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Pronunciation |
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(sef
ti ZOKS
eem) |
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U.S. Brand
Names |
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Cefizox® |
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Generic
Available |
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No |
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Synonyms |
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Ceftizoxime Sodium |
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Pharmacological Index |
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Antibiotic, Cephalosporin (Third Generation) |
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Use |
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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 |
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Pregnancy Risk
Factor |
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B |
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Contraindications |
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Hypersensitivity to ceftizoxime, any component, or
cephalosporins |
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Warnings/Precautions |
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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 |
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Adverse
Reactions |
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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 |
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Overdosage/Toxicology |
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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 |
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Drug
Interactions |
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Increased effect: Probenecid may decrease cephalosporin elimination
Increased toxicity: Furosemide, aminoglycosides may be a possible additive to
nephrotoxicity |
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Stability |
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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 |
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Mechanism of
Action |
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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. |
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Pharmacodynamics/Kinetics |
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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 |
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Usual Dosage |
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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 |
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Monitoring
Parameters |
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Observe for signs and symptoms of anaphylaxis during first
dose |
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Test
Interactions |
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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 |
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Mental Health: Effects
on Mental Status |
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May cause nervousness; case reports of euphoria, delusion, illusions, and
depersonalization with cephalosporins |
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Mental Health:
Effects on Psychiatric
Treatment |
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May rarely cause neutropenia; use caution with clozapine and
carbamazepine |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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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. |
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Nursing
Implications |
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Do not admix with aminoglycosides in same bottle/bag |
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Dosage Forms |
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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 |
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References |
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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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