Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 1g
- 2g
- 10g
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (9)
- argatroban
cefoxitin will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity
- BCG vaccine live
cefoxitin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- bivalirudin
cefoxitin will increase the level or effect of bivalirudin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity
- chloramphenicol
chloramphenicol decreases effects of cefoxitin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.
- cholera vaccine
cefoxitin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- dalteparin
cefoxitin will increase the level or effect of dalteparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity
- enoxaparin
cefoxitin will increase the level or effect of enoxaparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity
- fondaparinux
cefoxitin will increase the level or effect of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity
- heparin
cefoxitin will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity
Monitor Closely (17)
- azithromycin
azithromycin decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- aztreonam
cefoxitin decreases effects of aztreonam by pharmacodynamic antagonism. Use Caution/Monitor. Increase in production of beta-lactamases by cefoxitin can inactivate aztreonam.
- bazedoxifene/conjugated estrogens
cefoxitin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- clarithromycin
clarithromycin decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- demeclocycline
demeclocycline decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- dienogest/estradiol valerate
cefoxitin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
- doxycycline
doxycycline decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin base
erythromycin base decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin lactobionate
erythromycin lactobionate decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin stearate
erythromycin stearate decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- minocycline
minocycline decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- probenecid
probenecid will increase the level or effect of cefoxitin by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
cefoxitin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- tetracycline
tetracycline decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- voclosporin
voclosporin, cefoxitin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- warfarin
cefoxitin increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
Minor (3)
- choline magnesium trisalicylate
cefoxitin will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- furosemide
cefoxitin increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.
- rose hips
rose hips will increase the level or effect of cefoxitin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
Adverse Effects
1-10%
Diarrhea
<1%
Anemia
Eosinophilia
Transient leukopenia
Thrombocytopenia
SCr & BUN increased
Elevated LFT's
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
Pregnancy & Lactation
Pregnancy
Available data from published prospective cohort studies, case series, and case reports with cephalosporin use in pregnant women have not established drug- associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes
Maternal gonorrhea may be associated with preterm birth, low neonatal birth weight, chorioamnionitis, intrauterine growth restriction, small for gestational age and premature rupture of membranes; perinatal transmission of gonorrhea to offspring can result in infant blindness, joint infections, and bloodstream infections
Animal data
- No adverse developmental effects observed in pregnant rats and mice administered parenteral doses of cefoxitin at approximately 1- 7.5 times maximum recommended human dose
Lactation
Limited data from published literature report presence of drug in human milk
For an infant fed exclusively with human milk, estimated infant daily dose through breastfeeding is less than 0.1% of maternal daily IV dose
Minimal data available on effects of drug on breastfed infant; none of these reports suggest serious safety concerns
No data are available on effects of drug on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for cefoxitin and any potential adverse effects on breastfed infant from drug or from underlying maternal condition
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.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%)
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)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| cefoxitin intravenous - | 1 gram vial |  | |
| cefoxitin intravenous - | 1 gram vial |  | |
| cefoxitin intravenous - | 1 gram vial |  | |
| cefoxitin intravenous - | 1 gram vial |  | |
| cefoxitin intravenous - | 2 gram vial |  | |
| cefoxitin intravenous - | 10 gram vial |  | |
| cefoxitin intravenous - | 10 gram vial |  | |
| cefoxitin intravenous - | 2 gram vial |  | |
| cefoxitin intravenous - | 1 gram vial |  | |
| cefoxitin intravenous - | 2 gram vial |  | |
| cefoxitin intravenous - | 10 gram vial |  | |
| cefoxitin intravenous - | 2 gram vial |  | |
| cefoxitin intravenous - | 1 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
cefoxitin intravenous
CEFOXITIN - INJECTION
(sef-OX-i-tin)
COMMON BRAND NAME(S): Mefoxin
USES: Cefoxitin is an antibiotic used to treat a wide variety of bacterial infections. It may also be used before and during certain surgeries to help prevent infection. This medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria.
HOW TO USE: This medication is given by injection into a muscle or vein as directed by your doctor. The dosage is based on your medical condition and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed treatment period is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Swelling, redness, pain, or soreness at the injection site may occur. This medication may also rarely cause loss of appetite, nausea, vomiting, diarrhea, or headache. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: dark urine, easy bruising/bleeding, fast/pounding/irregular heartbeat, seizures, unusual weakness, yellowing eyes/skin, mental/mood changes (such as confusion).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using cefoxitin, tell your doctor or pharmacist if you are allergic to it; or to other cephalosporins; or to penicillins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, stomach/intestinal diseases (such as colitis).Cefoxitin may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using cefoxitin before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may interfere with certain medical/laboratory tests (such as Coombs' test, urine glucose tests, serum or urine creatinine tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: trouble breathing, seizures.
NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as complete blood count) may be done while you are using this product. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised November 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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