cefotaxime (Claforan)
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Introduction
Tradename: Claforan. 3rd generation cephalosporin.
Indications
- treatment of bacterial infections due to susceptible organisms
- gram negative rod infection (other than Pseudomonas)
- CNS infections
- documented or suspected meningitis
- lower respiratory tract infections
- intra-abdominal infections
- urogenital infections
- skin or soft tissue infections
- sepsis
- proctitis
- ophthalmia neonatorum
- prophylaxis for perioperative infection
- empiric treatment of fever of unknown origin
Dosage
- 1-2g IV/IM every 6-8 hours.
- Children: 50-180 mg/kg/day IV divided every 4-6 hours.
- meningitis: 200 mg/kg/day
- severe infection (> 50 kg) : 1-2 g every 4-6 hours
- life-threatening infection 2 g every 4 hours
- maximum: 12 g/day
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 to body tissues & fluids, including
- aqueous humor, ascitic fluid, prostatic fluid bone
- penetrates CSF when meninges are inflammed
- crosses placenta
- appears in breast milk
- protein bindng 31-50%
- partially metabolized in the liver to an active metabolite, desacetylcefoxatime
- elimination 1/2life:
- cefotaxime: 1-1.5 hours, prolinged with renal &/or hepatic insufficiency (15-35 hours ESRD)
- desacetylcefoxatime: 1.5-1.9 hours, prolonged with renal impairment
- 60% excreted unchanged in the urine, 23% as metabolites
- time to peak serum concentration:
- elimination by hemodialysis 20-50%
elimination via kidney
elimination via liver
protein binding = 36 %
elimination by hemodialysis = +/-
Antimicrobial activity
- Neisseria
- Moraxella catarrhalis
- Haemophilus
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia species
- Salmonella species
- Shigella species
- Proteus
- Providencia species
- Morganella species
- Citrobacter species
- Aeromonas species
- Acinetobacter species
- Pseudomonas
- Yersinia
Adverse effects
- not common (1-10%)
- uncommon (< 1%)
- headache, pseudomembranous colitis, transient neutropenia, thrombocytopenia, phlebitis transient elevation of BUN, creatinine, transaminases
- other
- Coomb's test may be positive
Drug interactions
- probenecid decreases renal clearance of cefotaxime by 50%
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
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
- interferences:
- desacetyl metabolite may interfere with microbiological assay (MB)
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ 5.0 5.1 5.2 Deprecated Reference
- ↑ Department of Veterans Affairs, VA National Formulary
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=47399
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=456256
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=44555
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2631
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=657363