cefotaxime (Rx)

Brand and Other Names:Claforan
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 40mg/mL

powder for injection

  • 500mg
  • 1g
  • 2g
  • 10g

Gonococcal Urethritis/Cervicitis

0.5 g IM once

Gonorrhea, Rectal

Men: 1 g IM once

Women: 0.5 g IM once

Infections Caused by Susceptible Organisms

Uncomplicated: 1 g IV or IM q12hr

Moderate to severe: 1-2 g IV or IM q8hr

More serious (bloodstream infection [septicemia]): 2 g IV q6-8hr

Life-threatening: 2 g IV q4hr; not to exceed 12 g/day

Preparation for Surgery

Prophylaxis of surgical infection

1 g IM/IV once 30-90 minutes before start of procedure

Dosing Considerations

Susceptible organisms

  • Bacteroides spp, Citrobacter spp, Clostridium spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Peptococcus spp, Peptostreptococcus spp, Proteus mirabilis, Providencia rettgeri, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 40mg/mL

powder for injection

  • 500mg
  • 1g
  • 2g
  • 10g

Infections Caused by Susceptible Organisms

<12 years or <50 kg: 50-200 mg/kg/day IV/IM divided q6-8hr  

>12 years or >50 kg: 1-2 g IV/IM q8hr

Epiglottitis

<12 years or <50 kg: 150-200 mg/kg/day IV/IM divided q6hr plus clindamycin for 7-10 days  

>12 years or >50 kg: 1-2 g IV/IM q8hr

Meningitis

<12 years or <50 kg: 200 mg/kg/day IV/IM divided q6hr  

>12 years or >50 kg: 2 g IV q4-6hr in combination with other antimicrobial therapy as necessary

Pneumonia

<12 years or <50 kg: 200 mg/kg/day IV divided q8hr  

>12 years or >50 kg: 1-2 g IV/IM q8hr

Sepsis

<12 years or <50 kg: 150 mg/kg/day IV divided q8hr  

>12 years or >50 kg: 2 g IV q6-8hr

Typhoid Fever

<12 years or <50 kg: 150-200 mg/kg/day IV/IM divided q6-8hr; not to exceed 12 g/day  

Fluoroquinolone resistant: 80 mg/kg/day IV/IM divided q6-8hr; not to exceed 12 g/day

>12 years or >50 kg: 1-2 g IV/IM q4-8hr

Dosing Considerations

Usual dosage range in children

  • 0-1 week: 50 mg/kg IV q12hr
  • 1-4 weeks: 50 mg/kg IV q8hr
  • 1 month-12 years: 50-180 mg/kg/day IV divided q4-6hr
  • >12 years: 1-2 g IV/IM q4-8hr
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Interactions

Interaction Checker

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (3)

              • BCG vaccine live

                cefotaxime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                cefotaxime, 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.

              • typhoid vaccine live

                cefotaxime decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              Monitor Closely (9)

              • bazedoxifene/conjugated estrogens

                cefotaxime 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.

              • dienogest/estradiol valerate

                cefotaxime 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.

              • ethinylestradiol

                cefotaxime will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                cefotaxime will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • probenecid

                probenecid will increase the level or effect of cefotaxime by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                cefotaxime 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.

              • ticarcillin

                ticarcillin, cefotaxime. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • voclosporin

                voclosporin, cefotaxime. 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

                cefotaxime increases effects of warfarin by Other (see comment). Use Caution/Monitor. Comment: Decr vitamin K-producing intestinal flora may increase INR after a few days.

