Classifications: antibiotic; second-generation cephalosporin; Therapeutic: antibiotic; cephalosporin
Pregnancy Category: B
1 g, 2 g injection
Semisynthetic, broad-spectrum beta-lactam antibiotic classified as second-generation cephalosporin; structurally and pharmacologically
related to cephalosporins and penicillins. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located
on cell walls of susceptible organisms, thus making it bactericidal.
It shows enhanced activity against a wide variety of gram-negative organisms and is effective for mixed aerobic-anaerobic
infections. Considerably less active than most cephalosporins against Staphylococci.
Infections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin and skin structures, bones
and joints; also intra-abdominal endocarditis, gynecological infections, septicemia, uncomplicated gonorrhea, and perioperative
prophylaxis in prosthetic arthroplasty or cardiovascular surgery. May be cephalosporin of choice for mixed aerobic-anaerobic
infections (e.g., Bacteroides fragilis).
Hypersensitivity to cephalosporins and related antibiotics.
History of sensitivity to penicillin or other allergies, particularly to drugs; impaired renal function; coagulopathy; GI
disease, colitis; pregnancy (category B).
Route & Dosage
|Moderate to Severe Infections
Adult: IV/IM 12 g q68h, up to 12 g/d
Child (>3 mo): IV/IM 80160 mg/kg/d in 46 divided doses (max: 12 g/d)
Adult: IV/IM 2 g 3060 min before surgery, then 2 g q6h for 24 h
Child: IV/IM 3040 mg/kg 3060 min before surgery, then 3040 mg q6h for 24 h
Adult: IV/IM 2 g after clamping umbilical cord
Clcr 3050 mL/min: 12 g q812h; 1029 mL/min: 12 g q1224h; 59 mL/min: 0.51 g q1224h;
>5 mL/min: 0.51 g q2448h
Hemodialysis: Dose of 12 g post dialysis
- Reconstitute each 1 g with 2 mL sterile water for injection or 0.5 or 1% lidocaine hydrochloride (without epinephrine),
used to reduce discomfort of IM injection. After reconstitution for IM use, shake vial and allow solution to stand until
it becomes clear.
- Administer IM injections deep into large muscle mass such as upper outer quadrant of gluteus maximus. Aspirate before injecting
drug. Rotate injection sites.
- IV administration to neonates, infants and children: Verify correct IV concentration and rate of infusion/injection with
PREPARE: Direct: Dilute each 1 g with 10 mL sterile water, D5W, or NS. Intermittent: Following reconstitution, dilute 12 g in 50100 mL of D5W or NS.
ADMINISTER: Direct: Give over 35 min. Intermittent: Give over 15 min.
INCOMPATIBILITIES Solution/additive: aminoglycosides, ranitidine. Y-site: aminoglycosides, cisatracurium, fenoldopam, filgrastim, hetastarch, lansoprazole, pentamidine, vancomycin.
- Reconstituted solution may become discolored (usually light yellow to amber) if exposed to high temperatures; however, potency
is not affected. Solution may be cloudy immediately after reconstitution; let stand and it will clear.
- After reconstitution, solution is stable for 24 h at 25° C (77° F); 7 d when refrigerated at 4° C (39°
F), or 30 wk when frozen at 20° C (4° F).
Adverse Effects (≥1%)Body as a Whole:
Drug fever, eosinophilia, superinfections, local reactions: pain, tenderness, and induration (IM site), thrombophlebitis
site). GI: Diarrhea, pseudomembranous colitis. Skin:
Rash, exfoliative dermatitis,
pruritus, urticaria. Urogenital:
Diagnostic Test Interference
Cefoxitin causes false-positive (black-brown or green-brown color) urine glucose reaction with copper reduction reagents such as Benedict's or Clinitest, but not with enzymatic glucose oxidase reagents (Clinistix, TesTape). With high doses, falsely elevated serum and urine creatinine (with Jaffee reaction) reported. False-positive direct Coombs' test (may interfere with cross-matching procedures and hematologic studies) has also been reported.
elimination of cefoxitin.
2030 min after IM; 5 min after IV
penetration even with inflamed meninges; widely distributed in body tissues including pleural, synovial, and ascitic
fluid and bile; crosses placenta. Elimination:
85% unchanged in urine in 6 h, small amount in breast milk. Half-Life:
Assessment & Drug Effects
- Determine previous hypersensitivity to cephalosporins, penicillins, and other drug allergies before therapy is initiated.
- Lab tests: Perform culture and sensitivity testing prior to and periodically during therapy. Periodic renal function tests.
- Inspect injection sites regularly. Report evidence of inflammation and patient's complaint of pain.
- Monitor I&O rates and pattern: Nephrotoxicity occurs most frequently in patients >50 y, in patients with impaired renal
function, the debilitated, and in patients receiving high doses or other nephrotoxic drugs.
- Be alert to S&S of superinfections (see Appendix F). This condition is most apt to occur in older adult patients, especially
when drug has been used for prolonged period.
- Report onset of diarrhea (may be dose related). If severe, pseudomembranous colitis (see Signs & Symptoms, Appendix F) must
be ruled out. Older adult patients are especially susceptible.
Patient & Family Education
- Report promptly S&S of superinfection (see Appendix F).
- Report watery or bloody loose stools or severe diarrhea.
- Report severe vomiting or stomach pain.
- Report infusion site swelling, pain, or redness.