Classifications: antibiotic; third-generation cephalosporin;
Therapeutic: antibiotic
; cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B


1 g, 2 g injection


Semisynthetic third-generation cephalosporin antibiotic. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Spectrum of activity is similar to that of cefotaxime.

Therapeutic Effect

Generally active against a wide variety of gram-negative bacteria, including some strains of Pseudomonas aeruginosa. Also active against some organisms resistant to first- and second-generation cephalosporins, some aminoglycoside antibiotics and penicillins.


Infections of skin and skin structures, urinary tract, respiratory tract; peritonitis and other intra-abdominal infections, pelvic inflammatory disease, endometritis and other infections of the female genital tract; bacterial septicemia.

Unlabeled Uses

Children <12 y.


Hypersensitivity to cephalosporins and related beta-lactam antibiotics.

Cautious Use

History of hypersensitivity to penicillins, history of allergy, particularly to drugs; hepatic disease, history of colitis or other GI disease, history of bleeding disorders; pregnancy (category B), lactation.

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 1–2 g q12h; up to 16 g/d in 2–4 divided doses

Simultaneous Hepatic and Renal Impairment
Reduce total dose to 1–2 g/d.

Hemodialysis: Administer dose after dialysis


  • To prepare IM injections, appropriate diluents include sterile water for injection, bacteriostatic water for injection, and 0.5% lidocaine. See package insert for reconstitution procedure.
  • Reconstitute for IM: Dilute each 1 g with 5 mL sterile water. Shake vigorously to dissolve. If concentrations of ≥250 mg/mL are needed for IM injection, 2% lidocaine should be added. See manufacturer's directions.
  • IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.
  • Rapid, direct (bolus) IV injections are not recommended.

PREPARE: Intermittent: Dilute each 1 g with 5 mL sterile water. Shake vigorously to dissolve, then dilute in 50–100 mL of D5W or NS.  Continuous: Further dilute in 500–1000 mL of the selected IV solution.  

ADMINISTER: Intermittent: Give over 15–30 min.  Continuous: Give 500–1000 mL over 6–24 h.  

INCOMPATIBILITIES Solution/additive: aminoglycosides, doxapram. Y-site: aminoglycosides, amifostine, amphotericin B cholesteryl complex, cisatracurium, diltiazem, doxorubicin liposome, filgrastim, gemcitabine, hetastarch, labetalol, meperidine, ondansetron, pentamidine, perphenazine, promethazine, sargramostim, vinorelbine.

  • Protect sterile powder and piggyback units from light and store at or below 25° C (77° F). Reconstituted solutions may be stored in original containers for 24 h at 15°–25° C (59°–77° F); for 5 d under refrigeration at 5° C (41° F) or less, or for at least 3 wk in freezer.

Adverse Effects (≥1%)

Body as a Whole: Fever, eosinophilia, phlebitis (IV site), transient pain (IM site), superinfections. GI: Abdominal cramps, bloating, loose stools or diarrhea, pseudomembranous colitis, elevated liver function tests (AST, ALT, alkaline phosphatase). Hematologic: Abnormal PT/INR and PTT; hypoprothrombinemia. Skin: Skin rash, urticaria, pruritus. Urogenital: Transient increases in serum creatinine and BUN, oliguria.

Diagnostic Test Interference

Cefoperazone can cause positive direct Coombs' test, which may result in interferences with hematologic studies and cross-matching procedures. False-positive results for urine glucose using copper sulfate tests (Benedict's, Clinitest), but not with glucose enzymatic tests (e.g., Clinistix, TesTape, Diastix). Also causes prolonged prothrombin twice during therapy.


Drug: Alcohol produces disulfiram reaction.


Peak: 1–2 h after IM; 15–20 min after IV. Distribution: Low CNS penetration except with inflamed meninges; highest concentrations in bile; crosses placenta. Elimination: 70–75% excreted unchanged in bile in 6–12 h, small amount excreted in breast milk. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

  • Determine hypersensitivity to cephalosporins, penicillins, and other drug allergies before therapy begins.
  • Lab tests: Perform culture and sensitivity studies before initiation of therapy and during therapy, as indicated. Therapy may begin pending test results. Perform PTT and PT/INR before and during therapy.
  • Observe for and question patient about signs of hemostatic defects: wound bleeding (e.g., surgical patient), nose bleeds, bleeding gums, bloody sputum, hematuria. Hypoprothrombinemia and vitamin K deficiency are possible complications of therapy and can result in significant blood loss in some patients. Patients at risk are those with poor nutritional states, malabsorption problems, patients on hyperalimentation regimens, and alcoholism. Vitamin K supplements may be prescribed for these patients, if indicated.
  • Report the onset of loose stools or diarrhea. Most patients respond to replacement of fluids, electrolytes, and proteins. Discontinuation of drug may be required for some patients.
  • Monitor cefoperazone serum levels (at steady state: 150 mg/mL) in patients with hepatic disease or biliary obstruction who are receiving over 4 g/d, patients with both hepatic and renal disease receiving over 1–2 g/d, and patients with renal impairment on high dose therapy.

Patient & Family Education

  • Do not ingest alcohol within 72 h after drug administration as this will cause a disulfiram-like reaction (see Signs & Symptoms, Appendix F). Effects generally appear within 15–30 min after alcohol is taken and disappear spontaneously 1–2 h later.
  • Report promptly any signs or symptoms of superinfection (see Appendix F).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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