cefotaxime

(C) Vancouver General Hospital.
This monograph may not be reproduced without permission.
For further information, please contact a Pharmacist.

NAME OF DRUG
cefotaxime sodium

CLASSIFICATION

Cephalosporin antibiotic

ALTERNATE NAMES

CLAFORAN
(RESERVED ANTIMICROBIAL DRUG)

INDICATIONS

treatment of systemic infections caused by susceptible strains of micro-organisms

Therapeutic interchange policy: all cefotaxime orders will be changed to ceftriaxone 1-2g IV q24h, except for meningitis where the dose will be 2g IV q12h (effective July 2007).
Exceptions to TIP: Hhemodialysis patients and those on TPN.

RECONSTITUTION AND STABILITY

powder stable at room temperature, protect from light
reconstitute with sterile water for injection
may reconstitute with 1% lidocaine (without epinephrine) for IM use

Route	Vial Strength	Volume of Diluent	Final Volume	Final Concentration
IM	500 mg	2 mL	2.2 mL	230 mg/mL
IM	1 g	3 mL	3.4 mL	300 mg/mL
IM	2 g	5 mL	6.0 mL	330 mg/mL
IV	500 mg	10 mL	10.2 mL	50 mg/mL
IV	1 g	10 mL	10.4 mL	95 mg/mL
IV	2 g	10 mL	11.0 mL	180 mg/mL

reconstituted solutions should be stored for not more than 24 hours in refrigerator

COMPATIBILITY

compatible with commonly used IV solutions
compatible via Y-site with acyclovir, clindamycin, cyclosporine, hydromorphone, levofloxacin, lorazepam, magnesium sulphate, meperidine, metronidazole, midazolam, morphine, multivitamins, ondansetron, potassium chloride, verapamil
incompatible with alkaline solutions (e.g. aminophylline, sodium bicarbonate), aminoglycosides, fluconazole, vancomycin

ROUTES OF ADMINISTRATION

IM - deeply into muscle; 2 g doses should be divided equally into different muscle masses
IV direct - dilute to 10 mL with sterile water for injection and administer over 3-5 minutes
IV intermittent - in 50 mL of IV solution administered over 15-30 minutes

- Give dose post dialysis in hemodialysis patients

VH & HSC ADMINISTRATION POLICY

E - Direct IV route can be administered by nurses on general nursing units provided that a venous access has been established and according to policies and recommendations stated in this manual

DOSAGE

Adults

Systemic Infection: 1-2g every 8 hours IV
Meningitis/CNS infection: 2g q6h IV (maximum 12 g/day)

Dosage adjustments are necessary in renal dysfunction

Creatinine Clearance	Systemic Infection Dosage	Meningitis/CNS Infection Dosage
> 50 mL/minute	1-2 g q8h	2g q6h
10-50 mL/minute	1-2 g q8h	2 g q8h
< 10 mL/minute	1-2 g q12h	2 g q12h
Hemodialysis (HD)	1-2 g q24h (give dose after dialysis on HD days)	-
CAPD	0.5-1 g daily	-

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

thrombophlebitis
pain, induration, tenderness at IM injection site
rash, pruritus, fever
allergic reactions

IMPORTANT IMPLICATIONS

contraindicated in patients with known hypersensitivity to cephalosporins
use with caution in patients with hypersensitivity to penicillins
1 g cefotaxime contains 2.2 mmol (50.5 mg) of sodium

Rev. May 2008