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Ceftizoxime
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Monitoring Parameters
Test Interactions
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(sef ti ZOKS eem)

U.S. Brand Names
Cefizox®

Generic Available

No


Synonyms
Ceftizoxime Sodium

Pharmacological Index

Antibiotic, Cephalosporin (Third Generation)


Use

Treatment of susceptible bacterial infection, mainly respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic, as well as septicemia; active against many gram-negative bacilli (not Pseudomonas), some gram-positive cocci (not Enterococcus), and some anaerobes


Pregnancy Risk Factor

B


Contraindications

Hypersensitivity to ceftizoxime, any component, or cephalosporins


Warnings/Precautions

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


Adverse Reactions

1% to 10%:

Central nervous system: Fever

Dermatologic: Rash, pruritus

Hematologic: Eosinophilia, thrombocytosis

Hepatic: Elevated transaminases, alkaline phosphatase

Local: Pain, burning at injection site

<1%: Anaphylaxis, diarrhea, nausea, vomiting, injection site reactions, phlebitis, paresthesia, numbness, increased bilirubin, increased BUN, increased creatinine, anemia, leukopenia, neutropenia, thrombocytopenia, vaginitis

Other reactions reported with cephalosporins include Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, pseudomembranous colitis, angioedema, hemolytic anemia, candidiasis, encephalopathy, asterixis, neuromuscular excitability, seizures, serum-sickness reactions, renal dysfunction, interstitial nephritis, toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, pancytopenia, agranulocytosis, colitis, prolonged PT, hemorrhage, superinfection


Overdosage/Toxicology

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


Drug Interactions

Increased effect: Probenecid may decrease cephalosporin elimination

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


Stability

Reconstituted solution is stable for 24 hours at room temperature and 96 hours when refrigerated; for I.V. infusion in NS or D5W solution is stable for 24 hours at room temperature, 96 hours when refrigerated or 12 weeks when frozen; after freezing, thawed solution is stable for 24 hours at room temperature or 10 days when refrigerated


Mechanism of Action

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.


Pharmacodynamics/Kinetics

Distribution: Vd: 0.35-0.5 L/kg; widely distributed into most body tissues and fluids including gallbladder, liver, kidneys, bone, sputum, bile, and pleural and synovial fluids; has good CSF penetration; crosses placenta; small amounts excreted in breast milk

Protein binding: 30%

Half-life: 1.6 hours, increases to 25 hours when Clcr falls to <10 mL/minute

Time to peak serum concentration: I.M.: Within 0.5-1 hour

Elimination: Excreted unchanged in urine


Usual Dosage

I.M., I.V.:

Adults: 1-2 g every 8-12 hours, up to 2 g every 4 hours or 4 g every 8 hours for life-threatening infections

Dosing adjustment in renal impairment: Adults:

Clcr 10-30 mL/minute: Administer 1 g every 12 hours

Clcr <10 mL/minute: Administer 1 g every 24 hours

Moderately dialyzable (20% to 50%)

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


Monitoring Parameters

Observe for signs and symptoms of anaphylaxis during first dose


Test Interactions

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


Mental Health: Effects on Mental Status

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


Mental Health: Effects on Psychiatric Treatment

May rarely cause neutropenia; use caution with clozapine and carbamazepine


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

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.


Nursing Implications

Do not admix with aminoglycosides in same bottle/bag


Dosage Forms

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

Powder for injection, as sodium: 500 mg, 1 g, 2 g, 10 g


References

Deeter RG, Weinstein MP, Swanson KA, et al, "Crossover Assessment of Serum Bactericidal Activity and Pharmacokinetics of Five Broad-Spectrum Cephalosporins in the Elderly," Antimicrob Agents Chemother, 1990, 34(6):1007-13.

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

Klein NC and Cunha BA, "Third-Generation Cephalosporins," Med Clin North Am, 1995, 79(4):705-19.

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


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