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


1 g, 2 g, 10 g injection


Semisynthetic beta-lactam antibiotic, classified as a second-generation cephalosporin. 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.

Therapeutic Effect

Generally less active against susceptible Staphylococci than first-generation cephalosporins, but has broad spectrum of activity against gram-negative bacteria when compared to first- and second-generation cephalosporins. It also shows moderate activity against gram-positive organisms. Although it is generally inactive against Pseudomonas, it is avtive against the Enterobacteriaceae and anaerobes.


Infections caused by susceptible organisms in urinary tract, lower respiratory tract, skin and skin structures, bones and joints, gynecologic tract; also intra-abdominal infections, bacteremia, and perioperative prophylaxis.


Hypersensitivity to cephalosporins and related beta-lactam antibiotics.

Cautious Use

Preexisting coagulopathy; colitis, GI disease; renal impairment; pregnancy (category B); lactation.

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 1–2 g q12h

Adult: IV 500 mg q12h or 1–4 g/d

Surgical Prophylaxis
Adult/Adolescent: IV/IM 1–2 g 30–60 min before surgery

Renal Impairment
Clcr >30 mL/min: regular dose q12h
Clcr 10–30 mL/min: regular dose q24h
Clcr <10 mL/min: regular dose q48h
Hemodialysis: Give 1/4 dose q24h on days between sessions, ? dose on day of dialysis


  • For IM reconstitution (follow manufacturer's directions for selection of diluent), add 2 mL diluent to 1 g vial; yields approximately 2.4 mL (375 mg/mL).
  • For IM administration, inject well into body of large muscle such as upper outer quadrant of buttock (gluteus maximus).
  • IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.

PREPARE: Direct: Dilute each 1 g with 10 mL of sterile water for injection.  Intermittent: Following reconstitution, dilute each 1 g with 50–100 mL of D5W or NS.  

ADMINISTER: Direct: Give over 3–5 min.  Intermittent: Give a single dose over 30 min. For IV infusion, solution may be given for longer period of time through tubing system through which other IV solutions are being given.  

INCOMPATIBILITIES Solution/additive: aminoglycosides, heparin, promethazine, tetracyclines. Y-site: aminoglycosides, cistracurium, lansoprazole, pemetrexed, promethazine, vancomycin, vinorelbine.

  • Protect sterile powder from light; store at 22° C (71.6° F) or less; remains stable 24 mo after date of manufacture. May darken with age, but potency is unaffected. Reconstituted solutions: stable for 24 h at 25° C (77° F); 96 h when refrigerated at 5° C (41° F); or at least 1 wk when frozen at –20° C (–4° F).

Adverse Effects (≥1%)

Body as a Whole: Fever, chills, injection site pain, inflammation, disulfiram-like reaction. GI: Nausea, vomiting, diarrhea, abdominal pain, antibiotic-associated colitis. Hematologic: Thrombocytopenia, prolongation of bleeding time or prothrombin time. Skin: Rash, pruritus.

Diagnostic Test Interference

May cause falsely elevated serum or urine creatinine values (Jaffe reaction). False-positive reactions for urine glucose have not been reported using copper sulfate reduction methods (e.g., Benedict's, Clinitest); however, since it has occurred with other cephalosporins, it may be advisable to use glucose oxidase tests (Clinistix, TesTape, Diastix). Positive direct antiglobulin (Coombs') test results may interfere with hematologic studies and cross-matching procedures.


Drug: Probenecid decreases renal elimination of cefotetan; alcohol produces disulfiram reaction; chloramphenicol may effect therapeutic activity.


Peak: 1.5–3 h after IM. Distribution: Poor CNS penetration; widely distributed to body tissues and fluids, including bile, sputum, prostatic and peritoneal fluids; crosses placenta. Elimination: 51–81% unchanged in urine; 20% in bile; small amount in breast milk. Half-Life: 180–270 min.

Nursing Implications

Assessment & Drug Effects

  • Determine history of hypersensitivity to cephalosporins and 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 periodic hematologic studies (including PT/INR and PTT) and evaluation of renal function, especially if cefotetan dose is high or if therapy is prolonged in order to recognize symptoms of nephrotoxicity and ototoxicity (see Appendix F).
  • Report onset of loose stools or diarrhea. If diarrhea is severe, suspect pseudomembranous colitis (see Appendix F) caused by Clostridium difficile. Check temperature. Report fever and severe diarrhea to physician; drug should be discontinued.

Patient & Family Education

  • Report promptly S&S of superinfection (see Appendix F).
  • Report loose stools or diarrhea.

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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