extraintestinal focus of infection warrant a longer duration of treatment (eg, weeks to months) (HHS [OI adult] 2020; Hohmann 2020b).
Sepsis: IV: 2 g every 6 to 8 hours.
Septic arthritis due to susceptible gram-negative bacilli: IV: 2 g every 8 hours; duration of therapy is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy (Goldenberg 2019).
Skin and soft tissue necrotizing infections (off-label use):
Polymicrobial infection: IV: 2 g every 6 hours, in combination with metronidazole or clindamycin for empiric therapy of polymicrobial infections. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).
Necrotizing infection due to Vibrio vulnificus: IV: 2 g every 8 hours, in combination with doxycycline. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).
Spontaneous bacterial peritonitis, treatment:
Note: For patients without sepsis or risk for multidrug resistance (AASLD [Biggins 2021]).
IV: 2 g every 8 hours; duration is for 5 to 7 days, as long as fever and pain have resolved (AASLD [Biggins 2021]; AASLD [Runyon 2013]; Runyon 2021).
Surgical prophylaxis (off-label use): IV: 1 g within 60 minutes prior to surgical incision. Doses may be repeated in 3 hours if procedure is lengthy or if there is excessive blood loss (Bratzler 2013).
Obesity: The ASHP/IDSA/SIS/SHEA guidelines recommend that for patients weighing ≥120 kg (or alternatively defined as BMI >30 kg/m2), a dose of 2 g within 60 minutes prior to surgical incision should be administered (Bratzler 2013).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: IV:
|
CrCl |
If the usual indication-specific dose is 1 to 2 g every 8 hoursa |
If the usual indication-specific dose is 1 to 2 g every 6 hoursa |
If the usual indication-specific dose is 2 g every 4 hoursb |
|---|---|---|---|
|
a Expert opinion derived from Bouchet 1991; Matzke 1985; Seguin 2009. | |||
|
b Expert opinion only. | |||
|
c Dialyzable (~40%) (Ings 1982): When scheduled dose falls on a dialysis day, administer after hemodialysis. | |||
|
>50 mL/minute |
No dosage adjustment necessary |
No dosage adjustment necessary |
No dosage adjustment necessary |
|
>10 to 50 mL/minute |
1 to 2 g every 12 hours |
1 to 2 g every 8 hours |
2 g every 6 to 8 hours |
|
≤10 mL/minute |
1 to 2 g every 24 hours |
1 to 2 g every 12 hours |
2 g every 12 hours |
|
Hemodialysis, intermittent (thrice weekly)c |
1 to 2 g every 24 hours |
1 to 2 g every 12 hours |
2 g every 12 hours |
|
Peritoneal dialysisa |
1 to 2 g every 24 hours |
1 to 2 g every 12 hours |
2 g every 12 hours |
CRRT:
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions due to drug accumulation is important.
IV: Dose as for CrCl >10 to 50 mL/minute (expert opinion).
PIRRT (eg, sustained, low-efficiency diafiltration):
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions due to drug accumulation is important.
IV:
PIRRT days: Dose as for CrCl >10 to 50 mL/minute (on PIRRT days, when feasible administer one of the scheduled doses after the PIRRT session) (expert opinion).
Non-PIRRT days: Dose as for CrCl ≤10 mL/minute (expert opinion).
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Cefotaxime (United States: Limited availability): Pediatric drug information")
General dosing, susceptible infection: Infants, Children, and Adolescents: IM, IV: 150 to 180 mg/kg/day in divided doses every 8 hours; maximum daily dose: 8 g/day; higher doses necessary for treatment of meningitis (Bradley 2018; Red Book [AAP 2018]).
Acute bacterial rhinosinusitis, severe infection requiring hospitalization: Children and Adolescents: IV: 100 to 200 mg/kg/day divided every 6 hours for 10 to 14 days; maximum dose: 2,000 mg (IDSA [Chow 2012]).
Endocarditis, treatment: Children and Adolescents: IV: 200 mg/kg/day in divided doses every 6 hours; maximum daily dose: 12 g/day; treat for at least 4 to 6 weeks; longer durations may be necessary; may use in combination with gentamicin for some organisms (AHA [Baltimore 2015]).
