Classifications: antibiotic; third-generation cephalosporin;
; 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.

Therapeutic Effect

Generally resistant to inactivation by beta-lactamases that act principally as cephalosporinases and penicillinases. Its spectrum includes some gram-positive organisms but has predominantly gram-negative coverage.


Infections caused by susceptible organisms in lower respiratory tract, skin and skin structures, urinary tract, bones and joints; also used to treat intra-abdominal infections, pelvic inflammatory disease, uncomplicated gonorrhea, meningitis (Haemophilus influenzae, Streptococcus pneumoniae), and for surgical prophylaxis.

Unlabeled Uses

Meningitis caused by Neisseria meningitidis and E. coli.


Hypersensitivity to cephalosporins and other beta-lactam antibiotics; viral disease. Safe use in infants <6 mo not established.

Cautious Use

Penicillin hypersensitivity; coagulopathy; GI disease, colitis; elderly; renal disease, renal impairment; lactation; pregnancy (category B).

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 1–2 g q8–12h, up to 2 g q4h
Child (≥6 mo): IV/IM 50 mg/kg q6–8h, up to 200 mg/kg/d

Life Threatening Infections
Adult: IV 3–4 g q8h

Renal Impairment
Use lower dose.
Dialysis: Administer dose after dialysis


  • Reconstitute as follows with sterile water for injection: add 1.5 mL to 500 mg to yield 280 mg/mL; add 3 mL to 1 g or 6 mL to 2 g to yield 270 mg/mL.
  • Give deep IM into a large muscle. Give no more than 1 g into a single injection site.

PREPARE: Direct: Reconstitute each 1 g with 10 mL sterile water. Shake well.  Intermittent: Further dilute in 50–100 mL D5W, NS, D5/NS, D5/.45% NaCl, RL, or other compatible IV solution.  

ADMINISTER: Direct: Give over 3–5 min.  Intermittent: Give over 30 min.  

INCOMPATIBILITIES Solution/additive: Promethazine. Y-site: Filgrastim, lansoprazole, vancomycin.

  • Protect from light. Consult manufacturer's directions concerning storage of reconstituted solutions.

Adverse Effects (≥1%)

Body as a Whole: Fever, phlebitis, vaginitis, pain and induration at injection site, paresthesia. GI: Nausea, vomiting, diarrhea, pseudomembranous colitis. Skin: Rash, pruritus.

Diagnostic Test Interference

Ceftizoxime causes false-positive direct Coombs' test (may interfere with cross-matching procedures and hematologic studies).


Drug: Probenecid decreases renal elimination of ceftizoxime.


Peak: 1 h. Distribution: Crosses placenta. Metabolism: Not metabolized. Elimination: 80–90% unchanged in urine in 24 h; small amount in breast milk. Half-Life: 25–60 min.

Nursing Implications

Assessment & Drug Effects

  • Determine history of hypersensitivity reactions to cephalosporins, penicillin, or other drugs before therapy is instituted. Report to physician history of allergy, particularly to drugs.
  • Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results.
  • Be alert to symptoms of hypersensitivity reaction (see Appendix F). Serious reactions may require emergency measures.

Patient & Family Education

  • Report loose stools or diarrhea promptly.
  • Report any signs or symptoms of hypersensitivity (see Appendix F) promptly.

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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