cefoxitin (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection

  • 1g
  • 2g
  • 10g
more...

Uncomplicated Infections

1 g IV q6-8hr; 3-4 g/day maximum

Moderate-Severe Infections

1 g IV q4hr or 2 g IV q6-8hr; 6-8 g/day maximum

Gas Gangrene

Infections commonly requiring antibiotics in higher dosage

2 g IV q4hr or 3 g IV q6hr; 12 g/day maximum

Surgery Prophylaxis

Prevention of infection

Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV

Ruptured viscus: 1-2 g IV q6hr

Renal Impairment

CrCl 30-50 mL/min: 1-2 g q8-12hr

CrCl 10-30 mL/min: 1-2 g q12-24hr

CrCl 5-9 mL/min: 500 mg-1 g q24-28hr

CrCl <5 mL/min: 500 mg-1 g q24-48hr

Other Indications & Uses

Bacteroides spp., Clostridium spp., Enterobacter, E. coli, H. influenzae, Klebsiella spp., Peptococcus spp., Peptostreptococcus spp., Proteus mirabilis, S. aureus, S. pneumoniae, group A beta-hemolytic Streptococcus

Dosage Forms & Strengths

powder for injection

  • 1g
  • 2g
  • 10g
more...

Infections

<3 months old: Safety & efficacy not established

>3 months old: 80-160 mg/kg/day IV divided q4-6hr; higher dosages should be used for more severe or serious infections 

Surgery Prophylaxis

Prevention of infection

30-40 mg/kg 30-60 minutes before surgery 

30-40 mg/kg q6hr for 24 hours afterwards

Renal Impairment

Adjust similar to adult adjustment

Uncomplicated infections

1 g IV q6-8hr; 3-4 g/day maximum

Moderate-severe infections

1 g IV q4hr or 2 g IV q6-8hr; 6-8 g/day maximum

Gas gangrene

Infections commonly requiring antibiotics in higher dosage

2 g IV q4hr or 3 g IV q6hr; 12 g/day maximum

Surgery prophylaxis

Prevention of infection

Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV

Ruptured viscus: 1-2 g IV q6hr

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Interactions

Interaction Checker

and cefoxitin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Diarrhea

            <1%

            Anemia

            Eosinophilia

            Transient leukopenia

            Thrombocytopenia

            SCr & BUN increased

            Elevated LFT's

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            Warnings

            Contraindications (additional)

            Documented hypersensitivity

            Neonate (<3 mo)

            Cautions

            Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections, and promotion of non-susceptible organisms may occur with prolonged use or repeated therapy

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: excreted in low concentrations in breast milk, use caution (AAP Committee states compatible w/ nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Second-generation cephalosporin with activity against some gram-positive cocci, gram-negative rod infections, and anaerobic bacteria. Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins; inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death

            Pharmacokinetics

            Half-Life: 45-60 min

            Peak Plasma Time: 20-30 min (IM); within 5 min (IV)

            Protein Bound: 65-79%

            Distribution: Widely distributed to body tissues & fluids, including pleural, synovial, ascitic fluid, bile, poor CSF penetration

            Excretion: Unchanged in urine (85%)

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            Administration

            IV Incompatibilities

            Additive: ranitidine

            Y-site: cisatracurium(?, comp at low cisatra conc [0.1 mg/mL]), fenoldopam, filgrastim, gatifloxacin, hetastarch, pentamidine, vancomycin(?)

            IV Compatibilities

            Solution: compatible w/ most common solvents

            Additive: amikacin, aztreonam, cimetidine, clindamycin, gentamicin, kanamycin, metronidazole, metronidazole w/ NaHCO3, multivitamins, NaHCO3, tobramycin, verapamil, Vit B/C

            Syringe: heparin

            Y-site (partial list): acyclovir, amphotericin B cholesteryl SO4, aztreonam, diltiazem, fluconazole, linezolid, MgSO4, morphine sulfate, ondansetron, propofol

            IV Preparation

            Intermittent IV: reconstitute 1or 2 g w/ 10-20 mL SWI

            Continuous infusion: add reconstituted soln to D5W or NS

            IM Preparation

            Reconstitute by adding 2 mL SWI or 0.5-1% lidocaine HCl injection (without epinephrine) to each g of cefoxitin to obtain an approx 400 mg/mL solution

            IV Administration

            Injection: directly into a vein over 3-5-min or slowly into tubing of a compatible IV infusion solution

            IM Administration

            Deep into a large muscle (eg, upper outer quadrant of gluteus maximus)

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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