Enteric bacterial infections, empiric treatment, HIV-exposed/-infected: Adolescents: IV: 1,000 mg every 8 hours (HHS [OI adult 2018]).
Gonorrhea, disseminated infections (including arthritis and arthritis-dermatitis syndrome) (as an alternative to ceftriaxone) (CDC [Workowski 2015]): Adolescents: IV: 1,000 mg every 8 hours in combination with azithromycin for a total duration of at least 7 days.
Intra-abdominal infection, complicated: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours; maximum dose: 2,000 mg; use in combination with metronidazole (IDSA [Solomkin 2010]).
Lyme disease (Borrelia spp. infection) (alternative agent): Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day in divided doses every 6 to 8 hours; maximum daily dose: 6,000 mg/day. Duration of therapy depends on clinical syndrome; treat meningitis or radiculopathy for 14 to 21 days (IDSA/AAN/ACR [Lantos 2021]).
Meningitis: Infants, Children, and Adolescents: IV: 225 to 300 mg/kg/day divided every 6 to 8 hours; maximum dose: 2,000 mg/dose; use in combination with vancomycin for empiric coverage (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]); some experts recommend 300 mg/kg/day divided every 4 to 6 hours with a maximum daily dose of 12 g/day (Red Book [AAP 2018]).
Peritonitis (peritoneal dialysis) (ISPD [Warady 2012]): Infants, Children, and Adolescents: Intraperitoneal:
Intermittent: 30 mg/kg/dose every 24 hours in the long dwell.
Continuous: Loading dose: 500 mg per liter of dialysate; maintenance dose: 250 mg per liter; Note: 125 mg/liter has also been recommended as a maintenance dose (Aronoff 2007).
Pneumonia:
Bacterial pneumonia, HIV-exposed/-infected: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours; maximum dose: 2,000 mg/dose (HHS [OI adult 2018]; HHS [OI pediatric 2016]).
Community-acquired pneumonia (CAP): Infants >3 months, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg; Note: May consider addition of vancomycin or clindamycin to empiric therapy if community-acquired MRSA suspected. In children ≥5 years, a macrolide antibiotic should be added if atypical pneumonia cannot be ruled out (IDSA/PIDS [Bradley 2011]).
Salmonellosis, HIV-exposed/-infected: Adolescents: IV: 1,000 mg every 8 hours (HHS [OI adult 2018]).
Skin and soft tissue infections, necrotizing: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 6 hours in combination with metronidazole or clindamycin; maximum dose: 2,000 mg/dose. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).
Surgical prophylaxis: Children and Adolescents: IV: 50 mg/kg within 60 minutes prior to the procedure; may repeat in 3 hours if procedure is lengthy or if there is excessive blood loss; maximum dose: 1,000 mg; a larger maximum dose (2,000 mg) is recommended for obese patients (ASHP/IDSA [Bratzler 2013]).
Urinary tract infection: Infants and Children 2 to 24 months: IM, IV: 150 mg/kg/day divided every 6 to 8 hours (AAP 2011).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants, Children, and Adolescents: The following adjustments have been recommended (Aronoff 2007). Note: Renally adjusted dose recommendations are based on doses of 100 to 200 mg/kg/day divided every 8 hours.
GFR 30 to 50 mL/minute/1.73 m2: 35 to 70 mg/kg/dose every 8 to 12 hours
GFR 10 to 29 mL/minute/1.73 m2: 35 to 70 mg/kg/dose every 12 hours
GFR <10 mL/minute/1.73 m2: 35 to 70 mg/kg/dose every 24 hours
Intermittent hemodialysis: 35 to 70 mg/kg/dose every 24 hours
Peritoneal dialysis (PD): 35 to 70 mg/kg/dose every 24 hours
Continuous renal replacement therapy (CRRT): 35 to 70 mg/kg/dose every 12 hours
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Refer to indication-specific dosing for obesity-related information (may not be available for all indications).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Injection:
Generic: 1 g (1 ea); 2 g (1 ea)
Solution Reconstituted, Injection [preservative free]:
Generic: 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea [DSC]); 10 g (1 ea [DSC])
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Injection:
Generic: 500 mg ([DSC]); 1 g (1 ea); 2 g (1 ea)
IM: Inject deep IM into large muscle mass. Individual doses of 2 g may be given if the dose is divided and administered in different IM sites.
