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

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
Patient Handout
Formulary
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