Ceftoxitin

Uses

Ceftoxitin is used for the treatment of serious infections caused by susceptible strains of the designated microorganisms in the diseases listed below.

Lower respiratory tract infections, including pneumonia and lung abscess, caused by Streptococcus pneumoniae, other streptococci (excluding enterococci, e.g., Enterococcus faecalis), Staphylococcus aureus(including penicillinaseproducing strains), Escherichia coli, Klebsiella species, Haemophilus influenzae, and Bacteroides species.

Urinary tract infections caused by Escherichia coli, Klebsiella species, Proteus mirabilis, Morganella morganii, Proteus vulgarisand Providencia species (including P. rettgeri).

Intra-abdominal infections, including peritonitis and intra-abdominal abscess, caused by Escherichia coli, Klebsiella species, Bacteroides species including Bacteroides fragilis, and Clostridium species.

Gynecological infections, including endometritis, pelvic cellulitis, and pelvic inflammatory disease caused by Escherichia coli, Neisseria gonorrhoeae (including penicillinase-producing strains), Bacteroides species including B. fragilis, Clostridium species, Peptococcus niger, Peptostreptococcus species, and Streptococcus agalactiae. Ceftoxitin, like cephalosporins, has no activity against Chlamydia trachomatis. Therefore, when Ceftoxitin is used in the treatment of patients with pelvic inflammatory disease and C. trachomatis is one of the suspected pathogens, appropriate anti-chlamydial coverage should be added.

Septicemia caused by Streptococcus pneumoniae, Staphylococcus aureus (including penicillinase-producing strains), Escherichia coli, Klebsiella species, and Bacteroides species including B. fragilis.

Bone and joint infections caused by Staphylococcus aureus (including Penicillinaseproducing strains).

Skin and skin structure infections caused by Staphylococcus aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci e.g., Enterococcus faecalis), Escherichia coli, Proteus mirabilis, Klebsiella species, Bacteroides species includingB. fragilis, Clostridium species, Peptococcus niger, and Peptostreptococcus species.

Ceftoxitin is also used to associated treatment for these conditions: Abscess, Intra-Abdominal, Animal bite, Bacterial Infections, Bacterial Urinary Tract Infections, Bloodstream Infections, Bone and Joint Infections, Endometritis, Flu caused by Influenza, Gynaecological infection, Intra-Abdominal Infections, Lower respiratory tract infection bacterial, Lung Abscess, Pelvic Inflammatory Disease (PID), Pelvic cellulitis, Peritonitis, Pneumonia, Skin and Subcutaneous Tissue Bacterial Infections, Antibiotic pre-surgical prophylaxis

How Ceftoxitin works

The bactericidal action of cefoxitin results from inhibition of cell wall synthesis.

Dosage

Ceftoxitin dosage

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 mth80-160 mg/kg daily in 4-6 equally divided doses. Max: 12 g daily.

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 mth30-40 mg/kg 30-60 min prior to surgery, then 6 hrly for not more than 24 hr.

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.

Side Effects

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).

Toxicity

The acute intravenous LD50 in the adult female mouse and rabbit was about 8.0 g/kg and greater than 1.0 g/kg, respectively. The acute intraperitoneal LD50 in the adult rat was greater than 10.0 g/kg.

Precaution

Patient with history of penicillin allergy, GI disease (particularly colitis) and seizure disorder. Renal impairment. Pregnancy and lactation.

Interaction

Reduces renal clearance with probenecid. Concurrent use of nephrotoxic agents (e.g. aminoglycosides, colistin, polymyxin B, vancomycin) may increase the risk of nephrotoxicity.

Food Interaction

Ceftoxitin Hypertension interaction

[Moderate] Parenteral cefoxitin sodium contains approximately 53 mg (2.3 mEq) of sodium per each gram of cefoxitin activity.

The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

Ceftoxitin Drug Interaction

Minor: heparin, heparinUnknown: aspirin, aspirin, epinephrine, epinephrine, ciprofloxacin, ciprofloxacin, clotrimazole, clotrimazole, sulfamethoxazole / trimethoprim, sulfamethoxazole / trimethoprim, meperidine, meperidine, acetaminophen, acetaminophen, procaine penicillin, procaine penicillin, valproic acid, valproic acid

Ceftoxitin Disease Interaction

Major: colitisModerate: renal dysfunction, sodium, dialysis, liver disease, seizure disorders

Half Life

The half-life after an intravenous dose is 41 to 59 minutes.

Elimination Route

Approximately 85 percent of cefoxitin is excreted unchanged by the kidneys over a 6-hour period, resulting in high urinary concentrations. Ceftoxitin passes into pleural and joint fluids and is detectable in antibacterial concentrations in bile.

Pregnancy & Breastfeeding use

Pregnancy Category B. Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Contraindication

Hypersensitivity to cefoxitin and other cephalosporins.

Special Warning

Haemodialysis patient: Repeat loading dose after each dialysis session.

• CrCl <5 ml/min: 0.5-1 g 24-48 hrly.
• CrCl 5-9 ml/min: 0.5-1 g 12-24 hrly.
• CrCl 10-29 ml/min: 1-2 g 12-24 hrly.
• CrCl 30-50 ml/min: 1-2 g 8-12 hrly.

Storage Condition

Store between 2-25° C.

Innovators Monograph

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