ceftizoxime (Cefizox)

Introduction

Tradename: Cefizox. 3rd generation cephalosporin.

Indications

• treatment of bacterial infections due to susceptible organisms
  • lower respiratory tract infections
    • pneumonia
  • skin or soft tissue infection
  • osteomyelitis, infectious arthritis
  • urogenital infections
    • gonorrhea
  • septicemia
  • meningitis
  • intra-abdominal infection
  • proctitis
• empiric treatment of fever of unknown origin

Dosage

• 1-2 g IV every 8-12 hours
• Children: 50 mg/kg/dose IV every 6-8 hours

Powder for injection: 1 & 2 g.

Dosage adjustment in renal failure

Table

creatinine clearance	dosage
> 50-90 mL/min	1-2 g every 8-12 hours
10-50 mL/min*	1-2 g every 12-24 hours
< 10 mL/min#	1-2 g every 24 hours

* same dose for continuous arteriovenous hemofiltration

# 1 g IV after hemodialysis

Pharmacokinetics

• widely distributed into most body tissues
  • including gallbladder, liver, kidney, bone, sputum, bile, pleural fluid, synovial fluid,
  • good CSF penetration
  • crosses placenta
  • small amounts appear in breast milk
• protein binding 30%
• peak serum levels 30-60 minutes after IM injection
• elimination 1/2life 1.6 hours, (15-35 hours ESRD)
• excreted unchanged in the urine
• moderately dialyzable

elimination via kidney

protein binding = 28 %

elimination by hemodialysis = +

elimination by peritoneal dialysis = -

Antimicrobial activity

Gram positive

• Streptococcus
  • Streptococcus group A
  • Streptococcus group B
  • Streptococcus group C
  • Streptococcus group G
  • Streptococcus pneumonia (30% resistant)
  • Streptococcus viridans, milleri
• Staphylococcus aureus (MRSA)
• Staphylococcus epidermidis (+/-)

Gram negative

• Neisseria gonorrhoeae
• Neisseria meningitidis
• Moraxella catarrhalis
• Haemophilus influenzae
• Escherichia coli
• Klebsiella species
• Enterobacter species
• Serratia species
• Salmonella species
• Shigella species
• Proteus mirabilis
• Proteus vulgaris
• Providencia species
• Morganella species
  • Morganella morganii
• Citrobacter species
• Aeromonas species
• Acinetobacter species
• Pseudomonas aeruginosa (+/-)
• Pseudomonas cepacia
• Yersinia enterocolitica
• Pasteurella multocida
• Haemophilus ducreyi

Anaerobes

• Actinomyces
• Bacteroides fragilis (+/-)
• Bacteroides melaninogenicus
• Clostridium species
• Peptostreptococcus species

Adverse effects

• not common (1-10%)
  • rash, fever, pruritus, transient elevations of serum transaminases & alkaline phosphatase, eosinophilia, thrombocytosis, pain, burning at injection site
• uncommon (< 1%)
  • numbness, elevation of bilirubin, transient elevation of BUN & creatinine, anemia, leukopenia, neutropenia, thrombocytopenia, vaginitis
• other
  • hypersensitivity: rash, eosinophilia
  • phlebitis
  • Coomb's test may be positive

• drug adverse effects of cephalosporins

Laboratory

• specimen:
  • serum
  • keep specimen on ice-water
  • centrifuge at 4 degrees C
  • remove cells as soon as possible
  • freeze at -70 degrees C until assayed
• methods: HPLC, MB

More general terms

• cephalosporin, 3rd generation

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=50194
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=50196
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2655
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=50195
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441394