              Minor (6)

              • aminohippurate sodium

                cefotaxime will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chloramphenicol

                chloramphenicol decreases effects of cefotaxime by pharmacodynamic antagonism. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                cefotaxime will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • rose hips

                rose hips will increase the level or effect of cefotaxime by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • sulfasalazine

                cefotaxime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • willow bark

                cefotaxime will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Colitis

              Diarrhea

              Elevated blood urea nitrogen (BUN) and creatinine

              Elevated hepatic transaminases

              Eosinophilia

              Fever

              Injection site pain

              Nausea

              Pruritus

              Rash

              Thrombocytopenia

              Transient neutropenia

              Vomiting

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              Warnings

              Contraindications

              Documented hypersensitivity to drug or components

              Cautions

              Potentially life-threatening arrhythmia reported in patients receiving rapid bolus injection through central venous catheter

              Prolonged treatment has been associated with granulocytopenia (>10 days)

              Change infusion sites to minimize inflammation

              Use with caution in patients with history of penicillin allergy

              Use with caution in patients with history of colitis

              Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

              May need to adjust dose in renal impairment

              Cefotaxime may potentiate the nephrotoxic effects of nephrotoxic drugs, including aminoglycosides, NSAIDs, and furosemide

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              Pregnancy & Lactation

              Pregnancy category: B

              Lactation: Drug enters breast milk; use with caution

              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

              Binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase; proper dosing and appropriate route of administration are determined by condition of patient, severity of infection, and susceptibility of microorganism

              Absorption

              Peak plasma time: IM, 30 min

              Distribution

              Distribution: widely distributed to body tissues and fluids, including aqueous humor, ascitic and prostatic fluids, bone, penetrates CSF when meninges inflamed

              Widely distributed to body tissues and fluids, including aqueous humor, ascitic and prostatic fluids, and bone; penetrates CSF when meninges are inflamed

              Metabolism

              Partially metabolized in liver

              Metabolite: Desacetylcefotaxime (active)

              Elimination

              Half-life: Parent drug, 1-1.5 hr; active metabolite, 1-1.9 hr

              Excretion: Urine

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              Administration

              IV Incompatibilities

              Additive: Aminoglycosides, aminophylline, sodium bicarbonate

              Syringe: Doxapram

              Y-site: Allopurinol, filgrastim, fluconazole, gemcitabine, hetastarch, pentamidine

              IV Preparation

              Intermittent injection: Reconstitute 1 or 2 g with 10 mL SWI

              Infusion: Reconstitute infusion bottles with 50 or 100 mL NS or D5W

              May be diluted further

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Claforan intravenous
              -
              2 gram vial
              Claforan intravenous
              -
              1 gram vial
              Claforan injection
              -
              2 gram vial
              Claforan injection
              -
              10 gram vial
              Claforan injection
              -
              2 gram vial
              cefotaxime injection
              -
              1 gram vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

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              Patient Education
              cefotaxime intravenous

              CEFOTAXIME - INJECTION

              (SEF-oh-TAX-eem)

              COMMON BRAND NAME(S): Claforan

              USES: Cefotaxime is used to treat a wide variety of bacterial infections. It may also be used to prevent infection from certain surgeries. This medication belongs to a class of drugs known as cephalosporin antibiotics. 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. If given by injection into a vein, inject the drug slowly over at least 3 minutes to avoid possible serious side effects (such as irregular heartbeat). The dosage is based on your medical condition and response to treatment.If you are using this medication 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.If you are using the frozen pre-mixed solution, thaw the bag at room temperature or in the refrigerator. If the bag is thawed in the refrigerator, let it sit at room temperature at least 1 hour before using. Do not thaw by putting in a water bath or microwaving. After thawing, shake well and squeeze the bag to check for leaks. Discard solution if the bag leaks. Do not re-freeze the solution after thawing.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 for the full time prescribed, 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, or pain at the injection site may occur. 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: easy bruising/bleeding, unusual tiredness, uncontrollable movements, mental/mood changes (such as confusion), seizures, signs of kidney problems (such as change in the amount of urine), signs of liver problems (such as nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine).Get medical help right away if you have any very serious side effects, including: fast/slow/irregular heartbeat.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 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 cefotaxime, tell your doctor or pharmacist if you are allergic to it; or to other antibiotics (such as penicillins, other cephalosporins); 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, stomach/intestinal diseases (such as colitis).Cefotaxime may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.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 in small amounts and is unlikely to harm a nursing infant. 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 lab tests (including certain urine glucose tests), possibly causing false test results. Make sure lab 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: seizures.

              NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, kidney function tests) should be done while you are using this medication. Keep all medical and lab appointments.

              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 August 2021. Copyright(c) 2021 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.

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.