IV: Can be administered IV bolus over at least 3 to 5 minutes or as an IV intermittent infusion over 15 to 30 minutes.
Parenteral:
IM: Administer by deep IM injection into a large muscle mass such as the upper outer quadrant of the gluteus maximus. Doses of 2,000 mg should be divided and administered at two different sites.
IV:
IV Push: May be administered over 3 to 5 minutes; avoid rapid injection (<1 minute) due to association with arrhythmias
Intermittent infusion: Infuse over 15 to 30 minutes.
Bacteremia/Septicemia: Treatment of bacteremia/septicemia caused by Escherichia coli, Klebsiella species, and Serratia marcescens, Staphylococcus aureus and Streptococcus species (including Streptococcus pneumoniae).
Bone or joint infections: Treatment of bone or joint infections caused by S. aureus (penicillinase and nonpenicillinase producing strains), Streptococcus species (including Streptococcus pyogenes), and Proteus mirabilis.
CNS infections: Treatment of CNS infections (eg, meningitis, ventriculitis) caused by Neisseria meningitidis, Haemophilus influenzae, S. pneumoniae, Klebsiella pneumoniae, and E. coli.
Genitourinary infections: Treatment of genitourinary infections, including urinary tract infections (UTIs), caused by Staphylococcus epidermidis, S. aureus (penicillinase and nonpenicillinase producing), Citrobacter species, Enterobacter species, E. coli, Klebsiella species, P. mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Providencia rettgeri, and S. marcescens. Also uncomplicated gonorrhea (cervical, urethral, and rectal) caused by Neisseria gonorrhoeae, including penicillin-producing strains.
Gynecologic infections: Treatment of gynecologic infections, including pelvic inflammatory disease, endometritis, and pelvic cellulitis, caused by S. epidermidis, Streptococcus species, Enterobacter species, Klebsiella species, E. coli, P. mirabilis, Bacteroides species (including Bacteroides fragilis), Clostridium species, and anaerobic cocci (including Peptostreptococcus and Peptococcus species) and Fusobacterium species (including Fusobacterium nucleatum).
Intra-abdominal infection, mild to moderate, community-acquired infection in patients without risk factors for resistance or treatment failure: Treatment of intraabdominal infections, including peritonitis caused by Streptococcus species, E. coli, Klebsiella species, Bacteroides species, and anaerobic cocci (including Peptostreptococcus species and Peptococcus species), P. mirabilis, and Clostridium species.
Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, caused by S. pneumoniae, S. pyogenes (group A streptococci) and other streptococci (excluding enterococci, [eg, Enterococcus faecalis]), S. aureus (penicillinase and nonpenicillinase producing), E. coli, Klebsiella species, H. influenzae (including ampicillin-resistant strains), H. parainfluenzae, P. mirabilis, S. marcescens, Enterobacter species, and indole-positive Proteus
Skin and skin structure infections: Treatment of skin and skin structure infections caused by S. aureus (penicillinase and nonpenicillinase producing), S. epidermidis, S. pyogenes (group A streptococci) and other streptococci, Acinetobacter species, E. coli, Citrobacter species (including Citrobacter freundii), Enterobacter species, Klebsiella species, P. mirabilis, P. vulgaris, M. morganii, P. rettgeri, S. marcescens, Bacteroides species, and anaerobic cocci (including Peptostreptococcus species and Peptococcus species).
Surgical prophylaxis: Reduce the incidence of certain infections in patients undergoing surgical procedures (eg, abdominal or vaginal hysterectomy, GI and GU tract surgery) that may be classified as contaminated or potentially contaminated; reduce the incidence of certain postoperative infections in patients undergoing cesarean delivery.
