No

Antibiotic, Cephalosporin (Second Generation)

Less active against staphylococci and streptococci than first generation cephalosporins, but active against anaerobes including Bacteroides fragilis; active against gram-negative enteric bacilli including E. coli, Klebsiella, and Proteus; used predominantly for respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic as well as septicemia; surgical prophylaxis; intra-abdominal infections and other mixed infections

B

Hypersensitivity to cefotetan, any component, or cephalosporins

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; although cefotetan contains the methyltetrazolethiol side chain, bleeding has not been a significant problem; use with caution in patients with a history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis, urticaria); may cause antibiotic-associated colitis or colitis secondary to C. difficile

Contains MTT side chain which may lead to increased risk of hypoprothrombinemia and bleeding.

Gastrointestinal: Diarrhea (1.3%)

Hepatic: Increased transaminases (1.2%)

Miscellaneous: Hypersensitivity reactions (1.2%)

<1%: Anaphylaxis, urticaria, rash, pruritus, pseudomembranous colitis, nausea, vomiting, eosinophilia, thrombocytosis, agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia, prolonged PT, bleeding, elevated BUN, elevated creatinine, nephrotoxicity, phlebitis, fever

Other reactions with cephalosporins include: Seizures, Stevens-Johnson syndrome, toxic epidermal necrolysis, renal dysfunction, toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, pancytopenia, agranulocytosis, colitis, superinfection

Symptoms of overdose include neuromuscular hypersensitivity, convulsions especially with renal insufficiency; many beta-lactam antibiotics have the potential to cause neuromuscular hyperirritability or seizures

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Disulfiram-like reaction has been reported when taken within 72 hours of alcohol consumption

Increased cefamandole plasma levels: Probenecid

Increased nephrotoxicity: Aminoglycosides, furosemide

Reconstituted solution is stable for 24 hours at room temperature and 96 hours when refrigerated; for I.V. infusion in NS or D₅W solution and after freezing, thawed solution is stable for 24 hours at room temperature or 96 hours when refrigerated; frozen solution is stable for 12 weeks

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Distribution: Widely distributed to body tissues and fluids including bile, sputum, prostatic and peritoneal fluids; low concentrations enter CSF; crosses the placenta and appears in breast milk

Protein binding: 76% to 90%

Half-life: 3-5 hours

Time to peak serum concentration: I.M.: Within 1.5-3 hours

Elimination: Primarily excreted unchanged in urine with 20% excreted in bile

I.M., I.V.:

Adults: 1-6 g/day in divided doses every 12 hours; usual dose: 1-2 g every 12 hours for 5-10 days; 1-2 g may be given every 24 hours for urinary tract infection

Dosing interval in renal impairment:

Cl_cr 10-30 mL/minute: Administer every 24 hours

Cl_cr <10 mL/minute: Administer every 48 hours

Hemodialysis: Slightly dialyzable (5% to 20%)

Continuous arteriovenous or venovenous hemodiafiltration (CAVH) effects: Administer 750 mg every 12 hours

Observe for signs and symptoms of anaphylaxis during first dose

Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction

May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins

May rarely cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This medication is administered I.V. or I.M. Drink 2-3 L fluid/day. Avoid alcohol during therapy and for 72 hours after last dose (may cause severe disulfiram-like reactions). If diarrhea occurs, yogurt or buttermilk may help. May cause false-positive test with Clinitest®; use another form of testing. May interfere with oral contraceptives; additional contraceptive measures are necessary. Report severe, unresolved diarrhea; vaginal itching or drainage; sores in mouth; blood, pus, or mucus in stool or urine; easy bleeding or bruising; unusual fever or chills; rash; or respiratory difficulty. Breast-feeding precautions: Consult prescriber if breast-feeding.

Do not admix with aminoglycosides in same bottle/bag

Powder for injection, as disodium: 1 g (10 mL, 100 mL); 2 g (20 mL, 100 mL); 10 g (100 mL)

"Antimicrobial Prophylaxis in Surgery," Med Lett Drugs Ther, 1993, 35(906):91-4.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Marshall WF and Blair JE, "The Cephalosporins," Mayo Clin Proc, 1999, 74(2):187-95.

Martin C, Thomachot L, and Albanese J, "Clinical Pharmacokinetics of Cefotetan," Clin Pharmacokinet, 1994, 26(4):248-58.