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; indicated for bacterial Eikenella corrodens infections

B

Hypersensitivity to cefoxitin, any component, or cephalosporins

Use with caution in patients with history of colitis; cefoxitin may increase resistance of organisms by inducing beta-lactamase; modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; 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

1% to 10%: Gastrointestinal: Diarrhea

<1%: Anaphylaxis, dyspnea, fever, rash, exfoliative dermatitis, toxic epidermal necrolysis, pruritus, angioedema, nausea, hypotension, vomiting, dyspnea, pseudomembranous colitis, phlebitis, interstitial nephritis, increased BUN, increased creatinine, leukopenia, thrombocytopenia, hemolytic anemia, bone marrow suppression, eosinophilia, increased transaminases, jaundice, thrombophlebitis, increased nephrotoxicity (with aminoglycosides), exacerbation of myasthenia gravis, prolonged PT

Other reactions with cephalosporins include: Seizures, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, urticaria, serum-sickness reactions, renal dysfunction, toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, pancytopenia, agranulocytosis, colitis, vaginitis, 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

Increased effect: Probenecid may decrease cephalosporin elimination

Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity

Reconstituted solution is stable for 24 hours at room temperature and 48 hours when refrigerated; I.V. infusion in NS or D₅W solution is stable for 24 hours at room temperature, 1 week when refrigerated, or 26 weeks when frozen; after freezing, thawed solution is stable for 24 hours at room temperature or 5 days when refrigerated

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 pleural, synovial, ascitic fluid, and bile; poorly penetrates into CSF even with inflammation of the meninges; crosses the placenta and small amounts appear in breast milk

Protein binding: 65% to 79%

Half-life: 45-60 minutes, increases significantly with renal insufficiency

Time to peak serum concentration: I.M.: Within 20-30 minutes

Elimination: Rapidly excreted as unchanged drug (85%) in urine

I.M., I.V.:

Mild to moderate infection: 80-100 mg/kg/day in divided doses every 4-6 hours

Severe infection: 100-160 mg/kg/day in divided doses every 4-6 hours

Maximum dose: 12 g/day

Adults: 1-2 g every 6-8 hours (I.M. injection is painful); up to 12 g/day

Dosing interval in renal impairment:

Cl_cr 30-50 mL/minute: Administer every 8-12 hours

Cl_cr 10-30 mL/minute: Administer every 12-24 hours

Cl_cr <10 mL/minute: Administer every 24-48 hours

Hemodialysis: Moderately dialyzable (20% to 50%)

Continuous arteriovenous or venovenous hemodiafiltration (CAVH) effects: Dose as for Cl_cr 10-50 mL/minute

Monitor renal function periodically when used in combination with other nephrotoxic drugs; 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.M. or I.V. Drink 2-3 L fluid/day. 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.

Administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels; modify dosage in patients with renal insufficiency; can be administered IVP over 3-5 minutes at a maximum concentration of 100 mg/mL or I.V. intermittent infusion over 10-60 minutes at a final concentration for I.V. administration not to exceed 40 mg/mL

Infusion, as sodium, premixed, in D₅W (frozen): 1 g (50 mL); 2 g (50 mL)

Powder for injection, as sodium: 1 g, 2 g, 10 g

"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.

Feldman WE, Moffitt S, and Sprow N, "Clinical and Pharmacokinetic Evaluation of Parenteral Cefoxitin in Infants and Children," Antimicrob Agents Chemother, 1980, 17(4):669-74.

Garcia MJ, Garcia A, Nieto MJ, et al, "Disposition of Cefoxitin in the Elderly," Int J Clin Pharmacol Ther Toxicol, 1980, 18(11):503-9.

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

Regazzi MB, Chirico G, Cristiani D, et al, "Cefoxitin in Newborn Infants. A Clinical and Pharmacokinetic Study," Eur J Clin Pharmacol, 1983, 25(4):507-9.