Acute bacterial rhinosinusitis; Bite wound (animal); Chronic obstructive pulmonary disease, acute exacerbation (hospitalized patients without risk factors for Pseudomonas aeruginosa); Gonococcal infection, disseminated (arthritis and arthritis-dermatitis syndrome); Lyme disease (Borrelia spp. infection); Salmonella species infection (nontyphoidal Salmonella GI and bloodstream infections and typhoid [enteric] fever [Salmonella typhi and paratyphi]); Skin and soft tissue necrotizing infections
Cefotaxime may be confused with cefOXitin, cefuroxime
Spectrocef [Italy] may be confused with Spectracef brand name for cefditoren [US, Great Britain, Mexico, Portugal, Spain]
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Dermatologic: Pruritus (≤2%), skin rash (≤2%)
Gastrointestinal: Colitis (≤1%), diarrhea (≤1%), nausea (≤1%), vomiting (≤1%)
Hematologic & oncologic: Eosinophilia (≤2%)
Local: Induration at injection site (IM ≤4%), inflammation at injection site (IV ≤4%), pain at injection site (IM ≤4%), tenderness at injection site (IM ≤4%)
Miscellaneous: Fever (≤2%)
<1%, postmarketing and/or case reports: Acute generalized exanthematous pustulosis, acute renal failure, agranulocytosis, anaphylaxis, bone marrow failure, brain disease, candidiasis, cardiac arrhythmia (after rapid IV injection via central catheter), cholestasis, Clostridioides difficile-associated diarrhea, dizziness, erythema multiforme, granulocytopenia, headache, hemolytic anemia, hepatitis, increased blood urea nitrogen, increased gamma-glutamyl transferase, increased lactate dehydrogenase, increased serum alkaline phosphatase, increased serum ALT, increased serum AST, increased serum bilirubin, increased serum creatinine, injection site phlebitis, interstitial nephritis, jaundice, leukopenia, local irritation, neutropenia, pancytopenia, positive direct Coombs test, pseudomembranous colitis, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, urticaria, vaginitis
Hypersensitivity to cefotaxime, any component of the formulation, or other cephalosporins
Concerns related to adverse effects:
• Arrhythmia: A potentially life-threatening arrhythmia has been reported in patients who received a rapid (<1 minute) bolus injection via central venous catheter.
• Granulocytopenia: Granulocytopenia and more rarely agranulocytosis may develop during prolonged treatment (>10 days).
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Tissue inflammation: Minimize tissue inflammation by changing infusion sites when needed.
Disease-related concerns:
• Colitis: Use with caution in patients with a history of colitis.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment may be required.
None known.
Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy
Probenecid: May increase the serum concentration of Cefotaxime. Management: Avoid cefotaxime doses greater than 6 g/day with concurrent probenecid. Any patients receiving this combination should be monitored closely for evidence of cefotaxime toxicity. Risk D: Consider therapy modification
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Cefotaxime crosses the human placenta.
Cefotaxime is approved for use in women undergoing cesarean section (consult current guidelines for appropriate use).
Cefotaxime is present in breast milk.
Although the manufacturer recommends to use with caution, cephalosporins are generally considered acceptable for use in breastfeeding women (Ito 2000). In general, antibiotics that are present in breast milk may cause nondose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush or diarrhea (WHO 2002).
Some products may contain sodium.
Observe for signs and symptoms of anaphylaxis during first dose; CBC with differential (especially with long courses [>10 days]); renal function
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Cefotaxime has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria. Enterococcus species may be intrinsically resistant to cefotaxime. Most extended-spectrum beta-lactamase (ESBL)-producing and carbapenemase-producing isolates are resistant to cefotaxime.
Distribution: Widely to body tissues and fluids including aqueous humor, ascitic and prostatic fluids, bone; penetrates CSF best when meninges are inflamed
Protein binding: 31% to 50%
Metabolism: Partially hepatic to active metabolite, desacetylcefotaxime
Half-life elimination:
Cefotaxime: Infants ≤1500 g: 4.6 hours; Infants >1500 g: 3.4 hours; Children: 1.5 hours; Adults: 1 to 1.5 hours; prolonged with renal and/or hepatic impairment
Desacetylcefotaxime: 1.3 to 1.9 hours; prolonged with renal impairment (Ings 1982)
Time to peak, serum: IM: Within 30 minutes
Excretion: Urine (~60% as unchanged drug and metabolites)
Solution (reconstituted) (Cefotaxime Sodium Injection)
1 g (per each): $11.76
2 g (per each): $23.56
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