Cefotaxime

# cefotaxime ## Overview - **Classification**: Third-generation Cephalosporin Antibiotic - **Mechanism**: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to bacterial cell lysis. ## Primary Indications 1. **Serious Infections** - Including lower respiratory tract, urinary tract, intra-abdominal, skin/soft tissue, bone/joint, gynecologic infections. 2. **Meningitis** - Caused by susceptible organisms. 3. **Sepsis** - Suspected or confirmed bacterial sepsis. 4. **Gonorrhea** - Uncomplicated gonococcal infections. ## Adult Dosing ### Standard Dosing **Serious Infections (e.g., Pneumonia, UTI, Skin/Soft Tissue)** - **Dose**: **1 g** - **Frequency**: Every **8-12 hours** - **Route**: Intravenous (IV) or Intramuscular (IM) **Severe Infections (e.g., Sepsis, Meningitis)** - **Dose**: **2 g** - **Frequency**: Every **4-8 hours** - **Route**: Intravenous (IV) - **Maximum**: Up to **12 g/day** **Uncomplicated Gonorrhea** - **Dose**: **500 mg** - **Frequency**: Single dose - **Route**: Intramuscular (IM) ### Dose Adjustments - **Renal Impairment**: - **CrCl 10-50 mL/min**: Administer full dose, then **50% of dose** every **12 hours**. - **CrCl <10 mL/min**: Administer full dose, then **50% of dose** every **24 hours**. - **Hemodialysis**: Give dose after dialysis; supplemental dose needed if given before. - **Hepatic Impairment**: No specific dose adjustment recommended. - **Elderly Patients**: Adjust dose based on renal function due to age-related decline in CrCl. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: - **0-7 days**: **50 mg/kg** - **7-28 days**: **50 mg/kg** - **Frequency**: - **0-7 days**: Every **12 hours** (for <1200g), Every **8-12 hours** (for ≥1200g) - **7-28 days**: Every **8 hours** (for <1200g), Every **6-8 hours** (for ≥1200g) - **Maximum**: Max **100-150 mg/kg/day** - **Special Notes**: Higher doses (up to 200 mg/kg/day) for meningitis. IV infusion over 15-30 min preferred. ### Infants (1-12 months) - **Dose**: **50-180 mg/kg/day** - **Frequency**: Divided every **6-8 hours** - **Maximum**: Max **180 mg/kg/day** (up to **12 g/day** for severe infections/meningitis) ### Children (1-12 years) - **Dose**: **50-180 mg/kg/day** - **Frequency**: Divided every **6-8 hours** - **Maximum**: Max **180 mg/kg/day** (up to **12 g/day**) ### Adolescents (13-18 years) - **Dose**: Use **adult dosing guidelines** based on infection severity. - **Maximum**: Max **12 g/day**. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to cefotaxime or other cephalosporins. - **Absolute**: History of immediate and severe hypersensitivity to penicillin. - **Relative**: Use with caution in patients with a history of mild penicillin allergy. ### Common Adverse Effects - **Common (1-10%)**: Diarrhea, injection site pain/inflammation, rash, nausea, vomiting. - **Less Common (0.1-1%)**: Fever, headache, dizziness, increased LFTs, eosinophilia, leukopenia. - **Serious but Rare**: Seizures (especially with high doses in renal impairment), Clostridium difficile-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, SJS), hemolytic anemia, agranulocytosis. ### Key Drug Interactions - **Probenecid**: May increase cefotaxime levels by decreasing renal tubular secretion; not typically clinically significant but monitor. - **Aminoglycosides**: Potential for increased nephrotoxicity (rare); monitor renal function closely if co-administered. - **Oral Contraceptives**: May decrease efficacy; advise alternative contraception during and shortly after treatment. - **Live Bacterial Vaccines**: Cephalosporins may reduce the therapeutic effect of live typhoid vaccine; administer vaccine at least 24 hours after last antibiotic dose. ## Monitoring & Follow-up - **Before Treatment**: Obtain culture and sensitivity to confirm susceptibility. Assess renal function (SCr, CrCl). - **During Treatment**: Monitor for signs of superinfection, CDAD, or allergic reactions. Monitor renal function in patients with pre-existing impairment or on concomitant nephrotoxic drugs. - **Clinical Signs**: Watch for persistent fever, new rash, severe diarrhea, or seizure activity. ## Clinical Pearls - 💡 **Administration**: Administer IV doses slowly over **3-5 minutes** directly or **20-60 minutes** diluted. IM route is painful; use deep IM injection. - 💡 **Compatibility**: Incompatible with aminoglycosides in the same syringe or IV line due to precipitation. Administer separately. - 💡 **Meningitis Dosing**: For CNS penetration in meningitis, use higher doses and IV route. - 💡 **Storage**: Reconstituted solution is stable for 12-24 hours at room temperature, or 5-10 days refrigerated depending on diluent. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.