Adult: 1 g 30-90 min before surgery by deep IM, slow IV inj over 3-5 min or IV infusion over 20-60 min. Caesarean section: 1 g IV as soon as the umbilical cord is clamped and 2 further IM or IV doses 6-12 hr later.
Parenteral Septicaemia
Adult: Up to 6-8 g daily in 3-4 divided doses by deep IM, slow IV inj over 3-5 min or IV infusion over 20-60 min.
Parenteral Bone and joint infections, Central nervous system infections, Genitourinary infections, Gynaecological infections, Intra-abdominal infections, Respiratory tract infections, Skin and skin structure infections
Adult: 1-2 g 8-12 hrly depending on the severity of the infection. May be given via deep IM inj, slow IV inj over 3-5 min or by IV infusion over 20-60 min. Max: 12 g daily. Child: 0-1 wk 50 mg/kg/dose 12 hrly IV inj; >1-4 wk 50 mg/kg/dose 8 hrly IV inj; 1 mth to 12 yr <50 kg: 50-180 mg/kg IM or IV inj in 4-6 divided doses.
Parenteral Gonorrhoea
Adult: 0.5 or 1 g as a single dose by deep IM, slow IV inj over 3-5 min or IV infusion over 20-60 min.
Special Patient Group
Critically ill patients undergoing renal replacement therapy: Continuous venovenous haemofiltration: 1-2 g 8-12 hrly. Continuous venovenous haemodialysis: 1-2 g 8 hrly. Continuous venovenous haemodiafiltration: 1-2 g 6-8 hrly. Intermittent haemodialysis: 1-2 g every 24 hr (after dialysis run).
Renal Impairment
Severe: After an initial loading dose of 1 g, half the daily dose w/o changing the frequency.
Reconstitution
Intermittent IV: Add 10 mL of sterile water for inj to a vial containing 0.5 g, 1 g or 2 g to provide a soln containing approx 50 mg, 95 mg, or 180 mg per mL, respectively. Intermittent or continuous IV infusion: Add 50 mL or 100 mL of NaCl 0.9% inj or dextrose 5% inj to an infusion bottle containing 1 g or 2 g. Alternatively, reconstituted soln may be further diluted w/ 50-1,000 mL of a compatible soln. IM: Add 2 mL, 3 mL or 5 mL of sterile or bacteriostatic water for inj to a vial containing 0.5 g, 1 g or 2 g to provide a soln containing approx 230 mg, 300 mg or 330 mg per mL, respectively.
Incompatibility
Incompatible w/ alkaline soln (e.g. Na bicarbonate inj), soln containing aminophylline, aminoglycosides. Y-site: Incompatible w/ allopurinol, azithromycin, filgrastim, fluconazole, gemcitabine, pantoprazole, pemetrexed, pentamidine, hetastarch in normal saline.
Contraindications
Hypersensitivity to cefotaxime or other cephalosporins.
Special Precautions
Patient w/ history of penicillin allergy and colitis. Renal impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Rash (maculopapular or erythematous), pruritus, fever, eosinophilia; inflammation, phlebitis, thrombophlebitis (IV); pain, induration, tenderness at inj site (IM); anorexia, diarrhoea, nausea, vomiting, abdominal pain; transient neutropenia, granulocytopenia, leucopenia, eosinophilia or thrombocytopenia; transient increases in BUN and/or serum creatinine concentrations and interstitial nephritis; hepatitis, jaundice, cholestasis; transient increases in serum AST, ALT, LDH, γ-GT, bilirubin, and alkaline phosphatase concentrations; headache, agitation, confusion, fatigue, nocturnal perspiration. Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme. Potentially Fatal:Clostridium difficile-associated diarrhoea and colitis, arrhythmias, anaphylaxis.
Urinary glucose test using cupric sulfate (e.g. Benedict's or Fehling's tests soln, Clinitest®) may produce false-positive result. May induce a positive direct Coombs' test; false-positive serum or urine creatinine w/ Jaffe' reaction.
Action
Description: Cefotaxime binds to 1 or more of the penicillin-binding proteins (PBPs) which inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. Pharmacokinetics: Absorption: Rapidly absorbed (IM). Time to peak plasma concentration: 30 min (IM), 4 hr (IV). Distribution: Widely distributed into body tissues and fluids; occur in CSF esp when the meninges are inflamed. It crosses the placenta and enters breast milk (low concentrations). Plasma protein binding: Approx 40%. Metabolism: Undergoes partial metabolism in the liver and converted to desacetylcefotaxime and inactive metabolites. Excretion: Mainly via urine (approx 40-60% as unchanged drug, further 20% as desacetyl metabolite); bile (relatively high concentrations); faeces (approx 20%). Plasma half-life: Approx 1 hr (cefotaxime); approx 1.5 hr (desacetylcefotaxime).
Chemical Structure
Cefotaxime Source: National Center for Biotechnology Information. PubChem Database. Cefotaxime, CID=5742673, https://pubchem.ncbi.nlm.nih.gov/compound/Cefotaxime (accessed on Jan. 21, 2020)
Anon. Cefotaxime. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/11/2014.Buckingham R (ed). Cefotaxime Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/11/2014.Claforan Injection (Sanofi-Aventis U.S. LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/11/2014.Claforan Injection. U.S. FDA. https://www.fda.gov/. Accessed 06/11/2014.Claforan Sterile and Injection. U.S. FDA. https://www.fda.gov/. Accessed 06/11/2014.Joint Formulary Committee. Cefotaxime. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/11/2014.McEvoy GK, Snow EK, Miller J et al (eds). Cefotaxime Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 06/11/2014.
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