Cefoxitin


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Susceptible infections 1-2 g 6-8 hrly, up to 12 g/day in severe infections. Surgical prophylaxis 2 g 30-60 min prior to surgery, then 6 hrly for not more than 24 hr. Caesarian section: 2 g as a single dose as soon as the umbilical cord is clamped; a further 2 g dose 4 hr and 8 hr after the initial dose.
Dosage Details
Intravenous
Abdominal infections, Bone and joint infections, Gynaecological infections, Respiratory tract infections, Skin and skin structure infections, Urinary tract infections
Adult: 1-2 g 6-8 hrly, up to 12 g daily given in 4-6 divided doses in severe infections. Doses are given by slow inj over 3-5 min or, by intermittent or continuous infusion.
Child: ≥3 mth 80-160 mg/kg daily in 4-6 equally divided doses. Max: 12 g daily.

Intravenous
Prophylaxis of surgical infections
Adult: 2 g 30-60 min prior to surgery, then 6 hrly for not more than 24 hr. For caesarean section: 2 g as a single dose as soon as the umbilical cord is clamped; a further 2 g dose 4 hr and 8 hr after the initial dose may be given if necessary.
Child: ≥3 mth 30-40 mg/kg 30-60 min prior to surgery, then 6 hrly for not more than 24 hr.
Renal Impairment
Loading dose: 1-2 g. Maintenance dose: According to CrCl. Haemodialysis patient: Repeat loading dose after each dialysis session.
CrCl (mL/min) Dosage
<5 0.5-1 g 24-48 hrly.
5-9 0.5-1 g 12-24 hrly.
10-29 1-2 g 12-24 hrly.
30-50 1-2 g 8-12 hrly.
Reconstitution
As intermittent inj: Dissolve cefoxitin 1 g in 10 mL and 2 g in 10 mL or 20 mL of sterile water for inj. As intermittent or continuous infusion: Add 50 mL or 100 mL of dextrose 5% or 10% inj, NaCl 0.9% inj, or other compatible IV soln to cefoxitin 1 g or 2 g.
Incompatibility
Y-site: Anakinra, fenoldopam, filgrastim, hetastarch in normal saline, pantoprazole, pemetrexed, pentamidine.
Contraindications
Hypersensitivity to cefoxitin and other cephalosporins.
Special Precautions
Patient w/ history of penicillin allergy, GI disease (particularly colitis) and seizure disorder. Renal impairment. Pregnancy and lactation.
Adverse Reactions
Hypersensitivity reactions (e.g. maculopapular or erythematous rash, exfoliative dermatitis, pruritus, urticaria, eosinophilia, fever, angioedema); elevated serum creatinine and/or BUN concentrations, anaemia; transient increase in serum AST (SGOT), ALT (SGPT), LDH and alkaline phosphatase levels; jaundice; thrombophlebitis. Rarely, oliguria, renal toxicity, neutropenia, transient leucopenia, granulocytopenia, thrombocytopenia, bone marrow depression; GI effects (e.g. nausea, vomiting, diarrhoea).
Potentially Fatal: Anaphylaxis, pseudomembranous colitis.
IV/Parenteral: B
MonitoringParameters
Monitor renal function periodically when used in combination w/ other nephrotoxic drugs; prothrombin time. Observe for signs and symptoms of anaphylaxis during 1st dose.
Drug Interactions
Reduces renal clearance w/ probenecid. Concurrent use of nephrotoxic agents (e.g. aminoglycosides, colistin, polymyxin B, vancomycin) may increase the risk of nephrotoxicity.
Lab Interference
Positive direct antiglobulin (Coombs') test results. False-positive results in urine glucose determinations using cupric sulfate soln (Benedict's reagent, Clinitest®). Falsely elevated serum or urine creatinine values w/ Jaffe method.
Action
Description: Cefoxitin inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
Pharmacokinetics:
Absorption: Not absorbed from the GI tract.
Distribution: Widely distributed into body tissues and fluids (including bile, synovial and pleural); poorly penetrates CSF even w/ inflamed meninges. It crosses the placenta and enters breast milk. Plasma protein binding: Approx 70%.
Metabolism: Converted to descarbamylcefoxitin (approx 2%; inactive).
Excretion: Via urine (85% as unchanged drug). Plasma half-life: 45-60 min.
Chemical Structure

Chemical Structure Image
Cefoxitin

Source: National Center for Biotechnology Information. PubChem Database. Cefoxitin, CID=441199, https://pubchem.ncbi.nlm.nih.gov/compound/Cefoxitin (accessed on Jan. 21, 2020)

Storage
Store between 2-25°C.
MIMS Class
ATC Classification
J01DC01 - cefoxitin ; Belongs to the class of second-generation cephalosporins. Used in the systemic treatment of infections.
References
Anon. Cefoxitin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/11/2014.

Buckingham R (ed). Cefoxitin Sodium . Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/11/2014.

Cefoxitin Sodium Injection, Powder, for Solution (Apotex Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/11/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Cefoxitin Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 04/11/2014.

Disclaimer: This information is independently developed by MIMS based on Cefoxitin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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