cefoxitin (Rx)

1-10%

Diarrhea

<1%

Anemia

Eosinophilia

Transient leukopenia

Thrombocytopenia

SCr & BUN increased

Elevated LFT's

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

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.

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%)

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)